Nutritional indicators and metabolic alterations in outpatients with anorexia nervosa: a retrospective study (original) (raw)
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Evolution of serum biochemical indicators in anorexia nervosa patients: a 1-year follow-up study
Journal of Human Nutrition and Dietetics, 2007
Background Long-term studies on the evolution of serum biochemical indicators in anorexia nervosa (AN) patients during treatment are lacking in the literature. Thus, a 1-year follow-up of serum biochemical parameters in a homogeneous group of AN patients was performed.Methods Fourteen restricting-type AN patients were studied on admission to hospital, after 1 month of inpatient treatment and after 6 and 12 months after admission.Results Red blood cell count (RBC) and haemoglobin, serum glucose, total protein and the enzyme activities aspartate aminotransferase (AST), alkaline phosphatase (AlP), lactate dehydrogenase (LDH) and creatine kinase (CK) were significantly lower in patients on admission than in the control group. Total protein, high-density lipoprotein cholesterol (HDL-c), AST, AlP and CK showed significant changes among time points (anova, P < 0.05). Significant correlations were found between the change in RBC, haemoglobin, haematocrit, and the change in weight and body mass index (r = 0.74–0.86; P < 0.01). High cholesterol and amylase activity were found at all time points. While AST, LDH and CK reached control values within 6 months of treatment, AlP was always lower.Conclusion Serum AlP, hypercholesterolaemia and RBC seem to need longer periods of treatment with further weight gain to fully normalize. Therefore, these parameters should be monitored in AN patients long-term follow-up.
Metabolites, 2020
Acute anorexia nervosa (AN) constitutes an extreme physiological state. We aimed to detect state related metabolic alterations during inpatient admission and upon short- and long-term weight regain. In addition, we tested the hypothesis that metabolite concentrations adapt to those of healthy controls (HC) after long-term weight regain. Thirty-five female adolescents with AN and 25 female HC were recruited. Based on a targeted approach 187 metabolite concentrations were detected at inpatient admission (T0), after short-term weight recovery (T1; half of target-weight) and close to target weight (T2). Pattern hunter and time course analysis were performed. The highest number of significant differences in metabolite concentrations (N = 32) were observed between HC and T1. According to the detected main pattern, metabolite concentrations at T2 became more similar to those of HC. The course of single metabolite concentrations (e.g., glutamic acid) revealed different metabolic subtypes wi...
Anorexia nervosa and nutritional assessment: contribution of body composition measurements
Nutrition Research Reviews, 2011
The psychiatric condition of patients suffering from anorexia nervosa (AN) is affected by their nutritional status. An optimal assessment of the nutritional status of patients is fundamental in understanding the relationship between malnutrition and the psychological symptoms. The present review evaluates some of the available methods for measuring body composition in patients with AN. We searched literature in Medline using several key terms relevant to the present review in order to identify papers. Only articles in English or French were reviewed. A brief description is provided for each body composition technique, with its applicability in AN as well as its limitation. All methods of measuring body composition are not yet validated and/or feasible in patients with AN. The present review article proposes a practical approach for selecting the most appropriate methods depending on the setting, (i.e. clinical v. research) and the goal of the assessment (initial v. follow-up) in order to have a more personalised treatment for patients suffering from AN.
Metabolic abnormalities in adolescent patients with anorexia nervosa
1985
The intake laboratory data of 46 patients seen between 1970 and 1980 who were < 19 years of age with a discharge diagnosis of anorexia nervosa were retrospectively reviewed to determine their metabolic profile. The major findings for those who had laboratory data were as follows: 45% (19/42) had serum glutamic oxalacetic transaminase (SGOT) values > 36 International Units/liter (IU/L), and 65% (27/41) had alkaline phosphatase levels < 58 IU/L. We suggest that patients with anorexia nervosa may reflect a state of hepatic dysfunction and/or dehydration before therapy.
