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Menstrual and Uterine Disorders
Table 1: Average Energy Expenditure of Various body composition is the use of bioelectrical impedance analysis (BIA).
Physical Activities (Related to Body Mass of 50kg)
This simple and non-invasive method is based on a two-compartment
model in which proteins, water and minerals are considered together
Activity/Sport Energy Expenditure to form the FFM. The application of this method to patients with a BMI
(kilocalories/hour) <15kg/m
2
has been questioned.
7
Another parameter resulting from
Aerobic dance 270 BIA evaluation of particular interest from a nutritional point of view is
Aerobics 260
the phase angle. This is related to the ratio of intra- and extracellular
Archery 190
water to the body cell mass: it decreases in undernutrition, but
Artistic gymnastics 490
increases with intense physical activity.
Basketball 250
Body-building 375
Ultrasonographic (US) examination of the internal genital organs
Bowling 215
Boxing 190
makes it possible to document the effects of reduced ovarian
Canoeing 240
function on endometrial thickness and uterine dimensions. In these
Climbing 480
situations, ovarian morphology often presents with a multifollicular
Cross-country skiing 560
aspect, expression of low levels of luteinising hormone (LH) and
Cycling 165 oestradiol with normal or increased follicle-stimulating hormone (FSH)
Dance 223 levels inhibiting the progression of maturing follicles; only in severe
Fencing 240
states of undernutrition is the follicular component no longer evident
Golf 200
and the ovaries appear compact. A correlation between ovarian
Gymnastics 255
volume and BMI >18kg/m
2
has been demonstrated.
8
An abdominal US
Horse-riding 190
scan may highlight the accumulation of intrahepatic lipid as an
Jogging 520
adaptive response to increased adipose tissue lipolysis, and the
Martial arts 250
Rowing 190
consequent delivery of non-oesterified fatty acid to the liver relates to
Running (16km/hour) 719
prolonged periods of fasting. High levels of glucococorticoids also
Skating 480
appear to play a role in the genesis of hepatic steatosis.
9
Skiing 480
Soccer 430 Laboratory Analyses
Squash 480 Routine analyses are generally within reference ranges, but when
Swimming 255
there is a suspicion of behaviour to compensate for binge eating,
Tennis 335
such as forced vomiting or laxative or diuretic abuse, it is mandatory
Volleyball 280
to check hepatic enzymes, serum electrolytes and amylase. Mild
Walking (brisk) 240
hypokalaemia is a common consequence of excessive loss of
Water polo 640
potassium, which may explain muscle weakness, cramps and
Weight training 375
constipation. The real danger is severe hypokalaemia, which may
Note: energy expenditure is dependent on the weight and skill of the performer, the intensity
of the activity, etc.
result in cardiac arrhythmia. If present, hyperamylasemia generally
reflects an overproduction of the enzyme from the salivary glands
useful for identifying subjects with limited fat stores, even though a related to vomiting; however, pancreatic involvement is also possible
clear threshold for the preservation of reproductive function has not with bulimic behaviour and alcohol abuse, and can be confirmed by
been defined. We know that at menarche girls reach a body fat measuring the levels of serum lipase, trypsinogen and pancreatic
percentage of around 24%; in a study comparing eumenorrhoeic and amylase isoenzyme and through abdominal ultrasonography.
amenorrhoeic subjects with eating disorders,
4
a mean value of 20%
was observed in the first group. The lean body mass (expressed as In interpreting the results of endocrine tests, one should bear in
kg) highlights the impact of muscle on total weight and is also strictly mind that undernutrition, physical hyperactivity and, frequently,
related to bone density preservation in eating disorders.
5
Considering psychological distress interact at a hypothalamic level as multiple
that eating disorders, depending on their timing and duration, are a stressors,
10
activating a chronic stress response (see Figure 1). The
significant risk factor for bone loss, the evaluation of bone mineral extent to which this is expressed depends on the severity of
density is also of interest. DEXA-derived measurements can have a the metabolic impairment, as well as individual resilience and
certain bias: in the first place, age-adjusted software is required, and adaptive resources. A partial activation of corticotropin-releasing
second, local bone density measurements are affected by stature, hormone (CRH)–adrenocorticotropic hormone (ACTH) induces an
leading to an underestimation in short subjects and a overestimation increase in the daily production of cortisol and argin-vasopressin and
in tall women. Moreover, malnutrition has different effects on bone inhibits gonadotropin-releasing hormone (GnRH) pulsatile dismission
mass: in long bones it impairs bone modelling through a substantial and, consequently, pituitary LH production. The transient increase in
reduction in periosteal apposition; in the lumbar spine, a site with cathecolamines is probably responsible for the impairment in thyroid
more elevated turnover, the hormonal milieu related to impaired hormone metabolism, with generalised peripheral induction of type 3
eating produces a deficiency in the amount of bone within the deiodinase and a reduction of type 1 deiodinase contributing to the
vertebral bodies, with a more evident density reduction.
6
low T3 state associated with the sparing of energy-consuming
processes. Induction of type 2 deiodinase in the hypothalamus may
The drawback to the extensive use of DEXA in the follow-up of underlie the lack of compensatory increase in thyroid-stimulating
individual subjects is the exposure to radiation, albeit limited, with hormone. Sympathetic activation also promotes the recruitment of
each examination. Another possible option for the measurement of leukocytes and pro-inflammatory cytokines: these act in synergy
18 EUROPEAN OBSTETRICS & GYNAECOLOGY
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