Analysis of the effects of eating and emotions on reproductive axis function in patients with functional hypothalamic amenorrhea

Figures & data

Table 1. Weight-loss condition, PHQ-9, GAD-7 and EAT-26 scores in patients with FHA.

Item			Value
Age (years), mean ± SD			23.29 ± 5.27
Disease duration (months), M (P25, P75)			10 (4, 24)
Weight-loss duration (months), M (P25, P75)			12 (6, 24)
Magnitude of weight loss (%), M (P25, P75)			20.0 ± 9.7
Weight-loss speed (%/month), M (P25, P75)			1.25 (0.64, 2.29)
BMI before weight loss (kg/m^2), mean ± SD			21.52 ± 2.32
BMI change during disease onset (kg/m^2), M (P25, P75)			3.95 (2.47, 5.88)
Cause of weight loss, n (%)	Dietary control alone Exercise alone Diet combined with exercise Psychological stress alone		15 (25.9)
			3 (5.2)
			28 (65.5)
			2 (3.4)
PHQ-9 (scores), M (P25, P75)			7 (4, 11)
GAD-7 (scores), M (P25, P75)			6 (3, 12)
EAT-26 (scores), M (P25, P75)			11 (5, 20)
High risk of eating disorders, n (%)			15 (25.9)
Severity, n (%)/moderate		Depressive symptoms	Anxiety symptoms
	Absent	18 (31.0)	23 (39.7)
	Mild	20 (34.5)	18 (31.0)
	Moderate	12 (20.7)	8 (13.8)
	Moderately severe/severe	8 (13.8)	9 (15.5)

BMI: body mass index; PHQ-9: Patient health questionnaire-9; GAD-7: Generalized anxiety disorder-7; EAT-26: Eating attitude test-26.

Table 2. Comparison of clinical, endocrine and ultrasound characteristics between the two groups.

Item	Recovered group (n1 = 20)	Non-recovered group (n2 = 38)	t/z/χ^2	P
Age (years), mean ± SD	24.1 ± 6.07	22.9 ± 4.83	0.844	.403
Disease duration (months) M (P25, P75)	6 (4.12)	12 (4.24)	−0.801	.423
Weight loss duration (months) M (P25, P75)	12 (6.24)	12 (6.24)	−0.058	.954
Magnitude of weight loss (%) mean ± SD	18.75 ± 9.60	20.13 ± 9.80	−0.517	.608
Speed of weight loss (%/months) M (P25, P75)	1.25 (0.60, 2.70)	1.17 (0.67, 2.29)	−0.131	.896
Follow-up duration (months) M (P25, P75)	15.0 (8.3, 21.5)	16.0 (7.5, 30.0)	−0.221	.825
BMI change during disease onset (kg/m^2), M (P25, P75)	3.48 (2.40, 5.93)	4.05 (2.47, 5.88)	−0.417	.677
BMI change during recovery (kg/m^2) M (P25, P75)	1.61 (0.88, 3.53)	1.69 (0.64, 3.18)	−0.033	.974
PHQ-9 (scores) M (P25, P75)	5.00 (2.25, 7.75)	9.00 (4.00, 14.00)	−2.296	.022
GAD-7 (scores), M (P25, P75)	4.50 (2.00, 8.75)	6.50 (4.00, 13.00)	−1.437	.151
EAT-26 (scores), M (P25, P75)	8.50 (4.00, 11.75)	14.5 (6.75, 25.75)	−2.170	.03
Bulimia and food preoccupation M (scores) (P25, P75)	1.0 (0.0, 2.0)	2.0 (0.0, 4.0)	−2.041	.041
LH (mIU/mL) M (P25, P75)	1.69 (0.24, 3.19)	0.28 (0.01, 0.69)	−2.546	.011
FSH (mIU/mL) M (P25, P75)	5.97 (1.31, 8.17)	1.16 (0.31, 4.33)	−2.716	.007
E2 (pmol/mL) M (P25, P75)	116.56 (39.16, 161.11)	87.00(51.00, 165.74)	−0.351	.726
TT (nmol/L) M (P25, P75)	1.48 ± 0.83	1.25 ± 0.80	1.699	.095
Ovarian volume (mL) M (P25, P75)	5.10 (4.30, 7.57)	4.36 (3.52, 6.40)	−1.471	.141
Follicular diameter > 5 mm, n(%)	16 (80.0)	16 (42.1)	7.608	.006

BMI: Body mass index; PHQ-9: Patient health questionnaire-9; GAD-7: Generalized anxiety disorder-7; EAT-26: Eating attitude test-26 LH: luteinizing hormone; FSH: follicle stimulating hormone; E2: estradiol; TT: total testosterone.

Table 3. Correlation between basal LH level and magnitude of weight loss with change in BMI.

Group	Magnitude of weight loss		BMI change during disease onset
	R	P	R	P
All FHA (n = 58)	−0.361	.005	−0.341	.009
Recovered group (n1 = 20)	−0.288	.218	−0.191	.419
Non-recovered group (n2 = 38)	−0.343	.035	−0.358	.027

FHA: functional hypothalamic amenorrhea; BMI: body mass index.

Table 4. Correlation between basal LH and E2 levels and EAT-26, PHQ-9 and GAD-7 during disease onset.

Item	LH		E2
	R	P	R	P
EAT-26	−0.054	.685	−0.066	.629
PHQ-9	−0.200	.132	−0.017	.900
GAD-7	−0.208	.117	−0.149	.274

LH: luteinizing hormone; FSH: follicle stimulating hormone; E₂: estradiol; PHQ-9: Patient health questionnaire-9; GAD-7: Generalized anxiety disorder-7; EAT-26: Eating attitude test-26.

Table 5. Multivariate logistic regression analysis of factors that affect recovery outcomes in patients with FHA.

Variable	B	Standard error of B	Wald χ^2 value	P	OR	95% CI of OR
						Lower limit	Upper limit
Magnitude of weight loss (%)	10.540	15.616	0.456	.499	38127.453	0.000	7.472 × 10^17
BMI change during disease onset (kg/m^2)	−0.328	0.637	0.265	.607	0.720	0.207	2.509
PHQ-9 (scores)	−1.114	0.138	0.681	.409	0.893	0.681	1.169
GAD-7 (scores)	0.120	0.124	0.927	.336	1.127	0.883	1.438
EAT-26 (scores)	−0.001	0.057	0.000	.989	0.999	0.894	1.117
Bulimia and food preoccupation	−0.228	0.267	0.726	.394	0.796	0.471	1.345
LH (mIU/mL)	0.149	0.155	0.927	.336	1.161	0.857	1.572
FSH (mIU/mL)	−0.025	0.166	0.023	.878	0.975	0.705	1.349
Follicle with diameter > 5 mm during initial diagnosis	2.019	0.888	5.170	.023	7.532	1.321	42.930

BMI: body mass index; PHQ-9: Patient health questionnaire-9; GAD-7: Generalized anxiety disorder-7; EAT-26: Eating attitude test-26; LH: luteinizing hormone; FSH: follicle stimulating hormone.

Data availability statement

All data collected during the current study are not publicly available but are available from the corresponding author upon reasonable request.