Publications

The resumption of menses is a primary outcome in anorexia nervosa treatment and considered a sign of recovery. Identification of relevant factors in its prediction is important in clinical practice. Therefore we aimed to conduct a systematic review and meta-analysis of the association between total body-fat percentage (%BF) and resumption of menses after weight restoration in adolescents and young adults with anorexia nervosa. The study was conducted by adhering to Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Data were collated using meta-analysis and a narrative approach. Of the 604 articles retrieved, seven studies met the inclusion criteria and were reviewed, revealing three main findings. Firstly, patients who resumed their menstrual cycle had a significantly higher mean %BF when compared to those who did not, an overall effect confirmed by the meta-analysis (SMD: 3.62, 95% CI: 2.90-4.33, p<0.05). Secondly, %BF was found to be an independent predictor of the resumption of menses in this population and an increase of only one unit of %BF can increase the odds of menstruation by ≈15–20%. Thirdly, despite the paucity of data, a cut-off point of %BF≈21 was suggested as the minimum needed for resumption of menses. In conclusion a higher %BF is associated with the resumption of menses in weight-restored adolescent and young adult females with anorexia nervosa. Its assessment is important in a clinical setting, especially after complete weight restoration.