Table 1.
Studies included in the systematic review.
| First Author | Year | Method | Study | Sample | Intervention | BF Distribution before Weight Gain | BF Distribution after Partial/Complete Weight Restoration |
|---|---|---|---|---|---|---|---|
| Adolescents | |||||||
| Kerruish et al. [22] | 2002 | DXA | Cross-sectional | 23 adolescent AN females vs. 25 age-matched controls | - | Lower trunk fat, leg fat and trunk/leg fat ratio than in control subjects (less central fat) | - |
| Misra et al. [23] | 2003 | DXA | Longitudinal, over 1 year | 21 adolescent AN females (only 13 had a BMI increase) vs. 21 age-matched controls | Complete weight restoration (BMI >10th percentile) | Lower percentage trunk fat than controls, whereas percentage extremity fat was not significantly different between the groups | Trunk fat and trunk/extremity fat ratio did not exceed that of controls, indicating that the changes in adolescent females with AN most likely represented a normalization of BF distribution. |
| Misra et al. [24] | 2005 | DXA | Longitudinal, over 1 year | 23 adolescent AN females (only 11 obtained a BMI increase) vs. 20 age-matched controls | Complete weight restoration | Percentage trunk fat was significantly lower than in controls, whereas percentage extremity fat did not differ, suggesting preferential loss of trunk fat with weight loss | - |
| De Alvaro et al. [25] | 2007 | DXA | Longitudinal, over 24 months | 42 adolescent AN-R females (only 15 achieved weight and menses recovery) vs. 23 controls | Slow complete weight restoration | Lower trunk/extremity fat ratio in prolonged malnutrition patients due to a greater loss of trunk fat. | Slow and complete weight restoration was associated with an adequately distributed fat mass acquisition, with no changes in regional fat percentages |
| Misra et al. [26] | 2008 | DXA | Cross-sectional | 15 adolescent AN boys vs. 15 controls | - | Adolescent boys with AN had higher percentage trunk fat and trunk/extremity ratio than controls associated with lower testosterone concentrations | - |
| Franzoni et al. [27] | 2014 | DXA | Longitudinal, 1 year of treatment | 46 adolescent AN-R females; no controls | Short-term partial weight restoration | Not mentioned | More evident deposition of fat in trunk region, in the absence of healthy control group |
| Forbes [28] | 1990 | AM | Cross-sectional | 2 males and 30 females with AN (adolescents) aged 10–22 years vs. normative data | - | Regional adiposity was measured using waist and hip circumferences—these measures decreased, with no change in waist-to-hip ratio | - |
| Adults | |||||||
| Kirchengast et al. [29] | 1999 | DXA | Cross-sectional | 15 adult AN females vs. 15 age-matched controls | - | Underweight infertile AN patients showed hypergynoid distribution despite low oestrogen levels | - |
| Iketani et al. [30] | 1999 | DXA | Longitudinal, inpatient and outpatient treatments | 21 adult AN females vs. 10 age-matched controls | Short-term partial weight restoration | BF reduction in all regions (trunk, pelvis, upper and lower extremities) but no mention of its relative distribution. | Trunk and pelvis BF increased remarkably and reached the levels of controls, but the upper and lower extremity BF remained below the control level. |
| Pagliato et al. [31] | 2000 | DXA | Longitudinal, inpatient treatment | 17 adult AN patients; no controls | Short-term partial weight restoration | Not mentioned | In the inpatient group, the increase of BF in trunk region was higher with respect to other patterns |
| Grinspoon et al. [32] | 2001 | DXA | Longitudinal, outpatient treatment | 27 adult AN females vs. 20 age-matched controls | Spontaneous partial weight restoration | Percentage trunk fat not statistically different between patients and controls, percentage extremity fat significantly lower than in controls, but trunk/extremity fat ratio no different to that in healthy controls | Increase in trunk adiposity. Estrogen administration did not appear to prevent such distribution |
| Kirchengast et al. [33] | 2003 | DXA | Cross-sectional | 15 adult AN females vs. 19 age-matched controls | - | AN patients showed a gynoid fat pattern no different from healthy controls | - |
| Dellava et al. [34] | 2010 | DXA | Cross-sectional | 16 adult AN females vs. 18 age- and BMI-matched controls | Long-term weight maintenance | - | Women recovered from AN for two years or more had similar body fat distribution to controls |
| Prioletta et al. [35] | 2011 | DXA | Longitudinal, 12-week multidisciplinary re-education program | 19 AN females aged 17–32 years vs. 20 age-matched controls | Short-term partial weight restoration | No difference in percentage trunk fat with respect to controls | Minimum and short-term partial weight restoration led to a preferential redistribution of BF in trunk region with respect to controls, and such distribution was correlated with insulin-resistance status |
| El Ghoch et al. [36] | 2014 | DXA | Longitudinal, (20-week inpatient treatment) | 50 adult AN females vs. 100 healthy, lean age- and BMI-matched controls | Short-term complete weight restoration | Arm, leg, trunk, android and gynoid fat mass percentages were lower than in controls, but no significant difference was found between the two groups in term of the android/gynoid ratio. | Preferential distribution of body fat in central regions (trunk, android), but such distribution did not appear to influence eating disorder psychopathology or psychological distress factors. |
| Mayo-Smith et al. [37] | 1989 | CT | Cross-sectional | 15 AN females aged 15–33 years vs. 39 controls aged 18–35 years | - | Subcutaneous and visceral adipose tissue evaluated by CT. AN patients tend to lose more subcutaneous fat than intra-abdominal fat compared to controls | - |
| Zamboni et al. [38] | 1997 | CT | Longitudinal, 12-week inpatient treatment | 21 adult AN females; no controls | Short-term partial weight restoration | Patients lost more subcutaneous adipose tissue than visceral adipose tissue | The increase in fat in subcutaneous abdominal tissue was significantly greater than visceral abdominal tissue. |
| Mayer et al. [39] | 2009 | MRI | Long-term longitudinal, 1-year follow-up after inpatient treatment | 21 adult AN females vs. 10 age- and BMI-matched controls | Long-term weight maintenance | With acute weight restoration, AN patients had significantly greater visceral and intramuscular adipose tissue than control women | The abnormal fat distribution appeared to normalize within a 1-year period of weight maintenance |
| Orphanidou et al. [40] | 1997 | Skin-fold Thickness and DXA | Longitudinal, 20-week inpatient or 48-week outpatient | 26 adult AN females vs. 21 controls | Short-term partial weight restoration | Not mentioned | BF distribution showed greater deposition in the central regions than in the extremities |
| Mayer et al. [14] | 2005 | AM DXA MRI | Longitudinal, inpatient treatment (4–17 weeks) | 29 adult AN females vs. 15 age- and BMI-matched controls | Short-term complete weight restoration | At baseline, trunk/total fat was not statistically different from controls | Using different methods to assess body fat distribution suggested disproportionate central adipose tissue deposition |
AN: Anorexia Nervosa; AN-R: restrictive Anorexia Nervosa; AM: anthropometric measurements; BF: body fat; CT: Computerized axial tomography; DXA: dual-energy X-ray absorptiometry; MRI: Magnetic resonance imaging.