Background: Anorexia nervosa (AN) is a good biological model of chronic malnutrition. Although some reports according to the gastrointestinal disturbances in response to starvation have been published so far, the exocrine function of pancreas in patients with AN has not been studied thoroughly, yet. There is also no data on the effect of hormonal changes in AN on it. Therefore, the aim of this study is: 1) Evaluation of pancreatic exocrine function in patients with anorexia nervosa and control group of healthy girls in the 13C-labeled triglycerides (MTG-BT) breath test; 2) Analysis of the relationships between the results of the breath test and the hormonal parameters in the studied groups of girls.
Material and methods: The study group comprised 31 patients with AN aged 1217 years. The control group consisted of 38 healthy girls at comparable age. Anthropometric measurements (height, weight, BMI) biochemical (lipid profile, fasting glucose and insulin, alanine and asparagine aminotransferase, bilirubin, GGTP and amylase) and hormonal (serum insulin, leptin, soluble leptin receptor, fT4, cortisol, FSH, LH, estradiol) assays were performed in all examined subjects. HOMA-IR and total leptin (serum leptin+soluble leptin receptor) values were also calculated. Breath samples were collected before and every 30 minutes after the ingestion of 150 mg of the 13C mixed triglycerides for 360 minutes. The cumulative percentage of 13C recovered in the breath during the 360 minute collection (CP360) as well as time to peak (TTP) of 13C recovery were established using IRIS analyser (Wagner GmBH, Bremen, Germany).
Results: The AN girls had significantly lower weight, BMI, fasting glucose, insulin, HOMA-IR, fT4, FSH, LH, estradiol, leptin, soluble leptin receptor and total leptin values in comparison to control group. Serum cortisol levels in the AN group was significantly higher than in healthy controls. The mean CP360 was similar in both examined groups, however the time to peak (TTP) was significantly longer in the AN girls. In the control group TTP correlated negatively with serum insulin and HOMA-IR values. In the AN girls significant negative correlations between CP360 and LH, soluble leptin receptor and total leptin were observed.
Conclusions: 1) In girls with AN kinetics of pancreatic secretion of lipase is disturbed; 2) These disorders are dependent on the degree of energy deficit measured by serum total leptin concentration; 3) The abnormalities observed in patients with AN may result from impaired pancreatic endo-exocrine axis.
27 - 29 Sep 2018
European Society for Paediatric Endocrinology