1
|
Brennan C, Cini E, Illingworth S, Chapman S, Simic M, Nicholls D, Chapman V, Simms C, Hayes E, Fuller S, Orpwood J, Tweedy N, Baksh T, Astaire E, Bhakta D, Saglio E, Stevenson A, Buchbinder M. A prospective observational study comparing rates of medical instability between adolescents with typical and atypical anorexia nervosa. J Hum Nutr Diet 2024; 37:1100-1108. [PMID: 38923043 DOI: 10.1111/jhn.13328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/15/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Recognition of atypical anorexia nervosa (AAN) has challenged underweight as a defining factor of illness severity in anorexia nervosa (AN). The present study aimed to compare rates of medical instability in adolescents with underweight (AN) and non-underweight (AAN) anorexia nervosa. METHODS The study examined assessment data from specialist eating disorder services in the UK between January and December 2022. Participants (n = 205) aged 11-18 years were recruited across eight eating disorder clinics and diagnosed with AN (n = 113) or AAN (n = 92) after clinical assessment. Parameters associated with risk of medical instability were compared between AN and AAN groups, using t tests and regression analysis. RESULTS Rates of bradycardia and hypotension did not differ significantly between AN and AAN groups (p = 0.239 and p = 0.289). Although white blood cell counts were lower in the AN group, rates of leukopaenia could not be statistically compared as a result of there being too few counts in at least one group. No incidences of hypophosphataemia were found in the sample. A significant regression equation was found for percentage median body mass index, but not rate of weight loss, as a predictor of blood pressure, serum phosphorous and magnesium. CONCLUSIONS Our findings indicate that medical instability occurs across a range of body weights in young people with AN and AAN. Although certain parameters of risk such as blood pressure, serum phosphorous and magnesium may be worsened at lower weight, both AN and AAN are serious mental health conditions that can lead to medical instability.
Collapse
Affiliation(s)
- Cliona Brennan
- South London and Maudsley NHS Trust, London Metropolitan University, London, UK
| | - Erica Cini
- East London NHS Foundation Trust, Kings College London, University College London, London, UK
| | | | - Simon Chapman
- South London and Maudsley NHS Trust, Kings College Hospital London, London, UK
| | - Mima Simic
- South London and Maudsley NHS Trust, London, UK
| | - Dasha Nicholls
- Central North West London NHS Trust, Imperial College London, London, UK
| | | | | | | | | | | | | | | | | | - Dee Bhakta
- London Metropolitan University, London, UK
| | | | | | | |
Collapse
|
2
|
Lin JA, Matthews A, Adhikari R, Freizinger M, Richmond TK, Jhe G. Associations between presenting weight and premorbid weight and the medical sequelae in hospitalized youth with anorexia nervosa or atypical anorexia nervosa. J Pediatr Nurs 2024; 77:125-130. [PMID: 38518688 DOI: 10.1016/j.pedn.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 03/24/2024]
Abstract
PURPOSE To identify unique treatment considerations for youth with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) and premorbid overweight or obesity, we examined unique relationships between premorbid and presenting weight status and medical sequelae in youth with AN/AAN requiring medical hospitalization. DESIGN AND METHODS We performed a retrospective study of 150 youth aged mean [SD] of 14.1[2.3] years, hospitalized for AN/AAN. Independent t-tests and Fischer's exact tests assessed differences in demographic and clinical characteristics by premorbid weight status. Logistic regressions assessed associations between premorbid and presenting weight status and vital sign or laboratory abnormalities. RESULTS Compared to youth with premorbid 'normal' weights, youth with premorbid overweight/obesity demonstrated greater percent (p = .042) and faster rate (p < .001) of weight loss and had 10.9 times the odds of having anemia (p = .025). Youth with AN (<5th percentile for body mass index [BMI]) were more likely to experience hypoglycemia (p < .018) than youth with AAN (≥5th percentile BMI). Greater percent of weight loss significantly predicted bradycardia (p < .001) and hypoglycemia (p = .002), independent of premorbid or presenting weight status. CONCLUSION Acute medical management of AN/AAN should be commensurate for hospitalized patients, regardless of premorbid weight status. However, those with more significant weight loss and those presenting as underweight may warrant particular monitoring for complications such as bradycardia and hypoglycemia. PRACTICE IMPLICATIONS In youth with AN/AAN, high percent of weight loss warrants closer monitoring for medical complications during hospitalization. Those with premorbid overweight/obesity may need additional monitoring for anemia, as there may be additional contributors to anemia aside from malnutrition.
Collapse
Affiliation(s)
- Jessica A Lin
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA.
| | - Abigail Matthews
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Richa Adhikari
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Melissa Freizinger
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Tracy K Richmond
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Grace Jhe
- Department of Psychiatry, Boston Children's Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
3
|
Mashimoto M, Higuchi F, Okazaki S, Hoshii Y, Nakagawa S. Decreased Volume of Bone Marrow Adipocytes With Sparse Gelatinous Marrow Transformation in a Patient With Pancytopenia With Anorexia Nervosa: A Case Report. Cureus 2024; 16:e58390. [PMID: 38756270 PMCID: PMC11097236 DOI: 10.7759/cureus.58390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Patients with anorexia nervosa (AN) often have complications of hematologic abnormalities and pancytopenia, which can be fatal. In patients with AN, the rates of anemia, leukopenia, and thrombocytopenia have been reported as 16.7-39%, 7.9-39%, and 5-11%, respectively; in patients with severe AN, the rates of anemia, leukopenia, thrombocytopenia, and pancytopenia have been reported as 47-83%, 49.5-79%, 16.8-25%, and 16.4-23%, respectively. Hematologic abnormalities are often associated with morphological myeloid transformations such as hypoplasia, aplasia, and gelatinous marrow transformation (GMT). Hypocellularity, such as hypoplastic or aplastic, often results in a dry tap, whereas GMT does not usually result in this because of the aspiration of gelatinous material. Therefore, bone marrow aspiration in patients with pancytopenia with AN usually does not show a dry tap. The bone marrow adipocyte (BMA) volume increases in patients with AN, except in those with severe malnutrition. Patients with AN experiencing pancytopenia often exhibit GMT associated with atrophy of the originally increased volume of BMAs. Herein, we report the case of a patient with pancytopenia with AN who exhibited a dry tap on bone marrow aspiration. A bone marrow biopsy revealed sparse GMT with decreased BMA volume and areas of hematopoietic cells, adipocytes, and no GMT. A 13-year-old Japanese girl weighing 25.8 kg (BMI: 10.0 kg/m2) was admitted to our hospital and received nutritional therapy. The patient presented with pancytopenia and fever, prompting the conduct of bone marrow examinations. Bone marrow aspiration resulted in a dry tap, and the bone marrow biopsy revealed sparse GMT with a decreased volume of BMAs. Additionally, an area devoid of hematopoietic cells, adipocytes, or GMT was observed. Nutritional therapy resulted in weight gain and improved pancytopenia. Upon discharge, the patient weighed 40.0 kg (BMI: 15.5 kg/m2) with a normal WBC count, hemoglobin levels, and platelet count. It is significant to study hematological and bone marrow changes because patients with AN often present with hematologic abnormalities. The identification of sparse GMT, which is associated with a decrease in BMA volume and the presence of an area devoid of hematopoietic cells, adipocytes, or GMTs, is a novel finding. The improvement in pancytopenia following nutritional therapy suggests a link between myeloid transformation and malnutrition. Consequently, in patients with pancytopenia associated with AN exhibiting these bone marrow findings, nutritional therapy is necessary.
