Indicators of nutritional status in restricting-type anorexia nervosa patients: a 1-year follow-up study (original) (raw)
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“Serum ferritin – a nutritional marker for Anorexia Nervosa?”
Brazilian Journal of Health Review
Introduction: A new marker that correlates with nutritional recovery in Anorexia Nervosa would be of great value. Our study aimed to analyse the influence of Body Mass Index variations on serum ferritin levels in adolescents with Anorexia Nervosa followed up in a specialised consultation. Methods: We conducted a retrospective, observational, single-centre study in adolescents with Anorexia Nervosa evaluated between 2011 and 2019. Serum ferritin values at baseline and during follow-up were analysed, together with the corresponding Body Mass Index (BMI) and Z-Score values. Further analytical data such as hematological and inflammatory markers were recorded. Results: The study included 53 adolescents with Anorexia Nervosa. Patients were found to have higher initial serum ferritin levels compared to the last, under treatment, assessed values (p<0.001). There was a significant increase in BMI and BMI Z-Score during follow-up (p<0.001), reflecting nutritional recovery. Analysing t...
American Journal of Clinical Nutrition, 2012
Background: Only a few studies based on small cohorts have been carried out on iron status in anorexia nervosa (AN) patients. Objective: The aim of this study was to evaluate the role of hepcidin in hyperferritinemia in AN adolescents. Design: Twenty-seven adolescents hospitalized for AN in the pediatric inpatient unit of Ambroise Paré Academic Hospital were enrolled in the study. The control group comprised 11 patients. Hematologic variables and markers of iron status, including serum hepcidin, were measured before and after nutritional rehabilitation. Results: The mean age of patients was 14.4 y. Except for 2 AN patients and 1 control patient, all patients presented normal hemoglobin, vitamin B-12, and folate concentrations. Markers of inflammation and cytokines were normal throughout the study. None of the muscular lysis markers were elevated. Most AN patients had normal serum iron concentrations on admission. Serum ferritin concentrations were significantly higher in patients than in control subjects (198 compared with 49 lg/L, respectively; P , 0.001). The median hepcidin concentration was significantly higher in AN patients than in the control group (186.5 compared with 39.5 lg/L, respectively; P = 0.002). There was a highly significant correlation between ferritinemia and serum hepcidin concentrations (P , 0.0001). After nutritional rehabilitation, a significant reduction was observed (P = 0.004) in serum ferritin. Serum hepcidin analyzed in a smaller number of patients also returned to within the normal range. Conclusions: Hepcidin and ferritin concentrations were higher in the serum of AN patients, without any evidence of iron overload or inflammation. These concentrations returned to normal after nutritional rehabilitation. These results suggest that nutritional stress induced by malnourishment in the hepatocyte could be yet another mechanism that regulates hepcidin.
International Journal of Eating Disorders, 2004
ObjectivesTo study nutritional abnormalities in adolescent anorexia nervosa and to establish whether certain abnormalities persist after short-term refeeding.To study nutritional abnormalities in adolescent anorexia nervosa and to establish whether certain abnormalities persist after short-term refeeding.MethodSixty-one patients (10–19 years old) admitted to a reference unit for eating disorders between 1999 and 2000 with a diagnosis of anorexia nervosa were evaluated at admission and at discharge. A range of biochemical, nutritional, and hormonal parameters were determined.Sixty-one patients (10–19 years old) admitted to a reference unit for eating disorders between 1999 and 2000 with a diagnosis of anorexia nervosa were evaluated at admission and at discharge. A range of biochemical, nutritional, and hormonal parameters were determined.ResultsAt admission, no protein or lipid deficiencies were found, although many patients presented with hormonal abnormalities and red blood cell folate and zinc deficiencies. Hormonal abnormalities reverted significantly (p < .000) after renutrition. There were decreases in erythrocytes and in levels of hemoglobin (p < .000) and folic acid (p < .05). Red blood cell folate and zinc increased but did not reach normal levels.At admission, no protein or lipid deficiencies were found, although many patients presented with hormonal abnormalities and red blood cell folate and zinc deficiencies. Hormonal abnormalities reverted significantly (p < .000) after renutrition. There were decreases in erythrocytes and in levels of hemoglobin (p < .000) and folic acid (p < .05). Red blood cell folate and zinc increased but did not reach normal levels.ConclusionsIn a large proportion of adolescent anorexic patients, supplementation of folic acid and zinc is recommended although protein or hormonal replacement does not seem to be necessary. © 2004 by Wiley Periodicals, Inc. Int J Eat Disord 35: 169–178, 2004.In a large proportion of adolescent anorexic patients, supplementation of folic acid and zinc is recommended although protein or hormonal replacement does not seem to be necessary. © 2004 by Wiley Periodicals, Inc. Int J Eat Disord 35: 169–178, 2004.
