Steroid metabolism and excretion in severe anorexia nervosa: effects of refeeding

Wassif S. Wassif; Declan M. McLoughlin; Royce Vincent; Simon Conroy; Gerald F. M. Russell; Norman F. Taylor

doi:10.3945/ajcn.111.012666

Steroid metabolism and excretion in severe anorexia nervosa: effects of refeeding

Wassif S. Wassif^*, Declan M. McLoughlin, Royce Vincent, Simon Conroy, Gerald F. M. Russell, Norman F. Taylor

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

17 Citations (Scopus)

Abstract

Background: To our knowledge, changes in steroid metabolism in subjects with anorexia nervosa (AN) after weight gain have not been elucidated.

Objective: We characterized urinary steroid excretion and metabolism in AN patients and investigated the effects of refeeding.

Design: In an intervention study, we recruited 7 women with life-threatening weight loss upon admission and after a median [interquartile range (IQR)] of 95 d (88-125 d) of intensive refeeding; 15 age-matched women were recruited as control subjects. The major urinary metabolites were quantified in 24-h collections by capillary gas chromatography. A single examiner measured weights, heights, and skinfold thicknesses.

Results: The median (IQR) age of patients was 24 y (21-26 y), and the duration of AN was 4.0 y (3.3-8.0 y). Body mass index (BMI; in kg/m(2)) increased from 12.8 (12.7-13.1) to 18.6 (18.0-19.6) after refeeding (P <0.0001). Steroid values [median pre-, post-refeeding (P value)] were as follows: androgen metabolites [472, 1017 mu g/24 h (0.93)], cortisol metabolites [1960, 3912 mu g/24 h (0.60)], and ratios of androsterone (5 alpha)/etiocholanolone (5 beta) [0.28, 0.63 (= 1.00)]. BMI change was positively correlated with 5 alpha-/5 beta-tetrahydrocortisol (r = 0.95, P <0.001). Before refeeding, the following metabolites were lower in patients than in control subjects: androsterone, 5 alpha-tetrahydrocortisol, alpha-cortolone and alpha-cortol, 5 alpha-/5 beta-tetrahydrocortisol, androsterone/etiocholanolone, and 20-hydroxy/20-oxocortisol (all P <0.05). After refeeding, all steroid metabolites in patients were at concentrations that were comparable with those in control subjects.

Conclusions: Significant changes in urine steroid-metabolite excretion occurred upon starvation, which were reversed upon refeeding. For cortisol, there were decreases in 5 alpha-/5 beta-tetrahydrocortisol and 20-hydroxy-/20-oxometabolites; for androgen, there was a decrease in androsterone/etiocholanolone.

Original language	English
Pages (from-to)	911-917
Number of pages	7
Journal	American Journal of Clinical Nutrition
Volume	93
Issue number	5
DOIs	https://doi.org/10.3945/ajcn.111.012666
Publication status	Published - May 2011

Keywords

POLYCYSTIC-OVARY-SYNDROME
PITUITARY-ADRENAL AXIS
DEHYDROGENASE-ACTIVITY
INSULIN SENSITIVITY
CORTISOL METABOLISM
BODY-COMPOSITION
FAT DISTRIBUTION
ADIPOSE-TISSUE
WEIGHT-GAIN
ABNORMALITIES

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10.3945/ajcn.111.012666

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@article{b941782ba032447aa04195882267b24e,

title = "Steroid metabolism and excretion in severe anorexia nervosa: effects of refeeding",