Collapse
Affiliation(s)
- Masaya Mashimoto
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, JPN
| | - Fumihiro Higuchi
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, JPN
| | - Sakie Okazaki
- Department of Pediatrics, Yamaguchi University Graduate School of Medicine, Ube, JPN
| | - Yoshinobu Hoshii
- Department of Diagnostic Pathology, Yamaguchi University Hospital, Ube, JPN
| | - Shin Nakagawa
- Division of Neuropsychiatry, Department of Neuroscience, Yamaguchi University Graduate School of Medicine, Ube, JPN
| |
Collapse
|
4
|
Gibson D, Stein A, Khatri V, Wesselink D, Sitko S, Mehler PS. Associations between low body weight, weight loss, and medical instability in adults with eating disorders. Int J Eat Disord 2024; 57:869-878. [PMID: 38183342 DOI: 10.1002/eat.24129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/19/2023] [Accepted: 12/19/2023] [Indexed: 01/08/2024]
Abstract
OBJECTIVE The physical complications of atypical anorexia nervosa remain understudied, with most studies completed in adolescents. This study seeks to examine the impact of various weight measures as predictors of medical instability in a large cohort of adult eating disorder patients. METHODS In this retrospective cohort study, the impact of admission body mass index (BMI), weight suppression, and recent weight loss (the rate of weight loss within the last 12 months) toward the development of medical complications of malnutrition were examined. Multivariable logistic regression assessed the association of binary clinical outcomes of interest with recent weight loss and weight suppression (adjusting for age, admission BMI, gender, and purging behaviors). Odds ratios (OR) and 99% confidence intervals were reported. RESULTS Greater recent weight loss increased the odds of developing low prealbumin and reduced hand grip strength. A greater weight suppression was associated with increased likelihood of amenorrhea, reduced systolic blood pressure, nadir hemoglobin, and weekly weight gain upon nutritional rehabilitation. Lower admission BMI was predictive of all the medical outcomes examined, with the exception of bradycardia, and was generally the strongest predictor based on standardized coefficients. DISCUSSION Recent weight loss and weight suppression are predictive of some of the physiologic changes of malnutrition, although low BMI is seemingly the greatest predictor for the development of these complications. These findings suggest that some patients with aggressive weight suppression and/or acute weight loss would benefit from medical stabilization, although this needs to be further defined. PUBLIC SIGNIFICANCE In adults, low BMI seems to be a better predictor of medical complications than weight suppression or aggressive recent weight loss. In adults, greater weight suppression is associated with increased likelihood of amenorrhea, reduced systolic blood pressure, nadir hemoglobin, and weight gain upon nutritional rehabilitation.
Collapse
Affiliation(s)
- Dennis Gibson
- ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Amy Stein
- Center for Health Systems Research, Denver Health and Hospitals, Denver, Colorado, USA
| | - Vishnupriya Khatri
- ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Delaney Wesselink
- ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, Denver, Colorado, USA
| | - Shelby Sitko
- ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, Denver, Colorado, USA
| | - Philip S Mehler
- ACUTE Center for Eating Disorders and Severe Malnutrition at Denver Health, Denver, Colorado, USA
- Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Eating Recovery Center, Denver, Colorado, USA
| |
Collapse
|
5
|
Perry TR, Cai K, Freestone D, Steinberg DM, Bohon C, Menzel JE, Baker JH. Early weight gain as a predictor of weight restoration in avoidant/restrictive food intake disorder. J Eat Disord 2024; 12:27. [PMID: 38360833 PMCID: PMC10870495 DOI: 10.1186/s40337-024-00977-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/21/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Previous research has demonstrated that early weight gain in family-based treatment (FBT) is predictive of remission for adolescents with anorexia nervosa (AN). However, no published data has addressed if early weight gain is also predictive of reaching weight restoration (i.e., 95% EBW) in patients with avoidant/restrictive food intake disorder (ARFID). Furthermore, no studies have evaluated the performance of the statistical models used to predict weight restoration at the end of treatment. This study sought to examine whether early weight gain in ARFID is predictive of weight restoration at 20 weeks using ROC analysis. Additionally, this study assessed how accurately the model classified patients and what types of misclassifications occurred. METHODS Participants (n = 130, 57.7% cisgender female 70.0% white) received virtual outpatient FBT. Receiver operating characteristics (ROC) were used to predict successful weight restoration at end of treatment, using early weight gain as the predictor. Twenty weeks was considered as the end of treatment, to align with the definition of end of treatment in FBT clinical trials. ROC analyses demonstrated that gaining at least 6.2 pounds by week 5 of treatment was the strongest predictor of achieving 95% EBW at 20 weeks (AUC = 0.72 [0.63, 0.81]). ROC analyses misclassified 35% of patients; the most common misclassification was predicting that a patient would not achieve 95% EBW when they actually did (61.6%). A logistical regression model, which included the patients' %EBW at admission in addition to early weight gain as a predictor, outperformed the ROC analyses (AUC = 0.90 [0.85, 0.95]) and provided additional context by showing the probability that a patient would succeed. CONCLUSION Taken together, research demonstrates that early weight gain is a useful predictor of 95% EBW at 20 weeks of treatment for patients with ARFID who require weight restoration. Furthermore, results suggest that statistical models need to take into account additional information, such as %EBW at admission, along with early weight gain in order to more accurately predict which patients will reach weight restoration at week 20.