Background & aims: Refeeding severely malnourished patients with Anorexia nervosa requires specialized in-patient treatment to reduce medical risks, to avoid refeeding syndrome and other life-threatening situations. Methods: The authors present a retrospective cohort nutritional rehabilitation study of 33 very severe Anorexia nervosa in-patients, aged 22.8 AE 7.6 years (xAESD) and with an initial body mass index 12 kg/ m 2 , treated in a specialized Eating Disorders Unit. Results: Thirty-three female patients were included and treated. Mean BMI increased from 11.3 AE 0.7 Kg/ m 2 , to 13.5 AE 1 Kg/m 2 , and mean body weight from 29.1 AE 3.2 Kg to 34.5 AE 3.3 Kg, after 60 days of intensive in-patient treatments (p < 0.0001). Feeding was carefully instituted; caloric intake levels were established after measuring REE by indirect calorimetry. Nutritional support was initiated with temporary nasogastric feeding in 30 patients, and with oral supplementation in 3 patients. Vitamins, potassium and phosphate supplements were administered during refeeding. All patients achieved a significant increase in body weight, none developed refeeding syndrome as far as laboratory and clinical investigations were concerned. Conclusions: Our findings show that, even in cases of extreme undernutrition, if feeding is performed cautiously and in a specialized unit, it is possible to avoid the refeeding syndrome.
Micronutrients Deficiencies in 374 Severely Malnourished Anorexia Nervosa Inpatients
Nutrients
Introduction: Anorexia nervosa (AN) is a complex psychiatric disorder, which can lead to specific somatic complications. Undernutrition is a major diagnostic criteria of AN and it can be associated with several micronutrients deficiencies. Objectives: This study aimed to determinate the prevalence of micronutrients deficiencies and to compare the differences between the two subtypes of AN (restricting type (AN-R) and binge-eating/purging type (AN-BP)). Methods: We report a large retrospective, monocentric study of patients that were hospitalized in a highly specialized AN inpatient unit between January 2011 and August 2017 for severe malnutrition treatment in the context of anorexia nervosa. Results: Three hundred and seventy-four patients were included, at inclusion, with a mean Body Mass Index (BMI) of 12.5 ± 1.7 kg/m2. Zinc had the highest deficiency prevalence 64.3%, followed by vitamin D (54.2%), copper (37.1%), selenium (20.5%), vitamin B1 (15%), vitamin B12 (4.7%), and vitami...
Zinc Andtryptophan Levels in Anorexianervosa; a Co-Relational Study
2014
Anorexia nervosa (AN) is a condition in which an individual possess low body weight, obsession with having a thin figure, fear of gaining weight and inappropriate eating habit. It is often coupled with a distorted self-image. Irrational fear of gaining weight and immoderate eating habits may cause it. People suffering from anorexia nervosa have low leptin level and high tryptophan levels. Tryptophan and zinc levels have their eminent effect on anorexia nervosa. Tryptophan synthesizes serotonin, in brain neurons and stored in vesicles. Serotonin (5 hydroxy-tryptophan--5-HT) is a neurotransmitter in the brain that has an enormous influence over many brain functions, involving appetite control. Zinc is involved in numerous aspects of cellular metabolism. Zinc daily intake is required to maintain a steady state as no specialized zinc storage system has found in body. Tryptophan and zinc serum levels were determined in 40 subjects out of which 20 were suffering from anorexia nervosa and ...
