Anorexia During Adolescence Linked to Stunted Growth in Females

A study of more than 250 female adolescents hospitalized for anorexia is offering perspective into the long-term health effects, including impact on bone health and height.

Results of the study, which was led by a team from Edmond and Lily Safra Children’s Hospital and Tel Aviv University in Israel, suggest girls with anorexia nervosa can have stunted growth and may not reach their full height potential.

"Our findings emphasize the importance of early and intensive intervention aiming at normalization of body weight, which may result in improved growth and allow patients to reach their full height potential," said the study's corresponding author, Dalit Modan-Moses, MD, of The Edmond and Lily Safra Children's Hospital in Israel, in a statement. "We suggest that the height impairment is a marker for other complications of anorexia nervosa affecting the person's overall health in several aspects: bone health, cognitive function, and problems with pregnancy and childbirth later in life.”

To further understand the effects of anorexia nervosa in female adolescents on overall health in adulthood, Modan-Moses and a team of colleagues sought to assess linear growth and adult height in female adolescents with anorexia nervosa in a prospective longitudinal, long-term study. For their study, investigators identified a cohort of 255 female patients hospitalized in the pediatric unit of the Edmond and Lily Safra Children’s Hospital between January 1, 2000 and May 31, 2015.

The mean age of the study cohort at admission was 15.4±1.75 years and the mean BMI was 15.7±1.8 kg/m2. Patients included in the study were placed on a nutritional rehabilitation program aimed toward a weight gain of 0.5-1.0 kg per week after initial assessment. Patients included in the study were also invited for a measurement of adult height.

Investigators obtained information related to demographic clinical data from medical records, including data related to pre-morbid height data, menstrual history, skeletal age, pertinent laboratory studies and parental heights. Patients were excluded from the study based on lifetime or current schizophrenic spectrum disorder, bipolar disorder, substance use disorder, organic brain disorder, mental retardation, any medical illness potentially affecting appetite or weight, and chronic use of medications.

The analysis indicated dire-morbid height standard deviation were not significantly different form this expect in normal adolescents, but further analysis indicated height-SDS at admission (-0.36±0.99), discharge (-0.34±0.96), and at adult height (-0.29± 0.95), were significantly (P <.001) lower than expected. Additionally, investigators found adult height among these patients was significantly shorter compared to the mid-parental target height (P=.006).

In a stepwise forward linear regression analysis, results suggested age (R=.32; P=.002) and bone age (R=-.29; P=.006) on admission, linear growth during hospitalization (R=.47; P <.001), and change in luteinizing hormone during hospitalization (R=-.265; P=.021) were independent predictors of improvement in height SDS from admission to adulthood.

"This study may have implications for the management of malnutrition in adolescents with other chronic diseases in order to achieve optimal adult height and bone health," Modan-Moses added, in the aforementioned statement.

This study, “A Prospective Longitudinal Assessment of Linear Growth and Adult Height in Female Adolescents with Anorexia Nervosa,” was published in the Journal of Clinical Endocrinology & Metabolism.