Collapse
Affiliation(s)
- Taylor R Perry
- Equip Health, Inc, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA.
- State University of New York at Albany, Albany, NY, USA.
| | - Kelly Cai
- Equip Health, Inc, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
| | - David Freestone
- Equip Health, Inc, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
| | - Dori M Steinberg
- Equip Health, Inc, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
- Duke University, Durham, NC, USA
| | - Cara Bohon
- Equip Health, Inc, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
- Stanford University, Stanford, CA, USA
| | - Jessie E Menzel
- Equip Health, Inc, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
| | - Jessica H Baker
- Equip Health, Inc, 2659 State Street Suite 100 #1012, Carlsbad, CA, 92008, USA
| |
Collapse
|
6
|
Bottoni-Tito E, Messa-Aguilar W. Haematological adverse effects associated with olanzapine in adolescents with anorexia nervosa: Three case reports. REVISTA COLOMBIANA DE PSIQUIATRIA (ENGLISH ED.) 2024; 53:107-111. [PMID: 38653660 DOI: 10.1016/j.rcpeng.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 10/18/2021] [Indexed: 04/25/2024]
Abstract
OBJECTIVES To describe haematological adverse effects in adolescents with anorexia nervosa who are taking olanzapine. METHODS Case series report. CASE REPORT The reported cases (two female patients and one male) were found to have blood test abnormalities after starting olanzapine and to rapidly recover their platelet and neutrophil values after the drug was discontinued. Low haemoglobin values persisted longer than observed in other series. These abnormalities became more noticeable when the dose of olanzapine was increased to 5 mg/day (initial dose 2.5 mg/day). It should be noted that two of the patients already had values indicative of mild neutropenia before they started the antipsychotic drug, and that these worsened as they continued taking the drug. In one of the patients there was only a decrease in neutrophil values, as well as mild anaemia. CONCLUSIONS This first case series of haematological abnormalities in adolescents with anorexia nervosa who are taking olanzapine found values corresponding to pancytopenia in two of the three cases reported. It would be worthwhile to consider heightening haematological surveillance in this population when starting treatment with olanzapine and rethinking our knowledge regarding the frequency of these side effects.
Collapse
Affiliation(s)
- Elard Bottoni-Tito
- Departamento de Salud Mental, Unidad de Psiquiatría Infanto Juvenil, Hospital Nacional Edgardo Rebagliati Martins, Essalud, Lima, Peru
| | - Wendy Messa-Aguilar
- Departamento de Salud Mental, Unidad de Psiquiatría Infanto Juvenil, Hospital Nacional Edgardo Rebagliati Martins, Essalud, Lima, Peru.
| |
Collapse
|
7
|
Chen L, Liu Z, Zheng Y. Acute liver failure and aplastic crisis due to anorexia nervosa in an adolescent girl: a case report. J Int Med Res 2023; 51:3000605231214922. [PMID: 38017360 PMCID: PMC10686022 DOI: 10.1177/03000605231214922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 10/17/2023] [Indexed: 11/30/2023] Open
Abstract
Anorexia nervosa (AN) has a high mortality rate due to the widespread organ dysfunction caused by the underlying severe malnutrition. Malnutrition-induced hepatitis is common among individuals with AN especially as body mass index decreases, while acute liver failure and aplastic crisis related to coagulation disease and encephalopathy rarely occur in AN patients. The supervised increase of caloric intake can quickly improve the elevated aminotransferases caused by starvation and aplastic crisis. This current case report describes a 12-year-old adolescent girl who was admitted with a 3-month history of weight loss. Within 3 months, she had lost 10 kg of weight. The girl was diagnosed with AN, acute liver failure, severe malnutrition with emaciation, electrolyte disorder, bradycardia and aplastic crisis. She was gradually supplemented with vitamins and enteral nutrition to avoid refeeding syndrome. After treatment, her liver function and haematopoietic function returned to normal. In conclusion, acute liver failure and aplastic crisis are rare but potentially life-threatening complications of AN, which could be improved by supervised feeding and timely rehydration. AN should be considered as the potential aetiology of acute liver failure and aplastic crisis.
Collapse
Affiliation(s)
- Leilei Chen
- Department of Paediatrics, Yancheng No.1 People’s Hospital, Affiliated Hospital of Medical School, Nanjing University, Yancheng, Jiangsu Province, China
| | - Zhifeng Liu
- Department of Gastroenterology, Nanjing Children’s Hospital, Clinical Teaching Hospital of Medical School, Nanjing University, Nanjing, Jiangsu Province, China
| | - Yucan Zheng
- Department of Gastroenterology, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China
| |
Collapse
|
8
|
Thrombocytopenia and PT-INR in patients with anorexia nervosa and severe liver dysfunction. Biopsychosoc Med 2023; 17:9. [PMID: 36890598 PMCID: PMC9996900 DOI: 10.1186/s13030-023-00269-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/28/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND We previously reported a case that led us to hypothesize that decreased production of thrombopoietin (TPO) leads to thrombocytopenia in patients with anorexia nervosa (AN) with severe liver dysfunction and that prolonged prothrombin time-international normalized ratio (PT-INR) predicts thrombocytopenia in such cases. To validate this hypothesis, we report another case in which TPO levels were measured. In addition, we examined the association between prolonged PT-INR and thrombocytopenia in such patients. MAIN BODY Similar to the previously reported patient, a patient with AN with severe liver dysfunction showed that TPO levels increased after improvements in liver enzyme levels and PT-INR, followed by recovery of platelet count. In addition, a retrospective study was also conducted to review patients with AN whose liver enzyme levels were > 3 × the upper limit of normal (aspartate aminotransferase > 120 U/L or alanine aminotransferase > 135 U/L). The study included 58 patients and showed a correlation coefficient of -0.486 (95% confidence interval [CI], -0.661 to -0.260; P < 0.001) between maximum PT-INR and minimum platelet count. These patients showed higher PT-INR (β, 0.07; 95% CI, 0.02 to 0.13; P = 0.005) and lower platelet count (β, -5.49; 95% CI, -7.47 to -3.52; P < 0.001) than the 58 matched control patients without severe liver dysfunction, even after adjusting for body mass index. CONCLUSIONS In patients with AN with severe liver dysfunction, prolongation of PT-INR could predict thrombocytopenia, which may be mediated by decreased TPO production due to decreased hepatic synthetic function.
