Common physiological changes in anorexia nervosa

Halmi, Katherine A.; Falk, James R.

doi:10.1002/1098-108x(198123)1:1<16::aid-eat2260010103>3.0.co;2-h

Cited by 48 publications

(18 citation statements)

References 18 publications

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“…A high degree of selection of patients of certain subgroups in these studies could be the reason. The range of total Chol levels (3·65 -10·12 mmol/l) and of the LDL-Chol concentrations (1·97 -8·11 mmol/l) was larger than in CO (total Chol 1·17-5·10 mmol/l, LDL-Chol 2·82 -6·81 mmol/l), a phenomenon that has also been previously reported Halmi & Falk, 1981). The metabolic causes for elevated LDL-Chol were unknown until now.…”

Section: Discussionmentioning

confidence: 99%

Lipoprotein metabolism in patients with anorexia nervosa: a case–control study investigating the mechanisms leading to hypercholesterolaemia

et al. 2004

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Hypercholesterolaemia is a common finding in patients with anorexia nervosa (AN). To investigate the type, frequency and pathophysiological mechanisms of changes in lipoprotein metabolism in AN we performed a cross-sectional study in fifty-eight female patients (mean age 24·2 years, BMI 15·3 (SD 1·5) kg/m 2 ) and fifty-eight healthy age-matched controls (CO; BMI 22·2 (SD 1·7) kg/m 2 ). Total cholesterol and LDL-cholesterol were higher in AN (5·5 (SD 1·3) v. 5·0 (SD 0·8) mmol/l, P¼0·023; 3·6 (SD 1·1) v. 3·2 (SD 0·7) mmol/l, P¼0·025 respectively). LDL particles were significantly more enriched in cholesterol and triacylglycerol in AN. In multiple regression analysis with LDL-cholesterol as the dependent and BMI, total body fat ( %), lathosterol:cholesterol ratio (endogenous cholesterol synthesis), 7a-hydroxy-4-cholesten-3-one (bile acid synthesis), non-esterified glycerol, free triiodothyronine and free thyroxine as independent variables, BMI was the only significant predictor in CO (R 2 0·36, overall P¼0·001). In AN the variability of LDL-cholesterol was significantly predicted by total body fat, free thyroxine, BMI, free triiodothyronine and non-esterified glycerol (R 2 0·55, overall P,0·001). Subgroup analysis between restricting (AN-R) and binge-eating -purging patients (AN-B) indicated that in AN-R changes in lipoproteins, BMI and total body fat were more pronounced. AN-R patients had lower bile acid synthesis than AN-B (P¼0·02). We conclude that elevated cholesterol concentrations in AN are generally due to an increase in LDL-cholesterol, which is mostly determined by the severe loss of body fat and the resulting changes in thyroid hormones, increased lipolysis and decreased endogenous cholesterol synthesis with resulting decrease in LDL removal. The clinical subtype of AN plays a major role in the mechanisms leading to hypercholesterolaemia.Anorexia nervosa: Lipoprotein metabolism: Hypercholesterolaemia

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Section: Discussionmentioning

confidence: 99%

Lipoprotein metabolism in patients with anorexia nervosa: a case–control study investigating the mechanisms leading to hypercholesterolaemia

et al. 2004

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“…Thus, we started a prospective study to clarify the clinical implication of serum aminotransferase elevation in anorexia nervosa. To date, numerous studies have discussed the elevation of serum aminotransferase levels in the patients with anorexia nervosa (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). However, there have been no consistent patterns in the results and the clinical implication has not been clarified (2).…”

Section: Introductionmentioning

confidence: 99%

Elevation of Serum Aminotransferase as a Sign of Multiorgan-Disorders in Severely Emaciated Anorexia Nervosa.

1998

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To clarify the clinical significance of elevation of serum aminotransferase levels in anorexia nervosa, we analyzed the relationships of serum aminotransferase levels to other serum biochemistry and physical conditions before and during refeeding therapy in 101 patients with anorexia nervosa. Before refeeding therapy, body mass index (BMI) was distributed from 9.9 to 16.4 kg/m2 (13.2 ± 1.3, mean ± SD), and 29 patients (28.7 % ) showed abnormally high aminotransferase levels. Among17 patients with a BMIof less than 12 kg/m2, the aminotransferase level was abnormally high in 13 patients (76 % ). Incidence and severity of serum aminotransferase elevation were greater in the patients with lower BMI. The groups with high serum aminotransferase levels had a lower body temperature, lower pulse rate, and higher incidence of other biochemical abnormalities than the group with normal serum aminotransferase levels. These findings indicate that aminotransferase elevation develops at a high incidence in anorectic patients with a critically life-threatening condition, and it is a sign of multiorgan failure requiring urgent calorie repletion. This type of aminotransferase elevation is to be distinguished from refeeding-induced aminotransferase elevation.

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“…The resolution of depressive symptoms correlated with the normalization of DST results. It is possible that starvation, a state known to result in elevated cortisol levels and depressed mood, may have triggered a full-blown depressive syndrome in this anorectic child (Keys et al, 1950;Halmi and Falk, 1981;Fichter et al, 1984). It is important to note that these depressive symptoms and hypothalamic-pituitary-adrenal axis abnormalities resolve with weight gain in anorectic patients and do not indicate a need for antidepressant treatment in this population.…”

Section: Discussionmentioning

confidence: 94%