ESPE Yearbook of Paediatric Endocrinology

J Clin Endocrinol Metab. 2021;106(1):e1–e10. doi: 10.1210/clinem/dgaa510. PMID: 32816013

This prospective observational study on a cohort of 255 adolescents with anorexia nervosa (AN) aimed to investigate the effects of nutritional restriction on linear growth and adult height. Whereas premorbid height did not differ from reference standards, girls with AN showed a mild but significantly reduced height at admission, discharge and at the achievement of adult height that was lower than mid-parental target height, though still within the normal range. The observation that a younger age at admission was associated with a more unfavorable growth outcome, is likely explained by the stronger impact on growth of nutritional restriction occurring before or during pubertal growth spurt.

Anorexia nervosa (AN) is an increasingly common eating disorder whose age of onset is progressively decreasing. It affects approximately 0.2-1% of adolescents and young women in developed countries (1) and patients typically show multiple endocrine disorders (2,3), which represent mechanisms of adaptation to chronic starvation. Growth is impaired in patients with AN who show a state of acquired GH resistance, with higher GH and low IGF-I levels. As GH stimulates gluconeogenesis, its higher levels represent an adaptive mechanism favoring the maintenance of euglycemia in subjects with a reduced availability of energy substrates (3). Nutritional interventions are associated with an incomplete catch-up growth and genetic height potential is often not fulfilled.

This study confirms the importance of nutrition in the maintenance of normal growth trajectory and when nutritional restriction occurs during critical periods of growth, it may irreversibly affect adult height.

Reference: 1. Misra M, Klibanski A. Endocrine consequences of anorexia nervosa. Lancet Diabetes Endocrinol. 2014;2(7):581-92.2. Singhal V, Misra M, Klibanski A. Endocrinology of anorexia nervosa in young people: recent insights. Curr Opin Endocrinol Diabetes Obes. 2014;21(1):64-70.3. Stving RK. MECHANISMS IN ENDOCRINOLOGY: Anorexia nervosa and endocrinology: a clinical update. Eur J Endocrinol. 2019;180(1):R9-r27.