abstract = "Background: To our knowledge, changes in steroid metabolism in subjects with anorexia nervosa (AN) after weight gain have not been elucidated.Objective: We characterized urinary steroid excretion and metabolism in AN patients and investigated the effects of refeeding.Design: In an intervention study, we recruited 7 women with life-threatening weight loss upon admission and after a median [interquartile range (IQR)] of 95 d (88-125 d) of intensive refeeding; 15 age-matched women were recruited as control subjects. The major urinary metabolites were quantified in 24-h collections by capillary gas chromatography. A single examiner measured weights, heights, and skinfold thicknesses.Results: The median (IQR) age of patients was 24 y (21-26 y), and the duration of AN was 4.0 y (3.3-8.0 y). Body mass index (BMI; in kg/m(2)) increased from 12.8 (12.7-13.1) to 18.6 (18.0-19.6) after refeeding (P <0.0001). Steroid values [median pre-, post-refeeding (P value)] were as follows: androgen metabolites [472, 1017 mu g/24 h (0.93)], cortisol metabolites [1960, 3912 mu g/24 h (0.60)], and ratios of androsterone (5 alpha)/etiocholanolone (5 beta) [0.28, 0.63 (= 1.00)]. BMI change was positively correlated with 5 alpha-/5 beta-tetrahydrocortisol (r = 0.95, P <0.001). Before refeeding, the following metabolites were lower in patients than in control subjects: androsterone, 5 alpha-tetrahydrocortisol, alpha-cortolone and alpha-cortol, 5 alpha-/5 beta-tetrahydrocortisol, androsterone/etiocholanolone, and 20-hydroxy/20-oxocortisol (all P <0.05). After refeeding, all steroid metabolites in patients were at concentrations that were comparable with those in control subjects.Conclusions: Significant changes in urine steroid-metabolite excretion occurred upon starvation, which were reversed upon refeeding. For cortisol, there were decreases in 5 alpha-/5 beta-tetrahydrocortisol and 20-hydroxy-/20-oxometabolites; for androgen, there was a decrease in androsterone/etiocholanolone.",

keywords = "POLYCYSTIC-OVARY-SYNDROME, PITUITARY-ADRENAL AXIS, DEHYDROGENASE-ACTIVITY, INSULIN SENSITIVITY, CORTISOL METABOLISM, BODY-COMPOSITION, FAT DISTRIBUTION, ADIPOSE-TISSUE, WEIGHT-GAIN, ABNORMALITIES",

author = "Wassif, {Wassif S.} and McLoughlin, {Declan M.} and Royce Vincent and Simon Conroy and Russell, {Gerald F. M.} and Taylor, {Norman F.}",

year = "2011",

month = may,

doi = "10.3945/ajcn.111.012666",

language = "English",

volume = "93",

pages = "911--917",

journal = "American Journal of Clinical Nutrition",

issn = "0002-9165",

publisher = "American Society for Nutrition",

number = "5",

}

TY - JOUR

T1 - Steroid metabolism and excretion in severe anorexia nervosa

T2 - effects of refeeding

AU - Wassif, Wassif S.

AU - McLoughlin, Declan M.

AU - Vincent, Royce

AU - Conroy, Simon

AU - Russell, Gerald F. M.

AU - Taylor, Norman F.

PY - 2011/5

Y1 - 2011/5

N2 - Background: To our knowledge, changes in steroid metabolism in subjects with anorexia nervosa (AN) after weight gain have not been elucidated.Objective: We characterized urinary steroid excretion and metabolism in AN patients and investigated the effects of refeeding.Design: In an intervention study, we recruited 7 women with life-threatening weight loss upon admission and after a median [interquartile range (IQR)] of 95 d (88-125 d) of intensive refeeding; 15 age-matched women were recruited as control subjects. The major urinary metabolites were quantified in 24-h collections by capillary gas chromatography. A single examiner measured weights, heights, and skinfold thicknesses.Results: The median (IQR) age of patients was 24 y (21-26 y), and the duration of AN was 4.0 y (3.3-8.0 y). Body mass index (BMI; in kg/m(2)) increased from 12.8 (12.7-13.1) to 18.6 (18.0-19.6) after refeeding (P <0.0001). Steroid values [median pre-, post-refeeding (P value)] were as follows: androgen metabolites [472, 1017 mu g/24 h (0.93)], cortisol metabolites [1960, 3912 mu g/24 h (0.60)], and ratios of androsterone (5 alpha)/etiocholanolone (5 beta) [0.28, 0.63 (= 1.00)]. BMI change was positively correlated with 5 alpha-/5 beta-tetrahydrocortisol (r = 0.95, P <0.001). Before refeeding, the following metabolites were lower in patients than in control subjects: androsterone, 5 alpha-tetrahydrocortisol, alpha-cortolone and alpha-cortol, 5 alpha-/5 beta-tetrahydrocortisol, androsterone/etiocholanolone, and 20-hydroxy/20-oxocortisol (all P <0.05). After refeeding, all steroid metabolites in patients were at concentrations that were comparable with those in control subjects.Conclusions: Significant changes in urine steroid-metabolite excretion occurred upon starvation, which were reversed upon refeeding. For cortisol, there were decreases in 5 alpha-/5 beta-tetrahydrocortisol and 20-hydroxy-/20-oxometabolites; for androgen, there was a decrease in androsterone/etiocholanolone.

