Low bone mineral density is found in low weight female youth with avoidant/restrictive food intake disorder and associated with higher PYY levels

Aluma Chovel Sella; Kendra R Becker; Meghan Slattery; Kristine Hauser; Elisa Asanza; Casey Stern; Megan Kuhnle; Nadia Micali; Kamryn T Eddy; Madhusmita Misra; Jennifer J Thomas; Elizabeth A Lawson

doi:10.1186/s40337-023-00822-y

Low bone mineral density is found in low weight female youth with avoidant/restrictive food intake disorder and associated with higher PYY levels

J Eat Disord. 2023 Jul 1;11(1):106. doi: 10.1186/s40337-023-00822-y.

Authors

Aluma Chovel Sella^{1

2}, Kendra R Becker^{3

4}, Meghan Slattery¹, Kristine Hauser¹, Elisa Asanza¹, Casey Stern³, Megan Kuhnle¹, Nadia Micali^{5

6

7}, Kamryn T Eddy^{3

4}, Madhusmita Misra^#^{1

2

8

9}, Jennifer J Thomas^#^{3

4}, Elizabeth A Lawson^#^{10

11}

Affiliations

¹ Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA.
² Division of Pediatric Endocrinology, Mass General Hospital for Children, Boston, MA, USA.
³ Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA.
⁴ Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
⁵ Great Ormond Street Institute of Child Health, University College London, London, UK.
⁶ Department of Pediatrics Gynecology and Obstetrics, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
⁷ Mental Health Services in the Capital Region of Denmark, Eating Disorders Research Unit, Psychiatric Centre Ballerup, Ballerup, Denmark.
⁸ Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
⁹ Department of Medicine, Harvard Medical School, Boston, MA, USA.
¹⁰ Neuroendocrine Unit, Massachusetts General Hospital, 55 Fruit St., Boston, MA, 02114, USA. ealawson@mgh.harvard.edu.
¹¹ Department of Medicine, Harvard Medical School, Boston, MA, USA. ealawson@mgh.harvard.edu.

^# Contributed equally.

Abstract

Background: Avoidant/restrictive food intake disorder (ARFID) is a restrictive eating disorder commonly associated with medical complications of undernutrition and low weight. In adolescence, a critical time for bone accrual, the impact of ARFID on bone health is uncertain. We aimed to study bone health in low-weight females with ARFID, as well as the association between peptide YY (PYY), an anorexigenic hormone with a role in regulation of bone metabolism, and bone mineral density (BMD) in these individuals. We hypothesized that BMD would be lower in low-weight females with ARFID than healthy controls (HC), and that PYY levels would be negatively associated with BMD.

Methods: We performed a cross-sectional study in 14 adolescent low-weight females with ARFID and 20 HC 10-23 years old. We assessed BMD (total body, total body less head and lumbar spine) using dual x-ray absorptiometry (DXA) and assessed fasting total PYY concentration in blood.

Results: Total body BMD Z-scores were significantly lower in ARFID than in HC (- 1.41 ± 0.28 vs. - 0.50 ± 0.25, p = 0.021). Mean PYY levels trended higher in ARFID vs. HC (98.18 ± 13.55 pg/ml vs. 71.40 ± 5.61 pg/ml, p = 0.055). In multivariate analysis within the ARFID group, PYY was negatively associated with lumbar BMD adjusted for age (β = -0.481, p = 0.032).

Conclusion: Our findings suggest that female adolescents with low-weight ARFID may have lower BMD than healthy controls and that higher PYY levels may be associated with lower BMD at some, but not all, sites in ARFID. Further research with larger samples will be important to investigate whether high PYY drives bone loss in ARFID.

Keywords: ARFID; Adolescence; Avoidant/restrictive food intake disorder; BMD; Bone health; Bone mineral Density; DXA; Feeding and eating disorder; Low weight; PYY.

Plain language summary

Avoidant/restrictive food Intake disorder (ARFID) is a condition characterized by lack of interest in eating/food, sensory sensitivity and/or fear of aversive consequences of eating. It is associated with low weight and undernutrition, which can lead to medical complications. Specifically, low weight in patients with ARFID raises concerns of impaired bone health. In this study, we compared bone mineral density (BMD), a measure of bone health, in 14 low-weight females with ARFID and 20 healthy females 10–23 years old. We also examined the association between BMD and peptide YY (PYY), a hormone that induces satiety and inhibits bone formation. A strong negative association between bone health and PYY was previously reported in females with anorexia nervosa. Thus, we hypothesized a similar association in low weight females with ARFID. We found that BMD may be lower in low-weight females with ARFID than in healthy females and that higher PYY levels are associated with lower BMD at some but not all sites. We concluded that bone health may be a concern in low-weight females with ARFID. This finding is important as low BMD raises concerns for increased fracture risk, which in turn could have a detrimental effect on quality of life.