Original Study| Volume 24, ISSUE 6, P347-352, December 2011

Body Composition Variables and Leptin Levels in Functional Hypothalamic Amenorrhea and Amenorrhea Related to Eating Disorders

Published:September 12, 2011DOI:


      The purpose of the study was to identify diagnostic criteria that can distinguish between subjects with functional hypothalamic amenorrhea largely related to minimal energy deficiency and those in whom failure of adaptive response to stress prevails. We studied 59 young women with secondary amenorrhea related to modest eating disorders and 58 who complained of stressful events in their history. We assessed anthropometric measurements, body composition using dual energy X-ray absorptiometry (DEXA) and bioelectrical impedance analysis (BIA), and basal endocrine profile. Subjects with disordered eating had lower body mass index (BMI), fat mass (FM) measured with both techniques, lumbar mineral density and direct and indirect measures of lean mass. Leptin and free tri-iodothyronine(FT3) concentrations also proved lower in the group of subjects with eating disorders, although there was no significant difference in cortisol between the two groups. Leptin levels were positively associated not only with fat mass, but also with body cell mass indexed to height and phase angle, parameters studied with BIA as expression of active lean compartment. A multivariate model confirmed the utility of integrating endocrine data with the study of body composition. The use of bioelectrical impedance analysis proved to be, in clinical use, a valid diagnostic alternative to DEXA, especially considering body cell mass and phase angle.

