Is constitutional thinness really different from anorexia nervosa? A systematic review and meta-analysis

Rev Endocr Metab Disord. 2021 Dec;22(4):913-971. doi: 10.1007/s11154-021-09650-4. Epub 2021 Apr 30.


A growing interest in constitutional thinness has been observed in the last decades, but the publications however cover various fields of study and report equivocal results. The present work systematically reviewed any clinical trials enrolling participants with constitutional thinness and bibliographic researches were performed between December 2018 and June 2020. From a total of 1 212 records initially identified, 402 records were removed as duplicates, 381 articles were excluded based on titles or abstracts and 390 references were excluded against eligibility criteria. Thirty-nine articles were finally included in the systematic review. The results showed that constitutionally thin people seem to be underweight but not underfat and present a fat-free mass as blunted as anorexic patients, despite being a little less underweight. The meta-analysis confirmed that constitutionally thin people present normal energy intake and revealed a trend toward a higher resting metabolic rate to fat-free mass ratio which suggests a highly metabolic fat-free mass. Contrary to patients with anorexia nervosa, constitutionally thin people present normal levels of insulin-like growth factor 1, estradiol, growth hormone, follicle-stimulating hormone, and luteinizing hormone. An intermediate level of leptin between anorexic and control participants was however observed in constitutional thinness. While all the studies reported normal free triiodothyronine and cortisol levels in constitutionally thin individuals, a higher fasting free triiodothyronine level (p = 0.033) and a lower 24 h mean cortisol level (p = 0.005) were observed for the first time. Present results give robust evidence that constitutionally thin people present an atypical phenotype highly different from anorexia nervosa.

Keywords: Appetite-regulating hormones; Biochemical markers; Body composition; Constitutional thinness; Energy metabolism; Weight gain resistance.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Anorexia Nervosa* / metabolism
  • Energy Intake
  • Human Growth Hormone*
  • Humans
  • Thinness / metabolism


  • Human Growth Hormone