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

Abstract

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.

Prevalence and Predictors of Abnormal Liver Enzymes in Young Women with Anorexia Nervosa

“…In bivariate analyses, we found that BMI was inversely correlated with levels of ALT and GGT. Ozawa et al previously showed an inverse correlation between BMI and aminotransferase levels in severely malnourished hospitalized young women with AN (mean BMI 13.2 ± 1.3 kg/m 2 ) [22]. Therefore, the relationship between BMI and liver inflammation in AN may be present across a wide range of BMIs.…”

Hepatocellular Injuries Observed in Patients with an Eating Disorder Prior to Nutritional Treatment

“…In Japan, the frequency of hepatocellular damage on admission or prior to the effective therapy was reported to be 20% (2) or 29% (11). In the current study, we enrolled patients with eating disorders who had no previous nutritional treatment to exclude the possible hepatotoxic effect of nutritional support, and an elevation of ALT was observed in 52% (13/25), and all 13 patients were categorized as AN.…”

Cholinesterase and other serum liver enzymes in underweight outpatients with eating disorders

“…With regard to liver function, available evidence suggests that abnormalities in serum liver enzymes occur to a various extent, [6][7][8][9][10][11][12][13][14][15][16][17][18][19] and some cases of acute liver failure have also been described, [20][21][22][23] while mild to moderate hypertransaminasemia has been observed during nutritional rehabilitation. 16 However, previous studies on serum liver enzymes in A-NERV still remain to a large extent contradictory and inconsistent because flawed by small sample size, inaccurate diagnosis, incomplete description of results and patient's characteristics, absence of control group, evaluation of only some of liver enzymes commonly considered in the clinical setting. In particular, a small body of evidence is so far available on serum cholinesterase, which is considered a marker of overall hepatocyte function and therefore likely to be influenced by nutritional status.…”

“…In particular, a small body of evidence is so far available on serum cholinesterase, which is considered a marker of overall hepatocyte function and therefore likely to be influenced by nutritional status. 16 Finally, to the best of our knowledge, no consistent data are available on serum liver enzymes in underweight patients with eating disorders not otherwise specified (EDNOS) who could also be at higher risk for malnutrition.…”