Risk factors for elevated liver enzymes during refeeding of severely malnourished patients with eating disorders: a retrospective cohort study

Abstract

BackgroundThere are few previous reports regarding the cause and evolution of liver injury in patients with anorexia nervosa (AN) during the refeeding process, and its management remains controversial. This study aimed to determine the risk factors for elevated liver enzymes during refeeding and their effect on the therapeutic process in severely malnourished patients with eating disorders.MethodsIn a retrospective cohort study of 167 female inpatients in a single hospital from January 2004 to March 2015, 67 who had normal alanine aminotransferase (ALT) levels on admission were divided into two groups according to the presence or absence of elevated ALT levels during refeeding, and then compared.ResultsThe median age and body mass index (BMI) of the patients on admission were 22 [interquartile range (IQR), 16–33] years and 12.2 (IQR, 11.1–13.0) kg/m2, respectively. Compared with their cohorts, significantly more patients in the early onset age group (<15 years old) had elevated ALT levels during refeeding (67% vs. 33%, p = 0.033), as did patients with longer median time to nadir BMI (3.0 vs. 0 days, p = 0.03). In addition, onset age [odds ratio (OR): 0.274; 95% confidence interval (CI): 0.077–0.981; p = 0.047] and time to nadir BMI (OR: 1.271; 95% CI: 1.035–1.56; p = 0.022) were significantly associated with the odds of elevated ALT levels during refeeding.ConclusionsThe results of this study suggest that early age at onset may be a potential risk factor for elevated ALT levels during refeeding in severely malnourished patients with eating disorders. Furthermore, elevated ALT levels during refeeding were significantly associated with delay in the start of weight gain. No significant relationship was found between the amount of initial prescribed calories and elevated ALT levels during refeeding. The median time to maximum ALT was 27 (IQR, 21–38) days after the refeeding process started.Electronic supplementary materialThe online version of this article (doi:10.1186/s40337-016-0127-x) contains supplementary material, which is available to authorized users.

Goal energy intake for medically compromised patients with eating disorders: A systematic review

“…Medical complications should be reported consistently across future studies to assist with interpretation. Along with those complications reported in the studies conducted by Zuercher et al 24 and Matthews et al, 25 other studies also recommend monitoring alanine aminotransferase 40 and prealbumin levels 41 during refeeding. The effects of different refeeding approaches on long‐term outcomes, such as relapse and psychological distress, also remains unclear 29 …”

High Concentration of Serum Aspartate Aminotransferase in Older Underweight People: Results of the Kanagawa Investigation of the Total Check-Up Data from the National Database-2 (KITCHEN-2)

“…Indeed, individuals with mild-to-moderate anorexia nervosa, who are predominantly younger women, were likely to have been enrolled in the study. However, because many studies have shown that both serum AST and ALT activities are high in patients with anorexia nervosa [15,16], it is possible that, in fact, few individuals with anorexia nervosa were enrolled in this study.…”

“…Subjects with a serum AST of ≥200 IU/L, an ALT of ≥200 IU/L, and/or a gamma glutamyl transpeptidase (GGT) of ≥300 IU/L were excluded. Subjects with a BMI of <13 kg/m 2 were also excluded because this is the mean BMI for Japanese inpatients with anorexia nervosa [15,16]. Furthermore, subjects with a BMI of ≥40 kg/m 2 were excluded because this is the threshold for class III obesity, which is very rare in the Japanese population (0.02%–0.07%) [13,17].…”

Acute subdural haematoma accompanied by anorexia nervosa

“…Moreover, physicians must provide complete care considering the refeeding syndrome in severely malnourished patients and restrict the initial calorie intake. 16 Refeeding syndrome is defined as the metabolic alternations that develop due to rapid nutritional repletion in chronically malnourished patients. 15 17 With attentive monitoring via ECG, anthropometry, head CT and blood tests, we were able to avoid fatal medical complications.…”