***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: INTRODUCTION Adolescents with anorexia nervosa ( AN ) have low bone mineral density ( BMD ) . Baseline predictors of temporal BMD changes ( DeltaBMD ) in AN , including 1 ) gastrointestinal peptides regulating food intake and appetite that have been related to bone metabolism and 2 ) bone turnover markers , have not been well characterized . We hypothesized that baseline levels of nutritionally regulated hormones and of bone turnover markers would predict DeltaBMD overall . METHODS In a prospect i ve observational study , lumbar and whole-body BMD was measured at 0 , 6 , and 12 months in 34 AN girls aged 12 - 18 yr and 33 controls . Baseline body mass index , lean mass , nutritionally regulated hormones [ IGF-I , cortisol , ghrelin , leptin , and peptide YY ( PYY ) ] , bone formation , and resorption markers were examined to determine nutritional and hormonal predictors of bone density changes . RESULTS In a regression model , baseline ghrelin and PYY predicted changes in spine bone measures ; and baseline ghrelin , cortisol , and PYY predicted changes in whole-body bone measures independent of baseline nutritional status . CONCLUSIONS Neuroendocrine gastrointestinal-derived peptides regulating food intake are independent predictors of changes in bone mass in AN PURPOSE To evaluate mediators of resumption of menses ( ROM ) in adolescents with anorexia nervosa ( AN ) . METHODS Anthropometrics , body composition by dual-energy X-ray absorptiometry , hormonal studies , and responses to mental health screens  were obtained at 6-month intervals for 18 months in 37 adolescents with AN r and omized to the placebo arm of a double-blind treatment trial . Outcomes were compared between subjects with menstrual recovery and those without . RESULTS Twenty-four subjects ( 65 % ) had ROM . Higher percentage body fat was associated with ROM ( odds ratio , 1.19 ; 95 % confidence interval , 1.06 , 1.33 ; p < .01 ) , as was body mass index and percent median body weight . Estradiol ≥30 ng/mL alone did not predict menses ( p = .08 ) but was associated with ROM when coupled with percent mean body weight ( odds ratio , 2.49 ; 95 % confidence interval , 1.09 , 5.65 ; p = .03 ) . Changes in leptin , cortisol , and mental health were not associated with return of menses . CONCLUSIONS Percentage body fat may be an additional , useful clinical assessment to follow in caring for adolescents with AN To explore the differential effects of harassment on cardiovascular and neuroendocrine stress reactivity and recovery , 28 men and 32 women were r and omized to a harassment or no-harassment control condition ( four groups in total ) . The harassment consisted of three scripted statements delivered during performance of a mental arithmetic stress task . The harassing statements were delivered on a fixed schedule during the task by a same-gender experimenter . Cardiovascular , salivary cortisol , and state affect measures were taken at baseline , immediately posttask , and throughout an extended recovery period . In comparison to the control condition , harassment accentuated the stress reactivity responses on all measures , physiological and self-report of subjective affect . In addition , several gender differences in response to the stressor and during the recovery period were observed . Harassed men had the largest reactivity on cortisol and diastolic blood pressure , whereas the harassed women showed a more pronounced response on heart rate and self-reported hostility . The harassed groups were the only ones to show significant cortisol responses . Within the harassed condition , comparison of effect sizes revealed that cortisol reactivity in men was twice that of women . Control groups did not exhibit significant cortisol changes . During the recovery period , harassed men exhibited attenuated return to baseline on cardiovascular indices and cortisol , whereas women , overall , tended to exhibit an overcompensation response on cardiovascular measures . These results contribute to showing a pathway that may link negative affect ( i.e. , hostile or angry feelings ) with the development of cardiovascular disease OBJECTIVE The prevalence of eating disorders ( EDs ) in a representative scholastic sample was evaluated , and the demographic factors associated with ED were assessed . METHOD The study used a two-stage epidemiological design . The study population was a r and omly selected sample of 1545 students ( 12- to 21-year-old males and females ) in the region of Madrid ( Spain ) . RESULTS ED prevalence was 3.43 % . Prevalence estimations were as follows : 5.34 % for females : 2.72 % for eating disorders not otherwise specified ( EDNOS ) , 2.29 % for bulimia nervosa ( BN ) , and 0.33 % for anorexia nervosa ( AN ) ; and 0.64 % for males : 0.48 % for EDNOS , 0.16 % for BN , and 0.00 % for AN . Some demographic factors that were shown to be associated with ED included the following : sex , age , single child , single-parent families , and father or mother 's death . DISCUSSION Despite the method ological improvements over previous epidemiological studies developed in Spain , there were no