Collapse
|
9
|
Loisel A, Caunes A, Birsen R, Moro MR, Boussaid I, Blanchet C. When refeeding is not enough: severe and prolonged pancytopenia in an adolescent with anorexia nervosa. Eat Weight Disord 2022; 27:3797-3801. [PMID: 36131194 PMCID: PMC9492456 DOI: 10.1007/s40519-022-01478-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/11/2022] [Indexed: 01/04/2023] Open
Abstract
A 15-year-old female patient with anorexia nervosa presented an unusually prolonged and severe episode of pancytopenia with severe thrombopenia and severe leucopenia. Despite effective refeeding, active specialized interventions were necessary. Upon admission, the patient presented with severe and symptomatic thrombopenia, severe neutropenia and gelatinous marrow transformation. In addition to refeeding, active interventions such as platelet transfusion and granulocyte-colony stimulating factor were successful to manage the patient's complications. The etiological search for pancytopenia was negative. The patient's prolonged starvation was probably a key factor. Medical history, clinical presentation, evolution, and biological data including bone marrow aspiration results are presented. Management of cytopenia and of their complications in a context of severe starvation is discussed in regard of existing literature. A simple monitoring attitude may prove insufficient in cases of severe pancytopenia in anorexia nervosa.Level of evidence V, descriptive study.
Collapse
Affiliation(s)
- Alexandra Loisel
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Maison de Solenn-Maison des Adolescents, 75014, Paris, France
- Inserm U1018, Team DevPsy, CESP, Paris Saclay University, Paris, France
- PCPP, Paris Cité University, 92100, Boulogne-Billancourt, France
| | - Alexandra Caunes
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Maison de Solenn-Maison des Adolescents, 75014, Paris, France
| | - Rudy Birsen
- Assistance Publique-Hôpitaux de Paris Centre, Hôpital Cochin, Service d'hématologie clinique, 75014, Paris, France
- CNRS UMR 8104, Inserm UMR 1016, Université de Paris, Institut Cochin, Paris, France
| | - Marie Rose Moro
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Maison de Solenn-Maison des Adolescents, 75014, Paris, France
- Inserm U1018, Team DevPsy, CESP, Paris Saclay University, Paris, France
- PCPP, Paris Cité University, 92100, Boulogne-Billancourt, France
| | - Ismaël Boussaid
- CNRS UMR 8104, Inserm UMR 1016, Université de Paris, Institut Cochin, Paris, France
- Service d'hématologie biologique, Assistance Publique-Hôpitaux de Paris Centre, Hôpital Cochin, 75014, Paris, France
| | - Corinne Blanchet
- Assistance Publique-Hôpitaux de Paris, Hôpital Cochin, Maison de Solenn-Maison des Adolescents, 75014, Paris, France.
- Inserm U1018, Team DevPsy, CESP, Paris Saclay University, Paris, France.
- PCPP, Paris Cité University, 92100, Boulogne-Billancourt, France.
| |
Collapse
|
10
|
Freizinger M, Recto M, Jhe G, Lin J. Atypical Anorexia in Youth: Cautiously Bridging the Treatment Gap. CHILDREN 2022; 9:children9060837. [PMID: 35740774 PMCID: PMC9221982 DOI: 10.3390/children9060837] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/31/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022]
Abstract
Atypical anorexia nervosa (AAN) is a restrictive eating disorder (ED) that describes individuals who may be normal weighted or overweight; many have a premorbid history of obesity. Pediatric care providers are trained to identify and provide best practices for youth with pediatric obesity; however, most pediatric care providers are not trained to assess and treat restrictive EDs which typically present in youth aged 10 and 14 years. Although individuals with AAN may appear to be within a ‘healthy weight’, many experience malnutrition, psychological symptoms, and severe physiological complications after weight loss. These individuals are presenting to pediatric services at an increasing rate and exhibit acute medical instability along with severe ED psychopathology. One complicating factor is youth with AAN may take longer to be identified by pediatric providers and may be reluctant to engage in treatment. Delayed treatment for AAN, along with all EDs often results in poorer treatment outcomes. A greater understanding of this complex illness is essential to inform medical decisions, such as labs, vitals, hospital admissions, and psychological therapy. Currently, there are no standardized guidelines for treating AAN in youths. This review is designed to present evidence-based treatment to inform and guide best treatment practices.
Collapse
Affiliation(s)
- Melissa Freizinger
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (G.J.); (J.L.)
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Correspondence:
| | - Michelle Recto
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA
| | - Grace Jhe
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (G.J.); (J.L.)
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Jessica Lin
- Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, MA 02115, USA; (G.J.); (J.L.)
