Hypertransaminasemia in severely malnourished adult anorexia nervosa patients: Risk factors and evolution under enteral nutrition

Associations of Elevated Liver Enzymes among Hospitalized Adolescents with Anorexia Nervosa

“…The few studies of elevations in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in AN are limited to case reports [4][5][6][7][8][9][10] and studies with small sample sizes, [11][12][13][14][15] with a wide range in the reported prevalence of elevated ALT/AST, from 0% to 76%. 11 In initial studies researchers found that elevated ALT/AST was associated with lower body mass index (BMI) 11,13 and decreased percentage body fat. 13 In univariate analyses of the largest study to date, elevated aminotransferases were associated with increased age, male sex, and the pure restrictive form (vs binge-eating/purging type); however, these associations did not hold in the multivariate analyses.…”

“…In particular, whether the etiology of elevated aminotransferase stems from degree of malnutrition vs refeeding remains a source of debate. Some reports have found resolution of liver enzyme abnormalities with nutritional support and hydration, 10,11 supporting malnutrition as a potential cause. In contrast, in a few reports authors have found elevations in liver tests during the process of refeeding.…”

“…13 In univariate analyses of the largest study to date, elevated aminotransferases were associated with increased age, male sex, and the pure restrictive form (vs binge-eating/purging type); however, these associations did not hold in the multivariate analyses. 11 More recent studies have suggested that elevated aminotransferase in AN may occur secondary to refeeding. 4 The time course, evolution, and physiopathology of elevated aminotransferase during hospitalization for AN remain unclear.…”

“…4,7 In the largest study to date (n = 126), 96% of patients had normalizing aminotransferases by 4 weeks of enteral nutrition, whereas only 4% had worsening with refeeding. 11 Therefore, the objective of this study was to analyze, in a large sample of adolescents with AN hospitalized in a tertiary children's hospital, the prevalence of elevated liver enzymes, predictors of elevated liver enzymes including degree of malnutrition and refeeding, and the evolution of elevated liver enzymes throughout the hospitalization.From the …”

Gastrointestinal Complications of Refeeding in Anorexia Nervosa

“…The possible mechanism of liver damage in AN was studied by Rautou et al [41], who showed an up-regulation of the homeostatic mechanism, in which autophagy and the resultant increased permeability of the hepatocyte plasma membrane, are responsible for the elevated aminotransferase levels when hepatocyte necrosis is not present. The inverse relationship between hypertransaminasemia and BMI is well described [41][42][43][44][45]. Hypertransaminasemia and refeeding steatosis can also occur soon after nutrition therapy has been initiated in AN [46].…”