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Hormonal and Psychological Factors Linked to the Increased Thermic Effect of Food in Malnourished Fasting Anorexia Nervosa

Centre Européen des Sciences du Goût (D.R., V.V.W., L.B.), Unité Mixte de Recherche-Centre National de la Recherche Scientifique 5170, 21000 Dijon, France; Centre Hospitalier Universitaire Le Bocage (B.V., M.M.), 21079 Dijon, France; and Faculty of Medicine X. Bichat (N.C.-L., A.P.), 75018 Paris, France

Address all correspondence and requests for reprints to: Prof. Daniel Rigaud, Service d’Endocrinologie et Nutrition, Hôpital Centre Hospitalier Universitaire Le Bocage, 21079 Dijon Cedex, France. E-mail: daniel.rigaud{at}chu-dijon.fr.

Objectives: In patients with anorexia nervosa (AN), weight gain is lower than that expected from the energy content of the meals. Thus we investigated the thermic effect of food (TEF) in relation to subjective feelings and plasma hormone levels in a group of AN patients.

Methods: TEF, feelings (14 items), and plasma release of ß-endorphin, ACTH, cortisol, dopamine, and catecholamines were evaluated in 15 AN patients (body mass index, 13.6 ± 1.2 kg·m^–2) and in 15 healthy women after three gastric loads (0, 300, 700 kcal) infused by a nasogastric tube in a blind design.

Results: In AN, the blind loads induced an energy-dependent increase in TEF (P < 0.001), which was higher than that observed in healthy women (P < 0.001). Only in AN, a load-dependent decline in the high basal plasma level of ß-endorphin (P < 0.01), an increase in plasma ACTH (P < 0.02) after the two caloric loads, and an increase in cortisol, norepinephrine, and dopamine levels after the 700-kcal load only (P < 0.05) were noted. A calorie-dependent (P < 0.001) increase in nausea, abdominal discomfort, and fear of being fat ratings and a decrease in liking to eat (P < 0.001) and body image were observed in AN patients (P < 0.05). TEF correlated with ratings on satiation, nausea, uncomfortable abdominal swelling, body image, and fear of being fat (for all, P < 0.01).

Conclusion: In AN women, blindly infused loads induced a dose-dependent increase in TEF, which correlated with the increase in plasma cortisol, ACTH, and catecholamines as in unpleasant sensations, fear of being fat, and anxiety as well as a decline in elevated basal ß-endorphin. These results could explain the difficulty for AN patients in gaining weight.