Comparison of nutritional risk screening tools for predictingsarcopenia in hospitalized patients
Turkish Journal of Medical Sciences, 2017
Background/aim: The aim of this study was to assess the risk of malnutrition in hospitalized patients with three different tests and to compare these tests in terms of long hospitalization periods and sarcopenia. Materials and methods: Hospitalized patients in an internal medicine clinic were enrolled in this cross-sectional study. Patients were grouped as under 65 years (Group 1 = G1) and over 65 years old (Group 2 = G2). The nutritional status of the patients was evaluated with the Nutritional Risk Screening (NRS) 2002, Universal Malnutrition Screening Tool (MUST), Mini Nutritional Assessment Short Form (MNA-SF), and total Mini Nutritional Assessment (MNA) tests. Diagnosis of sarcopenia was assessed via bioimpedance analysis for muscle mass, a hand-grip strength test, and a "timed get up and go" test. Nutritional tests were compared in terms of sarcopenia and long hospitalization periods with receiver operating characteristic curve analysis. Results: Mean ages were 54 (G1, n = 84) and 76 (G2, n = 112) years old. Sarcopenia was found in 5% in G1 and 33% in G2. The MNA-SF in G1 (area under curve (AUC) = 0.585, P = 0.26; sensitivity 41%, specificity 44%) and the MUST in G2 (AUC = 0.614, P = 0.048; 25%, 86%) were better predictors of prolonged hospitalization. The MNA-SF was associated with sarcopenia in both groups (G1: AUC = 0.716, P = 0.147; 63%, 64% and G2: AUC = 0.762, P < 0.001; 86%, 48%). In addition, the MNA-SF was a better predictor of low lean muscle mass index (AUC = 0.762, P < 0.001; 86%, 48%), low grip strength (AUC = 0.594, P = 0.27; 65%, 50%), and reduced walking speed (AUC = 0.642, P = 0.01; 71%, 47%) in G2. Conclusion: None of the three tests are highly sensitive or specific for predicting sarcopenia. The MNA-SF is a better test to evaluate sarcopenia and/or related parameters than the others, and the MUST is related to prolonged hospitalization in older patients.
Clinical Nutrition, 2013
Background & aims: Aminotransferase abnormalities have been reported in malnourished patients with anorexia nervosa (AN). The aim of this study was to identify prevalence and risk factors of hyperaminotransferasemia in an adult cohort of AN patients and to describe evolution during nutritional rehabilitation with enteral nutrition for a period of 4 weeks. Methods: Retrospective study of all consecutive malnourished (BMI <16) AN adult patients, without previous liver diseases or hepatotoxic drugs or alcohol consumption, hospitalized for enteral nutrition in a single center between 1998 and 2008. Hypertransaminasemia was defined by an increase in AST and (or) ALT >2N. Results: In all, 126 AN patients (117 W, 9 M), age 30 AE 10.8 years, were included. At admission, 54 (43%) patients presented hypertransaminasemia. In univariate analysis, risk factors for hypertransaminasemia were: lower BMI (11.2 AE 2 vs. 13 AE 2, p < 0.0001) and age (28 AE 9 vs. 32 AE 12, p < 0.05), male sex (p < 0.05) and the pure restrictive form (p ¼ 0.07). In multivariate analysis only BMI, at a threshold of 12, remained significant [OR 3.7, CI: 95% 2.24e5.2]. Normalization of aminotransferases at the end of week 4 of enteral nutrition was obtained in 96%. Only 2/54 patients (4%) presented a worsening of aminotransferases during the refeeding period, including one that died of liver failure. None of the patients without hypertransaminasemia admission presented a subsequent elevation. At the end of the 4-week refeeding period, the increase in BMI was greater in patients without hypertransaminasemia than in those with it (2.0 AE 0.8 vs. 1.5 AE 1.0, p < 0.0001). Conclusion: Elevated transaminases is common in severe malnourished AN patients. Four risk factors were identified: young age, low BMI (the only independent factor in multivariate analysis), the pure restrictive form of the disease and male sex. After 4 weeks of enteral nutrition the evolution is in most cases favourable, albeit with a lower increase in BMI, but can be severe. The long-term evolution remains to be determined.
