Original Article

Association between Body Composition Parameters and Heart Rate in a Sample of Adolescents with Anorexia Nervosa

Authors: Brenna N. Denhardt, RD, Sarah E. Sobalvarro, PhD, Jasmine M. Reese, MD, Jason Parton, PhD, Amy Ellis, PhD


Objectives: Eating disorders affect the physical and mental health of millions of Americans. Body composition trends in relation to heart rate in adolescents with eating disorders remain understudied. The aim of the present study was to determine whether body composition parameters (percent body fat, percent skeletal muscle mass) are correlated with heart rate in a sample of adolescents with anorexia nervosa.

Methods: This study included patients 11 to 19 years old who presented to an outpatient eating disorder clinic (N = 49). Patients underwent bioelectrical impedance analysis to estimate body composition parameters. Descriptive statistics, linear regression, and paired t tests were used to evaluate the data.

Results: Heart rate was inversely associated with percent skeletal muscle mass (P < 0.001) and positively associated with percent body fat (P = 0.001). Patients demonstrated significant improvements in weight, body mass index percentile, skeletal muscle mass, percent body fat, and heart rate when comparing results at the first and last visits (P < 0.01).

Conclusions: Overall, there was an inverse relation between percent skeletal muscle mass and heart rate and a positive association between body fat and heart rate. Our study demonstrates the importance of assessing percent body fat and skeletal muscle mass rather than weight or body mass index alone in adolescents with eating disorders.
Posted in: Eating Disorders (Not Including Obesity)3

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1. Swanson SA, Crow SJ, Le Grange D, et al. Prevalence and correlates of eating disorders in adolescents. Arch Gen Psychiatry 2011;68:714–723.
2. Chesney E, Goodwin GM, Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry 2014;13:153–160.
3. Portilla MG. Bradycardia: an important physical finding in anorexia nervosa. J Ark Med Soc 2011;107:206–208. .
4. Sawyer SM, Whitelaw M, Le Grange D, et al. Physical and psychological morbidity in adolescents with atypical anorexia nervosa. Pediatrics 2016; 137:e20154080.
5. Hornberger L, Grubb L, Zapata L. Identification and management of eating disorders in children and adolescents. Pediatrics 2021;147:e2020040279.
6. Müller MJ, Bosy-Westphal A, Later W, et al. Functional body composition: insights into the regulation of energy metabolism and some clinical applications. Eur J Clin Nutr 2009;63:1045–1056.
7. Kyle UG, Bosaeus I, De Lorenzo AD, et al. Bioelectrical impedance analysis —part I: review of principles and methods. Clin Nutr 2004;23:1226–1243.
8. Duren DL, Sherwood RJ, Czerwinski SA, et al. Body composition methods: comparisons and interpretation. J Diabetes Sci Technol 2008;2:1139–1146.
9. Miller R, Chambers T, Burns S. Validating InBody® 570 multi-frequency bioelectrical impedance analyzer versus DXA for body fat percentage analysis. J Exerc Physiol Online 2016;19:71–78.
10. Rawiwan S, Celine H, Christine W, et al. A comparison of body composition measurements between bioelectrical impedance analysis (InBody 570) and air displacement plethysmography (BOD POD®). Curr Dev Nutr 2020;20:1689.
11. Lim JS, Hwang JS, Lee JA, et al. Cross-calibration of multi-frequency bioelectrical impedance analysis with eight-point tactile electrodes and dual-energy X-ray absorptiometry for assessment of body composition in healthy children aged 6-18 years. Pediatr Int 2009;51:263–268.
12. Saladino CF. The efficacy of bioelectrical impedance analysis (BIA) in monitoring body composition changes during treatment of restrictive eating disorder patients. J Eat Disord 2014;2:34.
13. Jáuregui-Garrido B, Jáuregui-Lobera I. Sudden death in eating disorders. Vasc Health Risk Manag 2012;8:91–98.
14. Yahalom M, Spitz M, Sandler L, et al. The significance of bradycardia in anorexia nervosa. Int J Angiol 2013;22:83–94.
15. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders Fifth Edition. Arlington, VA: American Psychiatric Association; 2013.
16. National Center for Health Statistics, Centers for Disease Control and Prevention. Growth charts. https://www.cdc.gov/growthcharts/. Published September 9, 2010. Accessed November 30, 2022.
17. Hübel C, Yilmaz Z, Schaumberg KE, et al. Body composition in anorexia nervosa: meta-analysis and meta-regression of cross-sectional and longitudinal studies. Int J Eat Disord 2019;52:1205–1223.
18. Kezelman S, Touyz S, Hunt C, et al. Does anxiety improve during weight restoration in anorexia nervosa? A systematic review. J Eat Disord 2015;3: 1–15.
19. Lock J, Grange DL. Treatment Manual for Anorexia Nervosa: A FamilyBased Approach. New York: Guilford Press; 2015.