Determinants of Height in Adolescent Girls With Anorexia Nervosa

BUL 457, MassGeneral Hospital, Neuroendocrine Unit, 55 Fruit St, Boston, MA 02114, USA.
PEDIATRICS (Impact Factor: 5.47). 06/2008; 121(6):e1517-23. DOI: 10.1542/peds.2007-2820
Source: PubMed


Anorexia nervosa, a condition characterized by marked caloric restriction and low insulin like growth factor-1 levels, would be expected to cause short stature. However, this disorder is also associated with hypogonadotropic hypogonadism and high growth hormone levels. Delays in growth-plate closure from associated hypogonadism may result in a longer period of time available for statural growth with protective effects on stature. In addition, growth hormone may have direct effects on the growth plate independent of insulin-like growth factor 1 to increase statural growth.
To determine the impact of undernutrition, hypogonadism, and acquired growth hormone resistance on height in adolescents with anorexia nervosa (aged 12-18 years), we examined 208 girls: 110 with anorexia nervosa and 98 controls of comparable chronological age. Sixty-three girls with anorexia nervosa and 79 controls were followed prospectively over 1 year. Mean duration of illness was 11.6 +/- 13.2 months. In a subset, overnight growth hormone sampling was performed every 30 minutes for 12 hours, and fasting insulin-like growth factor 1 levels were obtained.
The difference between height and target height and between predicted adult height and target height did not differ between the groups, indicating preservation of height potential. The groups had comparable bone age, but bone age was lower than chronological age in girls with anorexia nervosa. Girls with anorexia nervosa had lower insulin-like growth factor 1 levels and higher nadir growth hormone levels than those of controls. Nadir growth hormone levels predicted height SD scores and predicted adult-height SD scores in controls but not in the girls with anorexia nervosa. In girls with anorexia nervosa, insulin-like growth factor 1 and duration of illness predicted height measures. Height SD scores of <0 were more likely after 32 months of illness and at insulin-like growth factor 1 levels of <134 ng/mL. Delayed baseline bone age predicted subsequent increases in height SD scores in immature girls with anorexia nervosa.
Our data suggest that preservation of height potential in this cohort of girls with anorexia nervosa may be a consequence of delayed bone age. Hypogonadism may negate the deleterious effects of undernutrition on stature by allowing for a longer duration of growth.

Full-text preview

Available from:
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The nonlinear dipolar method is dedicated to the simulation of quartz crystal oscillators with high quality factor. In this method, the oscillator is considered as a resonator connected across an amplifier that behaves like a nonlinear dipole whose impedance evaluated at the resonator's frequency depends on the current amplitude. This dipole allows us to compute very quickly the behavior of the oscillator. The computation time of the dipolar impedance by SPICE is of the order of seconds. To gain one order of magnitude in the simulation time of the oscillator, this paper propose a modification of the nonlinear dipolar method by changing the dipolar impedance SPICE calculation. that is the most time consuming part of the program, by a system of equations obtained through a symbolic manipulation of the circuit equations.
    Full-text · Conference Paper · Sep 2004
  • [Show abstract] [Hide abstract]
    ABSTRACT: Anorexia nervosa (AN), an eating disorder characterized by severe undernutrition and associated with hypogonadotropic hypogonadism, causes marked deficits in bone mass accrual when the disorder begins in the teenage years. Although bone mass accrual improves with weight gain and menstrual recovery, residual deficits persist. Women with a history of teenage onset of AN are more likely to be osteopenic than age-matched women without this history, even after many years of weight and menstrual recovery. Non-recovered women with persistent low weight and amenorrhea have continued decreases in bone density, with a high prevalence of both osteopenia and osteoporosis. Unlike anorexia nervosa, normal-weight bulimia is not associated with low bone density, unless there is a past history of low weight or amenorrhea. A second possible skeletal effect of teenage-onset anorexia nervosa is short stature. Duration of illness and time of onset of anorexia nervosa in relation to the pubertal growth spurt are likely important determinants of statural growth. Adolescent boys with anorexia nervosa are more likely than adolescent girls to have short stature, possibly because growth potential persists for two years longer in boys than in girls. Thus, many adolescent girls may have completed growth or be close to growth completion at the time that they develop anorexia nervosa, whereas adolescent boys may still have significant growth potential remaining. This remaining growth potential may be impaired as a consequence of low levels of insulin-like growth factor-I (IGF-I) levels from persistent undernutrition.
    No preview · Article · Jul 2008 · Annals of the New York Academy of Sciences
  • [Show abstract] [Hide abstract]
    ABSTRACT: Children's growth is a hallmark of their normal development and the association between nutrition and linear growth in children is well accepted. Growth requires an adequate supply of many different nutritional factors, some form the "building materials," whereas others play regulatory roles. In this article we describe the growth of the growth plate and discuss the role of nutritional affected hormones on this process. In addition we describe the effect of local regulators and nutritional factors on the growth process and suggest the involvement of new regulatory factors in the translation of nutrition to growth.
    No preview · Article · Oct 2009 · Endocrinology and metabolism clinics of North America
Show more