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH 45229, USA;
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH 45229, USA
| |
Collapse
|
11
|
Funayama M, Koreki A, Mimura Y, Takata T, Ogino S, Kurose S, Shimizu Y, Kudo S. Restrictive type and infectious complications might predict nadir hematological values among individuals with anorexia nervosa during the refeeding period: a retrospective study. J Eat Disord 2022; 10:64. [PMID: 35513879 PMCID: PMC9074196 DOI: 10.1186/s40337-022-00586-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although hematological abnormalities in patients with anorexia nervosa have been documented, the mechanisms involved have not been fully clarified, especially during the refeeding period when hematological values further decrease after admission prior to improving. Here we address potential mechanisms underlying the hematological abnormalities of inpatients with anorexia nervosa during the refeeding period. METHODS We recruited patients from 101 admissions corresponding to 55 individual patients with anorexia nervosa with severe malnutrition (body mass index, 13.4 ± 3.4) from the neuropsychiatry unit in Ashikaga Red Cross Hospital during the period from October 1999 to March 2018. We analyzed three hematological cell measures, i.e., hemoglobin, white cell count, and platelet count, to determine their levels at admission and their lowest levels during the refeeding period and calculated the percent decrease in those values from admission to the nadir levels. We analyzed each measure using a general mixed model with explanatory variables, including data upon admission and a treatment-related indicator, i.e., energy intake. RESULTS The initial hemoglobin value of 12.1 ± 2.7 g/dl decreased by 22.3% to 9.4 ± 2.5 g/dl; the initial white cell count was 5387 ± 3474/μl, which decreased by 33.6% to 3576 ± 1440/μl; the initial platelet count of 226 ± 101 × 103/μl decreased by 24.3% to 171 ± 80 × 103/μl. All nadir levels were observed during the refeeding period from the fifth to tenth day of hospitalization. Significant correlations among the three hematological cell measures, particularly at the nadir levels, were found. Of note, 41.7% of our patients who received red blood cell transfusion during hospitalization showed normal hemoglobin levels upon admission. The anorexia nervosa restrictive type was associated with a lower nadir level of white blood cell count. Infectious complications were related to a lower nadir level of hemoglobin and a greater percent decrease in hemoglobin level as well as to the need for red blood cell transfusion. CONCLUSIONS Nadir hematological cell measures of inpatients with anorexia nervosa might be predicted by the restrictive type and infectious complications. The anorexia nervosa restrictive type was associated with further decrease in hematological values during the refeeding period.
Collapse
Affiliation(s)
- Michitaka Funayama
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1 Yobe, Ashikaga, Tochigi, 326-0843, Japan.
| | - Akihiro Koreki
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1 Yobe, Ashikaga, Tochigi, 326-0843, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku, Tokyo, Japan.,Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Yu Mimura
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1 Yobe, Ashikaga, Tochigi, 326-0843, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| | - Taketo Takata
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1 Yobe, Ashikaga, Tochigi, 326-0843, Japan
| | - Satoyuki Ogino
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1 Yobe, Ashikaga, Tochigi, 326-0843, Japan.,Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Shin Kurose
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1 Yobe, Ashikaga, Tochigi, 326-0843, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku, Tokyo, Japan.,Department of Psychiatry, National Hospital Organization Shimofusa Psychiatric Medical Center, Chiba, Japan
| | - Yusuke Shimizu
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1 Yobe, Ashikaga, Tochigi, 326-0843, Japan.,Department of Trauma and Critical Care Medicine, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Shun Kudo
- Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1 Yobe, Ashikaga, Tochigi, 326-0843, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku, Tokyo, Japan
| |
Collapse
|
12
|
Min D, Kim B, Ko SG, Kim W. Effect and Mechanism of Herbal Medicines on Cisplatin-Induced Anorexia. Pharmaceuticals (Basel) 2022; 15:ph15020208. [PMID: 35215322 PMCID: PMC8877473 DOI: 10.3390/ph15020208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/04/2022] [Accepted: 02/05/2022] [Indexed: 12/04/2022] Open
Abstract
Cisplatin is a well-known chemotherapeutic agent used to treat various types of cancers; however, it can also induce anorexia, which results in reduced food intake, loss of body weight, and lower quality of life. Although drugs such as megestrol acetate and cyproheptadine are used to decrease this severe feeding disorder, they can also induce side effects, such as diarrhea and somnolence, which limit their widespread use. Various types of herbal medicines have long been used to prevent and treat numerous gastrointestinal tract diseases; however, to date, no study has been conducted to analyze and summarize their effects on cisplatin-induced anorexia. In this paper, we analyze 12 animal studies that used either a single herbal medicine extract or mixtures thereof to decrease cisplatin-induced anorexia. Among the herbal medicines, Ginseng Radix was the most used, as it was included in seven studies, whereas both Glycyrrhizae Radix et Rhizoma and Angelicae Gigantis Radix were used in four studies. As for the mechanisms of action, the roles of serotonin and its receptors, cytokines, white blood cells, ghrelin, and leptin were investigated. Based on these results, we suggest that herbal medicines could be considered a useful treatment method for cisplatin-induced anorexia.
Collapse
Affiliation(s)
- Daeun Min
- Department of Physiology, College of Korean Medicine, Kyung Hee University, Seoul 02453, Korea;
| | - Bonglee Kim
- Korean Medicine-Based Drug Repositioning Cancer Research Center, College of Korean Medicine, Kyung Hee University, Seoul 022447, Korea; (B.K.); (S.-G.K.)
| | - Seong-Gyu Ko
- Korean Medicine-Based Drug Repositioning Cancer Research Center, College of Korean Medicine, Kyung Hee University, Seoul 022447, Korea; (B.K.); (S.-G.K.)
| | - Woojin Kim
- Department of Physiology, College of Korean Medicine, Kyung Hee University, Seoul 02453, Korea;
- Korean Medicine-Based Drug Repositioning Cancer Research Center, College of Korean Medicine, Kyung Hee University, Seoul 022447, Korea; (B.K.); (S.-G.K.)
