Physical fitness and nutritional status in female adolescents with anorexia nervosa

MARTÍNEZ-SÁNCHEZ, Sofía María; MARTÍNEZ-GARCÍA, Tomás Eugenio; MUNGUÍA-IZQUIERDO, Diego

doi:10.1590/1678-9865202033e190154

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Sumário

Orginal • Rev Nutr 33 • 2020 • https://doi.org/10.1590/1678-9865202033e190154 copy

Physical fitness and nutritional status in female adolescents with anorexia nervosa

Aptidão física e estado nutricional em adolescentes do sexo feminino com anorexia nervosa

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

This study aimed to determine whether physical fitness is related to nutritional status in a sample of female adolescents with anorexia nervosa, to contrast the nourished and undernourished patients, and to compare the physical fitness in these patients with normative data of healthy subjects stratified by age and gender.

Methods

Nutritional status was determined using the body mass index Z-score, fat mass, fat-free mass (bioelectrical impedance analysis), and the Controlling Nutritional Status score in 15 anorexic adolescents with 14.3±1.6 years. Physical fitness was assessed using the ALPHA-Fitness Battery (handgrip strength, standing broad jump, 4x10m shuttle run, and 20m shuttle run tests).

Results

Handgrip strength was significantly associated with all variables of nutritional status, except with the three blood components of the Controlling Nutritional Status score. The undernourished anorexic patients showed significantly worse physical fitness than the nourished anorexic patients in all tests, except in the standing broad jump and the 4x10m shuttle run tests. The physical fitness tests of the female anorexic adolescents showed scores significantly worse than those of the normative European female adolescent population.

Conclusion

The observation of female adolescents with anorexia nervosa showed associations between higher physical fitness levels and better nutritional statuses. Handgrip strength and 20m shuttle run tests may be options of additional indicators of undernutrition in anorexic female adolescents. The undernourished anorexic patients showed worse physical fitness than the nourished ones. According to normative data for healthy sex- and agematched adolescents, physical fitness is severely impaired in anorexic female adolescents.

Keywords
Anorexia Nervosa; Exercise test; Female adolescents; Muscle strength; Nutritional status

Physical fitness	BMI Z-score	Fat mass	Fat-free mass	Albumin	Lymphocyte	Cholesterol
Handgrip strength	0.604 ^* * p<0.05;	0.529 ^* * p<0.05;	0.879 ^ p<0.01; Correlation values are Spearman correlation coefficients;	-0.089	0.429	-0.170
Standing long jump	0.021	-0.171	0.432	0.213	0.379	0.038
4x10m shuttle run	0.304	0.307	0.396	-0.125	0.104	-0.002
20m shuttle run	0.079	-0.027	0.529 ^* * p<0.05;	0.198	0.447 ^* * p<0.05;	0.006
Muscular fitness ^a a Mean of handgrip strength and standing long jump Z-scores;	0.346	0.168	0.700 ^ p<0.01; Correlation values are Spearman correlation coefficients;	0.118	0.475 ^* * p<0.05;	-0.050
Global physical fitness ^b b Mean of the four physical fitness Z-scores.	0.364	0.268	0.718 ^ p<0.01; Correlation values are Spearman correlation coefficients;	-0.007	0.407	-0.080

Variable		Nourished (n=6)	Undernourished (n=9)	p
Age (years)		14.9(1.5)	14.0(1.5)	0.157
Height (cm)		161.9(3.2)	157.5(9.0)	0.443
Weight (kg)		54.0(5.1)	41.4(6.9)	0.007
Nutritional status
	BMI Z-score	-0.2(0.6)	-1.1(0.7)	0.025
	Fat mass (kg)	14.8(3.0)	9.6(4.3)	0.034
	Fat-free mass (kg)	39.2(3.3)	31.8(4.5)	0.003
	Serum Albumin (g/dL)	4.8(0.5)	4.9(0.5)	0.859
	Total Lymphocytes/mL	1910.0(340.0)	1930.0(570.0)	0.906
	Cholesterol (mg/dL)	174.0(33.8)	178.3(28.9)	0.860
Physical Fitness
	Upper muscular fitness (kg)	27.4(4.3)	19.1(2.4)	0.001
	Lower muscular fitness (cm)	123.5(23.1)	108.0(16.5)	0.194
	Motor fitness (s) ^a a Lower values indicate better performance;	14.3(1.2)	15.2(1.1)	0.175
	Cardiorespiratory fitness (s)	182.7(55.5)	125.2(30.2)	0.045
	Muscular fitness (upper+lower muscular fitness; Z-scores)	-0.2(0.9)	-1.3(0.5)	0.010
	Global physical fitness (z-scores) ^b b Mean of the four physical fitness Z-scores; Data are shown as the Mean (Standard Deviation), unless otherwise indicated; Nutritional status differences were analyzed by the U Mann-Whitney test, with the variables of nutritional status and physical fitness as dependent variables.	-0.5(0.7)	-1.4(0.5)	0.018

Physical fitness	Female adolescents with AN (n=15)	European normative adolescent female sample (n=1845)	p
Handgrip strength (kg)	22.4(5.2)	26.1(4.8)	0.016
Standing long jump (cm)	114.2(20.2)	145.6(26.4)	0.001
4x10m shuttle run (s)^a a Lower values indicate better performance; Data are shown as the mean (Standard Deviation), unless otherwise indicated.	14.8(1.2)	12.8(1.2)	0.001
20m shuttle run (stage)	2.2(0.8)	3.8(1.9)	0.001

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[1] Correspondence to: SM MARTÍNEZ-SÁNCHEZ. E-mail: sofiams91@gmail.com.