Changes of BMI, steroid metabolome and psychopathology in patients with anorexia nervosa during hospitalization

• Published in: Steroids Vol. 153; p. 108523
• Main Authors: Bulant, Josef, Hill, Martin, Velíková, Marta, Yamamotová, Anna, Martásek, Pavel, Papežová, Hana
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2020
• Subjects: Adult; Anorexia nervosa; Anorexia Nervosa - metabolism; Anorexia Nervosa - psychology; Anxiety; Body Mass Index; Depression; Female; Hospitalization; Humans; Refeeding; Specific symptoms and physical activity; Steroid metabolome; Steroids - blood; Steroids - metabolism; Young Adult; Depression; Anxiety; Anorexia nervosa; Refeeding; Specific symptoms and physical activity; Steroid metabolome
• ISSN: 0039-128X; 1878-5867
• DOI: 10.1016/j.steroids.2019.108523

•We evaluated changes of blood steroidome in anorectic women during the refeeding.•GC–MS/MS analysis of 45 steroids followed by multivariate regression was completed.•Severity of anorexia correlated with 7β-/16α-hydroxylation of adrenal C19 steroids.•Severity of anorexia correlate with activities of further steroidogenic enzymes.•Catabolism of substrates for sex hormones correlated with severity of anorexia. Anorexia nervosa (AN) is associated with various alterations including the dysfunction of the HPA axis and consequently the hypercortisolemia and deficit in sex hormones but the comprehensive evaluation of changes in circulating steroids during the hospitalization of AN patients is lacking. We investigated the effect of realimentation of women with AN during hospitalization on 45 circulating steroids, the relationships between BMI, its change during hospitalization and physical activity, on one side and initial levels and their changes for two adipokines, circulating steroids, anorexia-specific (hunger, appetite and satiety), and anorexia non-specific symptoms (anxiety, depression fatigue, sleep, and body pain) on the other side. We included 33 women with anorexia who were hospitalized for 38(35, 44) days (median with quartiles). The increase of BMI from the initial value 15.2 (13.2, 16.6) kg/m2 was 1.69 (1.37, 2.66) kg/m2. The patients with more severe anorexia showed higher activity in 7β-, and 16α-hydroxylation of androgen precursors, which declined during hospitalization. Otherwise, the 7α-hydroxylation activity is higher in AN patients with less severe malnutrition and the ratio of 5-androstene-3β,7α,17β-triol to 5-androstene-3β,7β,17β-triol increased during the realimentation. Our data allow to speculate that the intensive 7β-, and 16α- and possibly also the 7α-hydroxylation of C19 Δ5 steroids participate in the pathophysiology of anorexia by additional catabolism of substrates available for synthesis of active androgens and estrogens. However, the question remains whether the synthetic analogues of 7α/β- and 16α-hydroxy-steroids prevent the catabolism of the sex steroid precursors, or further activate the “energy wasting” mitochondrial thermogenic metabolism.