- Correspondence:
| |
Collapse
|
13
|
Xu D, Wang X, Zhang X, Li F, Zhang D, Li X, Zhang Y, Zhao Y, Song Q, Cheng J, Zhao L, Wang J, Li W, Zhou B, Lin C, Wang W. Polymorphisms in the ovine GP5 gene associated with blood physiological indices. Anim Biotechnol 2021:1-11. [PMID: 34904532 DOI: 10.1080/10495398.2021.2013859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This study aimed to analyze the effects of polymorphisms in GP5 on blood physiological indices of 1065 sheep. The coefficients of variation of the red blood cell count (RBC), hemoglobin concentration (HGB), mean platelet volume (MPV), mean erythrocyte hemoglobin content (MCH), and red blood cell distribution-coefficient of variation (RDW-CV) were greater than 10%, and there was a very significant correlation between the main indices such as RBC, white blood cell, and platelet count (PLT) and most other indices (p < 0.01). qRT-PCR showed that GP5 was expressed in the heart, liver, spleen, lung, kidney, rumen, duodenum, muscle, tail fat, and lymph tissue, with significantly higher expression in the lymph. Subsequently, we detected single nucleotide polymorphisms (SNPs) in GP5 from group, which identified synonymous mutation g.657 T > C in the first exon of GP5. Association analysis showed significant correlations between the SNP and the physiological traits (p < 0.05), in which the RBC, neutrophilic granulocyte (NEUT) and RDW-CV values in sheep with the TC genotype and TT genotype were markedly lower than those in the CC genotype (p < 0.05). Thus, GP5 polymorphisms could be candidate biomarkers to screen blood physiological indices.
Collapse
Affiliation(s)
- Dan Xu
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou, China
| | - Xiaojuan Wang
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou, China
| | - Xiaoxue Zhang
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou, China
| | - Fadi Li
- The State Key Laboratory of Grassland Agro-ecosystems, College of Pastoral Agriculture Science and Technology, Lanzhou University, Lanzhou, China
| | - Deyin Zhang
- The State Key Laboratory of Grassland Agro-ecosystems, College of Pastoral Agriculture Science and Technology, Lanzhou University, Lanzhou, China
| | - Xiaolong Li
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou, China
| | - Yukun Zhang
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou, China
| | - Yuan Zhao
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou, China
| | - Qizhi Song
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou, China
| | - Jiangbo Cheng
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou, China
| | - Liming Zhao
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou, China
| | - Jianghui Wang
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou, China
| | - Wenxin Li
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou, China
| | - Bubo Zhou
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou, China
| | - Changchun Lin
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou, China
| | - Weimin Wang
- College of Animal Science and Technology, Gansu Agricultural University, Lanzhou, China
| |
Collapse
|
14
|
Cuntz U, Körner T, Voderholzer U. Rapid renutrition improves health status in severely malnourished inpatients with AN - score-based evaluation of a high caloric refeeding protocol in severely malnourished inpatients with anorexia nervosa in an intermediate care unit. EUROPEAN EATING DISORDERS REVIEW 2021; 30:178-189. [PMID: 34889001 PMCID: PMC9299673 DOI: 10.1002/erv.2877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/16/2021] [Accepted: 11/21/2021] [Indexed: 11/29/2022]
Abstract
Objective Refeeding syndrome is a feared complication of refeeding patients with anorexia nervosa. There are now a number of controlled studies showing that refeeding with an initial high calorie count is more beneficial than cautious refeeding and is safe under continuous monitoring. However, there have yet not been studies in severe anorexia nervosa. Method We present an observational study in two different samples. The first sample consists of those 1075 out of a total of 3230 patients with anorexia nervosa treated in our hospital within 4 years for whom a complete admission laboratory was available and who had an age of at least 18 years at admission. A risk score was calculated from the number of pathological laboratory values out of 12 parameters indicating either refeeding syndrome or health hazards related to malnutrition. The second sample was obtained from a special ward for patients with eating disorders medically at‐risk. During the period in question, 410 patients with anorexia nervosa were treated there. 142 patients had a BMI of 13 or less and at the same time a complete data set with the mentioned 12 laboratory parameters at admission and weekly in the following 4 weeks after admission. Results The risk represented by the laboratory parameters is significantly and negatively correlated to BMI and much higher for the group of patients with a BMI below 13 than for those with a higher BMI (χ2 sig < 0.000). The 142 patients in the special care unit gain an average of more than 4.1 kg within 4 weeks on the high‐calorie diet. With this rapid weight gain, the risk score decreases highly significantly. Neither hypophosphatemia nor rhabdomyolysis is found under phosphate substitution. Hyperhydration occurred often, which manifests itself in the drop in haematocrit by the second week. Discussion Under thorough medical surveillance, supplementation of phosphate and thiamine, and substitution of electrolytes whenever necessary rapid renutrition appeared to be save even in extremely malnourished inpatients with anorexia nervosa. As measured by the laboratory values, the health status of the severely malnourished patients improves significantly on a high‐calorie diet. Except for hyperhydration, there was no evidence of a refeeding syndrome. The risk, assessed by significant laboratory parameters, increases considerably with increasingly low weight. Rapid refeeding under medical supervision leads to rapid stabilization of health. Under these conditions, there was no evidence of a threatening refeeding syndrome. Even in extremely underweight patients with anorexia nervosa, rapid refeeding appears to significantly improve the risk profile.
Collapse
Affiliation(s)
- Ulrich Cuntz
- Schön Clinic Roseneck, Prien am Chiemsee, Germany.,Forschungsprogramm für Psychotherapieevaluation im komplexen Therapiesetting, PMU Paracelsus Medical University Salzburg, Salzburg, Austria
| | | | - Ulrich Voderholzer
- Schön Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-Universität München (LMU), Munich, Germany
| |
Collapse
|
15
|
Biddle KE. Opinion on the Optimal Histologic Evaluation of the Bone Marrow in Nonclinical Toxicity Studies. Toxicol Pathol 2021; 50:266-273. [PMID: 34875926 DOI: 10.1177/01926233211061712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Identification of bone marrow toxicity is an important issue in drug development and toxicologic pathologists play a critical role in that identification. Knowledge of the general components of bone marrow, relevant anatomical and species differences, and the standard approach (routine systematic histological evaluation of the bone marrow in conjunction with analysis of the peripheral complete blood count data) will be reviewed. Specific morphologic features that anatomic pathologists should look for in the various components of bone marrow as well as suggested terminology for bone marrow findings will be discussed. Finally, an opinion on the limitations of the standard approach to bone marrow evaluation will be provided including general recommendations on when additional methods (image analysis of hematoxylin and eosin stained slides, flow cytometry or Sysmex XT 2000iV analysis, cytological evaluation of bone marrow smears, in vitro models, and transmission electron microscopy) might be useful in the detection or further characterization of bone marrow toxicity. [Box: see text].
