Original Research Communications .4m J Clin Nutr 1993;57:3l9-22. Printed in USA. © 1993 American Society for Clinical Nutrition 319 Sex-hormone-binding globulin and protein-energy malnutrition indexes as indicators of nutritional status in women with anorexia nervosa1’2 Pierre Barbe, Antoine Bennet, Monique Stebenet, Bertrand Perret, and Jean-Pierre Louvet ABSTRACT Serum sex-hormone-binding globulin (SHBG), transferrin, prealbumin, retinol-binding protein, and ceruloplasmin concentrations were evaluated in 12 women with anorexia nervosa before and after weight gain and in 12 healthy women with normal weight. The serum SHBG concentrations were higher in patients with anorexia nervosa before weight gain than in control subjects and they returned to the normal range after weight gain. The changes of SHBG concentrations were not associated with any change in plasma testosterone, estradiol, or free thyroxin concentrations. The body mass index in our patients after weight gain was lower than in control subjects. Prealbumin, retinol-binding protein, ceruloplasmin, and trans- femn in anorectic patients before weight gain did not differ from those of the control subjects and increased after weight gain. The changes of serum SHBG concentrations in patients with anorexia nervosa during weight gain make SHBG deterniination a reliable index of nutritional status in this type of eating disorder. Am J Clin Nutr 1993;57:3 19-22. KEY WORDS Sex-hormone-binding globulin, prealbumin, retinol-binding globulin, transfemn, ceruloplasmin, nutritional status, anorexia nervosa Introduction Anorexia nervosa is an eating disorder characterized by ex- cessive weight loss with disturbed body composition: reduction of lean body mass and marked depletion of fat deposits (1 , 2). Restrictive eating behavior is usually progressive and the reduc- tion of energy intake can be in either proteins, fats, or carbo- hydrates. This leads to a semistarvation or complete starvation state. After a few months, most of these patients show a severe nonedematous protein-energy malnutrition (PEM) that is similar to marasmus. Sex-hormone-binding globulin (SHBG) is a dimeric glyco- protein that specifically binds testosterone and estradiol in serum. It is known that serum SHBG concentrations are under hor- monal regulation: they depend on the thyroidal status and the steroid milieu (3-6). Several recent studies show that SHBG concentrations are also altered by nutritional factors because SHBG concentrations are low in obese subjects and high in an- orectic patients (7-11). Binding proteins such as transfemn, prealbumin, retinol- binding protein (RBP), or acute-phase reactant proteins such as ceruloplasmin, are well-established PEM indexes widely used in nutritional assessment ( I 2). However, there have not been many studies during the refeeding phase for subjects with long-term reduced energy intake without physical disease, like anorexia nervosa. In this study, we evaluated serum transfemn, prealbumin, RBP, ceruloplasmin, and SHBG concentrations in a cohort of patients with anorexia nervosa before and after weight gain to determine the reliability ofSHBG as a nutritional index in this type of malnutrition. Subjects and methods The patients were I 2 women aged 16-3 1 y who had anorexia nervosa, as defined by the Diagnostic and Statistical Manual III criteria (1 3). They were admitted to our department for evalu- ation and therapy. The duration of anorexia ranged from 6 mo to 4 y. The only treatment consisted ofisolation, psychotherapy, and refeeding. Food intake was free for all patients. No drug was given during the study. The control subjects were 12 healthy women aged 18-33 y with documented ovulatory cycles and normal body weight [ie, their body mass indexes (BMIs)] were within the 1 5th and 85th percentiles of the anthropometric standards of white females of the same age ( 1 4). The study was carried out in accordance with the Helsinki Declaration of 1975, revised in 1983. All blood samples were collected in Vacutainer dry tubes (Becton Dickenson, Meylan, France) after an overnight fast and serum was prepared according to standard procedures and kept at -20 #{176}C until assayed. The samples were taken from each patient on the first day (before weight gain) and on the last day in the hospital (after weight gain); the interval between the first and the last sampling was 40 ± 5 d (1 ± SD; range 27-73 d). The samples were taken from each control subject on the eighth day ofa normal menstrual cycle to stanthrdize the steroid milieu. Serum SHBG concentrations were evaluated in terms of weight (mg/L) by using immunoelectrophoresis (SBP-film, I From the Departments of Endocrinology and Biochemistry, Purpan Medical School, Toulouse, France. 2 Address reprint requests to P Barbe, Department of Endocrinology, CHU Purpan, Place du Docteur Baylac, 31059 Toulouse Cedex, France. Received October 22, 1991. Accepted for publication August 10, 1992. by guest on July 12, 2011 www.ajcn.org Downloaded from