Journal of Eating Disorders, 2017
Background: The objective of the study was to determine whether levels of biochemical and haematological parameters in patients with eating disorders (EDs) varied from the general population. Whilst dietary restrictions can lead to nutritional deficiencies, specific abnormalities may be relevant to the diagnosis, pathogenesis and treatment of EDs. Methods: With ethics approval and informed consent, a retrospective chart audit was conducted of 113 patients with EDs at a general practice in Brisbane, Australia. This was analysed first as a total group (TG) and then in 4 ED subgroups: Anorexia nervosa (AN), Bulimia nervosa (BN), ED Not Otherwise Specified (EDNOS), and AN/BN. Eighteen parameters were assessed at or near first presentation: cholesterol, folate, vitamin B12, magnesium, manganese, zinc, calcium, potassium, urate, sodium, albumin, phosphate, ferritin, vitamin D, white cell count, neutrophils, red cell count and platelets. Results were analysed using IBM SPSS 21 and Microsoft Excel 2013 by two-tailed, one-sample t-tests (TG and 4 subgroups) and chi-square tests (TG only) and compared to the population mean standards. Results for the TG and each subgroup individually were then compared with the known reference interval (RI). Results: For the total sample, t-tests showed significant differences for all parameters (p < 0.05) except cholesterol. Most parameters gave results below population levels, but folate, phosphate, albumin, calcium and vitamin B12 were above. More patients than expected were below the RI for most parameters in the TG and subgroups. Conclusions: At diagnosis, in patients with EDs, there are often significant differences in multiple haematological and biochemical parameters. Early identification of these abnormalities may provide additional avenues of ED treatment through supplementation and dietary guidance, and may be used to reinforce negative impacts on health caused by the ED to the patient, their family and their treatment team (general practitioner, dietitian and mental health professionals). Study data would support routine measurement of a full blood count and electrolytes, phosphate, magnesium, liver function tests, ferritin, vitamin B12, red cell folate, vitamin D, manganese and zinc for all patients at first presentation with an ED.
The prediction of basal metabolic rate in female patients with anorexia nervosa
International journal of obesity and related metabolic disorders : journal of the International Association for the Study of Obesity, 2001
To evaluate in female patients with anorexia nervosa the accuracy of a specific predictive formula for basal metabolic rate (BMR) already proposed in the literature and to derive a new disease-specific equation with the same purpose. Cross-sectional study. One-hundred and twenty adolescent girls (<18 y) and young-adult women (18-30 y) with anorexia nervosa. BMR was determined by indirect calorimetry or predicted according to the Schebendach formula, which was specifically derived for anorexia nervosa. On average the Schebendach formula performed well in the adolescent group but not in the young-adult group. The range including 95% of the predicted-measured differences was in both cases wider than 2000 kJ/day. In the young-adult patients the accuracy of the prediction was also related to age and body mass index. Weight and age (but not height or body mass index) emerged as predictors of BMR in the sample as a whole, and only weight when the two age groups were considered separatel...
Basal metabolic rate in anorexia nervosa: relation to body composition and leptin concentrations
2000
Background: Leptin is thought to represent a peripheral signal involved in the regulation of energy balance. Its action has been studied in animals and obese subjects. Little is known about leptin's role during negative energy balance. Objective: The objective was to evaluate the relation between energy turnover, body composition, and plasma leptin concentrations in anorexia nervosa (AN). Design: Sixteen weight-stable women with AN were compared with 22 control subjects and 14 rehabilitated AN patients (R-AN). Basal metabolic rate (BMR) was measured by indirect calorimetry; fat-free mass (FFM) and fat mass (FM) were calculated according to a 4-compartment model. Plasma leptin was determined by radioimmunoassay. Results: The BMR of AN patients (2.73 ± 0.37 kJ/min) was significantly lower than that of control subjects (3.45 ± 0.34 kJ/min) (P < 0.001), even after adjustment for FFM (2.92 ± 0.33 kJ/min in AN patients and 3.30 ± 0.26 kJ/min in control subjects; P < 0.004). Plasma leptin concentrations in AN patients were 76% lower than in control subjects, even after body fat was controlled for. In RAN patients, BMR was not significantly different from that of control subjects and leptin concentrations were generally close to normal. Plasma leptin concentrations correlated significantly with FM (r 2 = 0.53, P < 0.0000) and BMR, even after adjustment for FFM (r 2 = 0.21, P < 0.0003). Conclusions: BMR and plasma leptin concentrations are depressed in patients with AN; this is not explained by bodycomposition changes. The relation between leptin and BMR suggests that leptin plays a role in the energy sparing response to exposure to chronic energy deficiency. The return of BMR to normal and the significant increase in leptin concentrations in RAN patients suggests a full reversibility of this adaptation mechanism.