Collapse
|
16
|
J Silla KE, S Brigham K, Goldstein M, Misra M, Singhal V. Clinical, biochemical, and hematological characteristics of community-dwelling adolescent and young adult males with anorexia nervosa. Int J Eat Disord 2021; 54:2213-2217. [PMID: 34617624 DOI: 10.1002/eat.23622] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 09/11/2021] [Accepted: 09/20/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Data regarding clinical characteristics in males with AN are limited. We aimed to delineate clinical, biochemical, and hematological features in community-dwelling adolescent and young adult males with AN. METHOD A retrospective chart review of electronic medical records from 2000 to 2016 was conducted for 53 males aged 10-23 years old; AN (n = 36) and healthy controls (n = 17) were similar for Tanner stage. RESULTS Adolescent and young adult males with AN were diagnosed at a mean age of 15.9 ± 3.0 years. The most prevalent strategy for weight loss (following calorie restriction) was over-exercising. Labs demonstrated polycythemia, leukopenia, and thrombocytopenia, but no electrolyte abnormalities. Compared with healthy controls of similar Tanner stage, males with AN had lower total testosterone levels. A significant proportion of males with AN had traumatic bone fractures. DISCUSSION Over-exercising is a common secondary weight loss strategy in males with AN. Testosterone levels are lower than in controls, but electrolyte abnormalities are rare. With enhanced provider awareness, diagnostic delays may be prevented.
Collapse
Affiliation(s)
| | - Kathryn S Brigham
- Division of Adolescent and Young Adult Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Mark Goldstein
- Division of Adolescent and Young Adult Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Vibha Singhal
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Division of Pediatric Endocrinology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
17
|
Nutritional indicators and metabolic alterations in outpatients with anorexia nervosa: a retrospective study. Eat Weight Disord 2021; 26:2693-2699. [PMID: 33608860 PMCID: PMC8602350 DOI: 10.1007/s40519-021-01121-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/19/2021] [Indexed: 11/16/2022] Open
Abstract
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/m2); (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 cut-off 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.
Collapse
|
18
|
Solomou EE, Salamaliki C, Lagadinou M. How to Make the Right Diagnosis in Neutropenia. Clin Hematol Int 2021; 3:41-46. [PMID: 34595466 PMCID: PMC8432397 DOI: 10.2991/chi.k.210216.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 02/11/2021] [Indexed: 11/05/2022] Open
Abstract
Isolated neutropenia without anemia or thrombocytopenia is a common clinical problem. The etiology of neutropenia may vary from transient bone marrow suppression, caused by self-limited viral illnesses, to previously undiagnosed congenital syndromes or serious systemic diseases. Consequently, determining the underlying cause of neutropenia and what treatment is required can be challenging. Acquired neutropenia is common and most of the times an etiologic factor can be found. Congenital neutropenia (CN) is rare, and we still have a lot to learn from mutational analysis as to the exact role of gene abnormalities in the pathogenesis of these complex diseases. This mini-review discusses a proposed approach to neutropenia in the adult patient.
Collapse
Affiliation(s)
- Elena E Solomou
- Department of Internal Medicine, University of Patras Medical School, Rion 26500, Greece
| | - Christina Salamaliki
- Department of Internal Medicine, University of Patras Medical School, Rion 26500, Greece
| | - Maria Lagadinou
- Department of Internal Medicine, University of Patras Medical School, Rion 26500, Greece
| |
Collapse
|
19
|
The Impact of Sedentary Lifestyle, High-fat Diet, Tobacco Smoke, and Alcohol Intake on the Hematopoietic Stem Cell Niches. Hemasphere 2021; 5:e615. [PMID: 34291194 PMCID: PMC8288907 DOI: 10.1097/hs9.0000000000000615] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/07/2021] [Indexed: 11/25/2022] Open
Abstract
Hematopoietic stem and progenitor cells maintain hematopoiesis throughout life by generating all major blood cell lineages through the process of self-renewal and differentiation. In adult mammals, hematopoietic stem cells (HSCs) primarily reside in the bone marrow (BM) at special microenvironments called “niches.” Niches are thought to extrinsically orchestrate the HSC fate including their quiescence and proliferation. Insight into the HSC niches mainly comes from studies in mice using surface marker identification and imaging to visualize HSC localization and association with niche cells. The advantage of mouse models is the possibility to study the 3-dimensional BM architecture and cell interactions in an intact traceable system. However, this may not be directly translational to human BM. Sedentary lifestyle, unhealthy diet, excessive alcohol intake, and smoking are all known risk factors for various diseases including hematological disorders and cancer, but how do lifestyle factors impact hematopoiesis and the associated niches? Here, we review current knowledge about the HSC niches and how unhealthy lifestyle may affect it. In addition, we summarize epidemiological data concerning the influence of lifestyle factors on hematological disorders and malignancies.
Collapse
|
20
|
Ibrahim N, Barruchet A, Moro MR, Blanchet C. Severe neutropenia in an anorexic adolescent girl: a stigma of underfeeding syndrome? Eat Weight Disord 2021; 26:1271-1275. [PMID: 32978756 DOI: 10.1007/s40519-020-01016-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/08/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE We describe a case of severe, prolonged neutropenia in an adolescent girl hospitalized for anorexia nervosa (AN) which occurred during a refeeding procedure in the absence of refeeding syndrome. METHODS This case report includes retrospective anamnestic, clinical and biological data from the patient's medical record. A literature review was conducted on the haematological changes described in the undernutrition and refeeding periods, and also on recent data for underfeeding syndrome in patients with anorexia nervosa. CONCLUSION Leuconeutropenia is an adaptive condition observed in undernutrition in AN, usually rapidly and completely reversible in the course of refeeding and weight gain. We describe a rare case of severe, prolonged neutropenia despite appropriate care in the absence of refeeding syndrome and without gelatinous bone marrow transformation. We suggest that neutropenia in adolescent anorexia nervosa could be a stigma of underfeeding syndrome resulting from an overly cautious refeeding strategy. LEVEL OF EVIDENCE Level V, descriptive study.