Antioxidant activity and nutritional status in anorexia nervosa: effects of weight recovery
Nutrients, 2015
Few studies are focused on the antioxidant status and its changes in anorexia nervosa (AN). Based on the hypothesis that renutrition improves that status, the aim was to determine the plasma antioxidant status and the antioxidant enzymes activity at the beginning of a personalized nutritional program (T0) and after recovering normal body mass index (BMI) (T1). The relationship between changes in BMI and biochemical parameters was determined. Nutritional intake, body composition, anthropometric, hematological and biochemical parameters were studied in 25 women with AN (19.20 ± 6.07 years). Plasma antioxidant capacity and antioxidant enzymes activity were measured. Mean time to recover normal weight was 4.1 ± 2.44 months. Energy, macronutrients and micronutrients intake improved. Catalase activity was significantly modified after dietary intake improvement and weight recovery (T0 = 25.04 ± 1.97 vs. T1 = 35.54 ± 2.60μmol/min/mL; p < 0.01). Total antioxidant capacity increased signif...
Biological Trace Element Research, 2008
This study was performed to investigate the serum zinc (Zn), plasma ghrelin, leptin levels and nutritional status, and to evaluate the potential association between malnutrition and these investigated parameters in malnourished hemodialysis (HD) patients. Fifteen malnourished HD patients, aged 42.9±2.11 years, who underwent the HD for 46.44±7.1 months and 15 healthy volunteers, aged 41.0±2.17 years, were included in this study. The nutritional status of the subjects was determined by the subjective global assessment (SGA). Anthropometric measurements were taken by bioelectrical impedance after HD. Blood samples were collected for the analysis of zinc (Zn), ghrelin, leptin, and selected blood parameters. The HD patients consumed less energy and nutrients than controls. In HD patients, body weight, body mass index (BMI) (p<0.001), basal metabolic rate (BMR), body fat, lean body mass (LBM), serum Zn, copper (Cu) (p<0.05), sodium (Na) (p<0.01), glucose (p<0.05), albumin (p<0.01), total cholesterol (p<0.001), and ghrelin (p<0.05) were lower whereas body water ratio (p<0.001), serum potassium (K) (p<0.01), inorganic phosphorous (Pi), blood urea nitrogen, creatinine (p<0.001), and plasma insulin (p<0.05) levels were higher than the controls. No difference existed between HD patients and controls regarding plasma leptin levels. There were positive correlations for body weight-fasting glucose and body weight-leptin (p<0.05), body weight-BMI and body weight-LBM (p<0.01); body fat-leptin (p<0.05); BMI-fasting glucose, BMI-leptin, and BMI-body fat (p<0.05); albumin-hemoglobin and albumin-insulin (p<0.05). Negative correlation was found for SGA score-ghrelin (p<0.05). Malnutrition in HD patients may result from inadequate energy and nutrient intake and low Zn and ghrelin levels. Zinc supplementation to the diets of HD patients may be of value to prevent the malnutrition.
Eating and Weight Disorders-studies on Anorexia Bulimia and Obesity, 2021
Purpose In patients living with Anorexia Nervosa (AN), dehydration and haemoconcentration, may prevent a correct interpretation of laboratory nutritional parameters. Our study aims to evaluate if some indicators of disease severity, as body mass index (BMI), Phase Angle (PhA) and months of amenorrhea may be predictors of metabolic alterations (serum albumin, liver enzymes). Methods In 154 outpatients with AN, case history was collected, and anthropometric and laboratory parameters measured. Patients were divided according to the following tertiles (T) of BMI, duration of amenorrhea and PhA: (1) BMI (T1 < 15.6; T2 15.6-16.8; T3 > 16.8 kg/m 2); (2) Amenorrhea duration (T1 < 7; T2 7-14; T3 > 14 months); (3) PhA value (T1 < 4.64; T2 4.64-5.35; T3: > 5.35°). ROC curves were used to determine which of these three indicators (BMI, PhA and amenorrhea duration) might better identify patients belonging to Group A or B (less than 3 or more metabolic abnormalities). Results The most frequent registered metabolic alterations were for alkaline phosphatase (ALP), alanine aminotransferase, cholesterol and hemoglobin. Aspartate aminotransferase, ALP and gamma glutamyl transferase abnormalities were frequent in the first tertiles of all the three indicators. Albumin was low in the T1 of BMI and PhA. No differences in nutritional alterations emerged according to amenorrhea duration. PhA had the best performance (AUCs: 0.721) in identifying patients with 3 or more abnormalities, with the optimal cutoff value of 4.5°. Conclusions Our data confirmed PhA as the more reliable predictor of metabolic alterations, followed by BMI and amenorrhea duration, especially in the first tertile. Evidence-based medicine Level 2.