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        • Berga S.L.
        • Loucks T.L.
        Use of cognitive behavior therapy for functional hypothalamic amenorrhea.
        Ann N Y Acad Sci. 2006; 1092: 114
        • Genazzani A.D.
        • Ricchieri F.
        • Lanzoni C.
        • et al.
        Diagnostic and therapeutic approach to hypothalamic amenorrhea.
        Ann N Y Acad Sci. 2006; 1092: 103
        • Mastorakos G.
        • Pavlatou M.
        • Diamanti-Kandarakis E.
        • et al.
        Exercise and the stress system.
        Hormones (Athens). 2005; 4: 73
        • Loucks A.B.
        • Laughlin G.A.
        • Mortola J.F.
        • et al.
        Hypothalamic-pituitary-thyroidal function in eumenorrheic and amenorrheic athletes.
        J Clin Endocrinol Metab. 1992; 75: 514
        • Michalaki M.
        • Vagenakis A.G.
        • Makri M.
        • et al.
        Dissociation in the early decline in serum T(3) concentration and serum IL-6 and TNFalpha in nonthyroidal illness syndrome induced by abdominal surgery.
        J Clin Endocrinol Metab. 2001; 86: 4198
        • Laughlin G.A.
        • Yen S.S.
        Nutritional and endocrine-metabolic aberrations in amenorrheic athletes.
        J Clin Endocrinol Metab. 1996; 81: 4301
        • Miller K.K.
        • Parulekar M.S.
        • Schonfeld E.
        • et al.
        Decreased leptin levels in normal weight women with hypothalamic amenorrhea: the effects of body composition and nutritional intake.
        J Clin Endocrinol Metab. 1998; 83: 2309
        • Welt C.K.
        • Chan J.L.
        • Bullen J.
        • et al.
        Recombinant human leptin in women with hypothalamic amenorrhea.
        N Engl J Med. 2004; 351: 987
        • Schneider L.F.
        • Monaco S.E.
        • Warren M.
        Ghrelin level in women of normal weight with amenorrhea is related to disordered eating.
        Fertil Steril. 2008; 90: 121
        • Scheid J.L.
        • Williams N.I.
        • West S.L.
        • et al.
        Elevated PYY is associated with energy deficiency and indices of subclinical disordered eating in exercising women with hypothalamic amenorrhea.
        Appetite. 2009; 52: 184
        • Uzum A.K.
        • Yucel B.
        • Omer B.
        • et al.
        Leptin concentration indexed to fat mass is increased in untreated anorexia nervosa (AN) patients.
        Clin Endocrinol (Oxf). 2009; 71: 33
      1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, (4th ed.), Text Revision.
        American Psychiatric Publishing, Washington, DC2000
        • Mattsson S.
        • Thomas B.J.
        Development of methods for body composition studies.
        Phys Med Biol. 2006; 51: R203
        • Kitano T.
        • Kitano N.
        • Inomoto T.
        • et al.
        Evaluation of body composition using dual energy X-ray absorptiometry, skinfold thickness and bioelectrical impedance analysis in Japanese female college students.
        J Nutr Sci Vitaminol. 2001; 47: 122
        • Sun G.
        • French C.R.
        • Martin G.R.
        • et al.
        Comparison of multifrequency bioelectrical impedance analysis with dual-energy X-ray absorptiometry for assessment of percentage body fat in a large, healthy population.
        Am J Clin Nutr. 2005; 81: 74
        • Gupta N.
        • Balasekaran G.
        • Victor Govindaswamy V.
        • et al.
        Comparison of body composition with bioelectric impedance (BIA) and dual energy X-ray absorptiometry (DEXA) among Singapore Chinese.
        J Sci Med Sport. 2010; 14: 33
        • Piccoli A.
        • Codognotto M.
        • Di Pascoli L.
        • et al.
        Body mass index and agreement between bioimpedance and anthropometry estimates of body compartments in anorexia nervosa.
        JPEN J Parenter Enteral Nutr. 2005; 29: 148
        • Kyle U.G.
        • Bosaeus I.
        • De Lorenzo A.D.
        • et al.
        Bioelectrical impedance analysis—part I: review of principles and methods.
        Clin Nutr. 2004; 23: 1226
        • Oliveira C.M.
        • Kubrusly M.
        • Mota R.S.
        • et al.
        The phase angle and mass body cell as markers of nutritional status in hemodialysis patients.
        J Ren Nutr. 2010; 20: 314
        • Buffa R.
        • Floris G.
        • Marini E.
        Bioelectrical impedance vector in pre- and postmenarcheal females.
        Nutrition. 2002; 18: 474
        • Rigaud D.
        • Boulier A.
        • Tallonneau I.
        • et al.
        Body fluid retention and body weight change in anorexia nervosa patients during refeeding.
        Clin Nutr. 2010; 29: 749
        • Marra M.
        • De Filippo E.
        • Signorini A.
        • et al.
        Phase angle is a predictor of basal metabolic rate in female patients with anorexia nervosa.
        Physiol Meas. 2005; 26: S145
        • Chan J.L.
        • Mantzoros C.S.
        Role of leptin in energy-deprivation states: normal human physiology and clinical implications for hypothalamic amenorrhea and anorexia nervosa.
        Lancet. 2005; 366: 74
        • Pinto S.
        • Roseberry A.G.
        • Liu H.
        Rapid rewiring of arcuate nucleus feeding circuits by leptin.
        Science. 2004; 304: 110
        • Kelesidis T.
        • Kelesidis I.
        • Chou S.
        • et al.
        Narrative review: the role of leptin in human physiology: emerging clinical applications.
        Ann Intern Med. 2010; 152: 93
        • Esteghamati A.
        • Khalilzadeh O.
        • Ashraf H.
        • et al.
        Physical activity is correlated with serum leptin independent of obesity: results of the national surveillance of risk factors of noncommunicable diseases in Iran.
        Metabolism. 2010; 59: 1730
        • Bréban S.
        • Chappard C.
        • Jaffré C.
        • et al.
        Hypoleptinaemia in extreme body mass models: the case of international rugby players.
        J Sci Med Sport. 2010; 13: 479
        • Lindahl M.S.
        • Olovsson M.
        • Nyberg S.
        • et al.
        Increased cortisol responsivity to adrenocorticotropic hormone and low plasma levels of interleukin-1 receptor antagonist in women with functional hypothalamic amenorrhea.
        Fertil Steril. 2007; 87: 136
        • Zagarins S.E.
        • Ronnenberg A.G.
        • Gehlbach S.H.
        • et al.
        The association of lean mass and fat mass with peak bone mass in young premenopausal women.
        J Clin Densitom. 2010; 13: 392
        • Bogl L.H.
        • Latvala A.
        • Kaprio J.
        • et al.
        An investigation into the relationship between soft tissue body composition and bone mineral density in a young adult twin sample.
        J Bone Miner Res. 2011; 26: 79
        • Diamanti A.
        • Bizzarri C.
        • Gambarara M.
        • et al.
        Bone mineral density in adolescent girls with early onset of anorexia nervosa.
        Clin Nutr. 2007; 26: 329
        • Bruni V.
        • Dei M.
        • Filicetti M.
        • et al.
        Predictors of bone loss in young women with restrictive eating disorders.
        Pediatr Endocrinol Rev. 2006; 3: 219
        • Bossu C.
        • Galusca B.
        • Normand S.
        • et al.
        Energy expenditure adjusted for body composition differentiates constitutional thinness from both normal subjects and anorexia nervosa.
        Am J Physiol Endocrinol Metab. 2007; 292: E132
        • Lutoslawska G.
        • Skierska E.
        • Byszerwska-Szpocinska E.
        Plasma leptin concentrations in lean, physically active males and females in relation to body composition and metabolic variables.
        J Sports Med Phys Fitness. 2004; 44: 200