AB - Background: To our knowledge, changes in steroid metabolism in subjects with anorexia nervosa (AN) after weight gain have not been elucidated.Objective: We characterized urinary steroid excretion and metabolism in AN patients and investigated the effects of refeeding.Design: In an intervention study, we recruited 7 women with life-threatening weight loss upon admission and after a median [interquartile range (IQR)] of 95 d (88-125 d) of intensive refeeding; 15 age-matched women were recruited as control subjects. The major urinary metabolites were quantified in 24-h collections by capillary gas chromatography. A single examiner measured weights, heights, and skinfold thicknesses.Results: The median (IQR) age of patients was 24 y (21-26 y), and the duration of AN was 4.0 y (3.3-8.0 y). Body mass index (BMI; in kg/m(2)) increased from 12.8 (12.7-13.1) to 18.6 (18.0-19.6) after refeeding (P <0.0001). Steroid values [median pre-, post-refeeding (P value)] were as follows: androgen metabolites [472, 1017 mu g/24 h (0.93)], cortisol metabolites [1960, 3912 mu g/24 h (0.60)], and ratios of androsterone (5 alpha)/etiocholanolone (5 beta) [0.28, 0.63 (= 1.00)]. BMI change was positively correlated with 5 alpha-/5 beta-tetrahydrocortisol (r = 0.95, P <0.001). Before refeeding, the following metabolites were lower in patients than in control subjects: androsterone, 5 alpha-tetrahydrocortisol, alpha-cortolone and alpha-cortol, 5 alpha-/5 beta-tetrahydrocortisol, androsterone/etiocholanolone, and 20-hydroxy/20-oxocortisol (all P <0.05). After refeeding, all steroid metabolites in patients were at concentrations that were comparable with those in control subjects.Conclusions: Significant changes in urine steroid-metabolite excretion occurred upon starvation, which were reversed upon refeeding. For cortisol, there were decreases in 5 alpha-/5 beta-tetrahydrocortisol and 20-hydroxy-/20-oxometabolites; for androgen, there was a decrease in androsterone/etiocholanolone.

KW - POLYCYSTIC-OVARY-SYNDROME

KW - PITUITARY-ADRENAL AXIS

KW - DEHYDROGENASE-ACTIVITY

KW - INSULIN SENSITIVITY

KW - CORTISOL METABOLISM

KW - BODY-COMPOSITION

KW - FAT DISTRIBUTION

KW - ADIPOSE-TISSUE

KW - WEIGHT-GAIN

KW - ABNORMALITIES

U2 - 10.3945/ajcn.111.012666

DO - 10.3945/ajcn.111.012666

M3 - Article

SN - 0002-9165

VL - 93

SP - 911

EP - 917

JO - American Journal of Clinical Nutrition

JF - American Journal of Clinical Nutrition

IS - 5

ER -

Steroid metabolism and excretion in severe anorexia nervosa: effects of refeeding

Abstract

Keywords

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