significant differences in the prevalence estimations Abstract Objectives One novel hypothesis of the pathogenesis of anorexia nervosa ( AN ) is the possible role of mental stress in hyperactivity of the autonomic nervous system ( ANS ) and of the hypothalamic – pituitary – adrenal ( HPA ) axis . Two components of stress response – salivary alpha-amylase ( sAA ) and free cortisol – have been proposed . They can be determined in saliva , which closely reflects their concentrations in plasma . The purpose of this study was to measure salivary free cortisol , sAA and their correlation to secretory IgA ( sIgA ) of patients with AN in comparison to the average population . Methods A controlled clinical trial was design ed for a matched group of 47 AN patients and 54 healthy individuals . After clinical examination , unstimulated salivary sample s were taken during the acute stage of AN ( BMI < 15 kg/m2 ) in the first week of hospitalisation . An enzyme-linked immunosorbent assay ( ELISA ) suitable for measuring sAA , sIgA and free cortisol  were used . Results Anorexic patients exhibited disturbances in sAA secretion , and significantly increased cortisol and sIgA levels with a distinct correlation between these two parameters . Conclusions The behaviour of cortisol , sAA and sIgA levels can be assessed as an effect of stress reaction among AN patients with hyperactivity of the HPA axis and ANS dysregulation . The effect of stress response can be assessed reliably in saliva The objective was to examine whether cerebral volumes are reduced , and in what regions , in adolescents with anorexia nervosa and to study changes after nutritional recovery . Twelve anorexia nervosa ( DSM-IV ) patients aged 11 - 17 consecutively admitted to an Eating Disorders Unit were assessed by means of  psychopathological scales  , neuropsychological battery and voxel-based morphometric ( VBM ) magnetic resonance imaging at admission and after 7 months ' follow-up . Nine control subjects of similar age , gender and estimated intelligence level were also studied . The two groups showed differences in gray matter ( F=22.2 ; p<0.001 ) and cerebrospinal fluid ( CSF ) ( F=21.2 ; p<0.001 ) but not in white matter volumes . In anorexic patients , gray matter volume correlated negatively with the copy time from the Rey Complex Figure Test . In the regional VBM study several temporal and parietal gray matter regions were reduced . During follow-up there was a greater global increase in gray matter ( F=10.7 ; p=0.004 ) and decrease in CSF ( F=22.1 ; p=0.001 ) in anorexic patients . The increase in gray matter correlated with a decrease in cortisol ( Spearman correlation=-0.73 ; p=0.017 ) . At follow-up there were no differences in global gray matter ( F=2.1 ; p=0.165 ) , white matter ( F=0.02 , p=0.965 ) or CSF ( F=1.8 ; p=0.113 ) volumes between both groups . There were still some smaller areas , in the right temporal and both supplementary motor area , showing differences between them in the regional VBM study . In conclusion , in adolescent anorexic patients  gray matter is more affected than white matter and mainly involves the posterior regions of the brain . Overall gray matter alterations are reversible after nutritional recovery STUDY OBJECTIVE To compare the cortisol levels and 24 hour salivary cortisol rhythm in patients with anorexia nervosa ( AN ) and normal controls . DESIGN Prospect i ve transversal controlled study . SETTING Tertiary-referral University Hospital . PARTICIPANTS Twenty-five patients aged 15 to 35 years , 13 of them with regular ovulatory cycles , and 12 with diagnosis of AN . INTERVENTIONS Salivary and blood collection for cortisol 24-hour rhythm determination . MAIN OUTCOME  Salivary cortisol  was determined at 9 am , 5 pm , and 11 pm . Seric follicle-stimulating hormone , luteinizing hormone ( LH ) , prolactin , estradiol ( E2 ) , progesterone , dehydroepi and rosterone-S ( DHEA-S ) , and cortisol were sample d together with the 9 am salivary sample . RESULTS LH , E2 , and DHEA-S levels were reduced in patients with AN . A correlation between salivary and serum cortisol levels was observed in the 9 am sample only in controls ( r = 0.67 , P = 0.01 ; AN : r = 0.48 , P = 0.12 ) . Cortisol rhythm was present in all control subjects , whereas it was absent in one third of AN patients . The area under the curve for the AN group with preserved rhythm was significantly higher than for the control group ( Me = 6811 ng/dl/24h vs 3708 ng/dl/24 h ; P = 0.034 ) . CONCLUSION Patients with AN have higher salivary cortisol levels when compared to normal women and some of them do not present circadian rhythm 
    Output:
    
Patients with eating disorders may have several clinical consequences , such as changes in body fat distribution , changes in bone mineral density , worsening of neurocognitive ability , and endocrine changes ( e.g. , hypercortisolemia ) , which in turn can lead to hyperglycemia , insulin resistance , hypertension , and increased risk of infections .
The findings demonstrate that adolescents with eating disorders , especially anorexia nervosa , have increased cortisol levels , which are reduced after the treatment period .