Risk of infection and immune function in anorexia nervosa

Abstract

The eating disorder, anorexia nervosa, like other forms of starvation, has been associated with an increased risk and severity of infectious diseases. However, there is conflicting evidence about the true risk of infection in anorectic patients. Indeed, some anorectics appear to be less susceptible to minor viral illnesses, possibly analagous to the attenuation of viral infections observed in protein‐starved mice. Leukopenia and neutrophil dysfunction, including abnormal chemotaxis and depressed microbicidal activity, have been well documented in some anorectic patients. Abnormalities of the complement system and impaired immunoglobulin synthesis have also been reported. Patients with severe anorexia nervosa are often anergic to skin testing but other abnormalities in cell‐mediated immune function have been difficult to document. Increased spontaneous tumor necrosis factor (TNF) production by peripheral blood mononuclear cells and lower cell‐mediated cytotoxicity have been reported in patients with anorexia nervosa. Further studies are needed to define the true risk of infection in anorexia nervosa and to clarify the types and extent of immune system abnormalities in this patient population.

T-lymphocyte subsets in patients with abnormal body weight: Longitudinal studies in anorexia nervosa and obesity

“…Our findings are consistent with previous studies of anorectics which reported that many aspects of immunity are well preserved and may even be enhanced in anorexia nervosa patients (Bentdal et al, 1991;Brambilla et al, 1993;Golla et al, 1981;Pertschuk, Crosby, Barot, & Mullen, 1982). However, some laboratory parameters of cellmediated immunity, especially anergy to delayed-type hypersensitivity skin testing, have also been reported (Pomeroy, Mitchell, & Eckert, 1992). Enhancement of cell-mediated immunity has also been reported in obese patients on a VLCD (McMurray et al, 1990).…”

Effect of body weight and caloric restriction on serum complement proteins, including Factor D/adipsin: studies in anorexia nervosa and obesity

“…These findings would suggest that body weight itself plays a role in determining levels of alternative pathway complement components. Interestingly, the low complement values observed in starving anorectics did not predispose these extremely low-weight patients to infection [25]. Although complement levels of anorectics were significantly decreased, the levels were apparently not low enough to increase infection risk, i.e.…”

Cytokine production in patients with anorexia nervosa, bulimia nervosa, and obesity

“…In contrast, patients with AN have been observed to be relatively protected from infection (Pomeroy, Mitchell, & Eckert, 1992;Bowers & Eckert, 1978). This is the case even though many abnormalities in the function of the immune system have been found in AN subjects including leukopenia (Kay & Stricker, 1983), low CD4+ counts (Pirke, Nerl, & Fichter, 1992), low CD8+ counts (Fink, Eckert, Mitchell, Crosby, & Pomeroy, 1996), and abnormal levels of many of the cytokines (Pomeroy et al, 1994;Polack et al, 1993;Schattner, Tepper, Steinbock, Hahn, & Schoenfeld, 1990;Bessler et al, 1993;Vaisman & Hahn, 1991).…”