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Elevated Physical Activity and Low Leptin Levels Co-occur in Patients with Anorexia Nervosa

Departments of Child and Adolescent Psychiatry and Psychotherapy (K.H., B.H.-D.) and Medical Statistics (N.H.), Aachen University, D-52074 Aachen, Germany; German Aerospace Center-Institute of Aerospace Medicine, Space Physiology (C.M., M.H.), D-51170 Cologne, Germany; Roseneck Hospital for Behavioral Medicine (M.F.), D-83209 Prien, Germany; Department of Psychiatry (M.F.), University of Munich, D-80336 Munich, Germany; Clinic of Psychotherapy and Psychosomatics (S.H., W.S.), University of Essen, D-45122 Essen, Germany; Lilly Deutschland GmBH (W.F.B.), D-61350 Bad Homburg, Germany; Childrens Hospital of the University of Giessen (W.F.B.), D-35385 Giessen, Germany; Department of Psychiatry and Psychotherapy (U.S.), University of Lübeck, D-23538 Lübeck, Germany; Department of Child and Adolescent Psychiatry and Psychotherapy (A.W.), University of Würzburg, D-97090 Würzburg, Germany; and Department of Child and Adolescent Psychiatry and Psychotherapy (A.B., H.R., J.H.), University of Marburg, D-35033 Marburg, Germany

Address all correspondence and requests for reprints to: Professor Dr. Johannes Hebebrand, Clinical Research Group, Department of Child and Adolescent Psychiatry, Hans-Sachs-Strasse 6, D-35033 Marburg, Germany. E-mail: Hebebran{at}post.med.uni-marburg.de.

Low leptin levels are an endocrinological hallmark of acute anorexia nervosa (AN); a subthreshold leptin secretion in adipocytes as a consequence of a reduced energy intake is presumed to be the major trigger of the adaptation of an organism to semistarvation. The aim of the current study is to define symptoms of AN that are potentially linked to low leptin levels. For this purpose, quantitative somatic and psychopathological variables were obtained in 61 inpatients with acute AN (study group 1) upon referral for inpatient treatment, and they were concomitantly blood sampled to allow determination of serum leptin levels. Correlations between these variables and logarithmic transformed (lg10) leptin levels were descriptively assessed. Apart from the well-known correlations between leptin levels and anthropometric measurements, the strongest correlation was observed between lg10 serum leptin levels and expert ratings of motor restlessness (r = -0.476; nominal P = 0.003) upon use of visual analog scales. We thus generated the hypothesis that physical activity levels in AN patients are related to serum leptin levels. This hypothesis was tested in an independent study group of 27 adolescent inpatients (study group 2) who were also assessed upon referral. Physical activity levels, which, in this study group, were assessed with the activity module of the expert rating form of the Structured Inventory for Anorexic and Bulimic Syndromes, were significantly correlated with lg10 leptin levels (r = -0.51; one-sided P = 0.006). A regression model based on the independent variables body mass index and lg10 leptin levels explained 37% of the variance of physical activity (R² = 0.37; P = 0.003); only the lg10 leptin levels contributed significantly to the variance (P = 0.003). Our results suggest that, similar to semistarvation-induced hyperactivity in rats, hypoleptinemia in patients with AN may be one important factor underlying the excessive physical activity.

This work was supported by the Christina Barz-Stiftung (Essen, Germany), the START program of the Technical University of Aachen (Aachen, Germany), Deutsche Forschungsgemeinschaft (DFG RE 471/11-2), and Bundesministerium für Bildung und Forschung (NeuroNet Marburg, German National Genome Research Network; 01 GS 0168 and 01 GS 0118).

Abbreviations: AN, Anorexia nervosa; BMI, body mass index; DSM-IV, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition; SIAB-EX, Structured Inventory for Anorexic and Bulimic Syndromes; SIH, semistarvation-induced hyperactivity.

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