Collapse
Affiliation(s)
- N Ibrahim
- APHP, Cochin Hospital, Maison de Solenn, 75014, Paris, France
| | - A Barruchet
- APHP, Cochin Hospital, Maison de Solenn, 75014, Paris, France
| | - M R Moro
- APHP, Cochin Hospital, Maison de Solenn, 75014, Paris, France
- University of Paris, PCPP, 92100, Boulogne-Billancourt, France
- University of Paris-Saclay-UVSQ, INSERM, CESP, Team DevPsy, 94805, Villejuif, France
| | - C Blanchet
- APHP, Cochin Hospital, Maison de Solenn, 75014, Paris, France.
- University of Paris, PCPP, 92100, Boulogne-Billancourt, France.
- University of Paris-Saclay-UVSQ, INSERM, CESP, Team DevPsy, 94805, Villejuif, France.
| |
Collapse
|
21
|
Lemille J, Le Bras M, Fauconnier M, Grall-Bronnec M. [Anorexia nervosa: Abnormalities in hematological and biochemical parameters]. Rev Med Interne 2021; 42:558-565. [PMID: 33461787 DOI: 10.1016/j.revmed.2020.12.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/30/2020] [Accepted: 12/26/2020] [Indexed: 12/30/2022]
Abstract
Abnormalities of hematological and biochemical parameters are various and frequent during anorexia nervosa, and are mainly related to malnutrition, weight loss, and compensatory purgative behaviors. They are most often moderate and reversible through appropriate nutritional and weight rehabilitation, as well as well-conducted symptomatic treatment. Severe abnormalities are rarer, but are potentially serious or even fatal. Isolated moderate anemia and leukopenia are frequently noted, with thrombocytopenia being less frequent. Severe, bi-cytopenic, pancytopenic, and spinal cord injury are less common. They can be explained by the gelatinous transformation of the bone marrow caused by malnutrition. Biochemical abnormalities are typically hydroelectrolytic disorders (hypokalemia, hyponatremia, metabolic alkalosis), acute or chronic renal failure, elevated transaminases, risk of potentially severe hypoglycemia, and elevated lipid parameters. During the refeeding syndrome, hypophosphatemia is characteristic and may be associated with hypomagnesemia and hypocalcemia, and thiamine deficiency. Malnutrition can also lead to alterations in hormone status, including hypothyroidism, hypercorticism and hypogonadism, which may be involved in the development of serious bone conditions such as osteoporosis. These abnormalities should be routinely investigated, monitored, and corrected during anorexia nervosa. Early and multidisciplinary management of this eating disorder is essential to prevent chronicity of the disorder and the potential severity of these abnormalities.
Collapse
Affiliation(s)
- J Lemille
- Service d'addictologie et de psychiatrie de liaison, hôpital Saint-Jacques, CHU, 85, rue Saint-Jacques, 44093 Nantes, France; Service d'addictologie, CHS, Le Pont Piétin, 44130 Blain, France.
| | - M Le Bras
- Service d'endocrinologie, diabétologie et nutrition, hôpital Saint-Jacques, CHU, 85, rue Saint-Jacques, 44093 Nantes, France
| | - M Fauconnier
- Service d'addictologie et de psychiatrie de liaison, hôpital Saint-Jacques, CHU, 85, rue Saint-Jacques, 44093 Nantes, France
| | - M Grall-Bronnec
- Service d'addictologie et de psychiatrie de liaison, hôpital Saint-Jacques, CHU, 85, rue Saint-Jacques, 44093 Nantes, France; UMR 1246, universités de Nantes et Tours, France
| |
Collapse
|
22
|
Guinhut M, Melchior JC, Godart N, Hanachi M. Extremely severe anorexia nervosa: Hospital course of 354 adult patients in a clinical nutrition-eating disorders-unit. Clin Nutr 2020; 40:1954-1965. [PMID: 33023762 DOI: 10.1016/j.clnu.2020.09.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS The clinical nutrition-eating disorders-unit in Raymond Poincaré Hospital is a reference center for the management of severe malnutrition and its complications in patients with anorexia nervosa (AN). The purpose of this study is to specify socio-demographic, anamnesic and clinical characteristics of AN patients hospitalized for extreme malnutrition, to identify types and prevalence of medical complications presented during their hospitalization for refeeding and the evolution of patients nutritional status. METHODS Demographic, clinical and paraclinical data of 354 severely malnourished AN patients were collected, during their first hospitalization in the unit, between November 1997 and January 2014, through medical records. The prevalence of medical complications was compared between the 2 AN subtypes (restricting and binging-purging). RESULTS 339 patients were female and mean age was 28.7 ± 10.7 years old. Duration of AN was 9.5 ± 9 years, 173 (48.9%) patients had a restricting AN subtype. BMI at admission was 12.2 ± 1.6 kg/m2, 280 (79.3%) patients had already been hospitalized for AN in other hospitals before. Psychiatric comorbidities were present in 168 (47.5%) patients. Associated somatic comorbidities concerned 70 (19.8%) patients. Outcomes during hospitalization were marked by 4.1 ± 3.9 kg weight gain on 36.9 ± 30.5 days. Enteral nutrition was provided in 304 (85.9%) patients. Main medical complications during hospitalization were: anemia (79%), neutropenia (53.9%), hypertransaminasemia (53.7%), osteoporosis (46.3%), hypokalemia (39.5%), hypophosphatemia (26%), hypoglycemia (13.8%), infectious complications (24.3%), cardiac dysfunction (7.1%), and proven gelatinous bone marrow transformation (6.5%). Hypokalemia was more frequent in binging-purging subtype. Lympho-neutropenia and hypertransaminasemia were more frequent in restricting subtype. During their hospitalization, 35 (10%) patients were referred to medical intensive care unit and 5 patients died. CONCLUSIONS AN patients hospitalized for severe malnutrition in a specialized clinical nutrition unit have severe and frequent medical complications. Psychiatric comorbidities are also frequent and could complicate medical care. A specialized and multidisciplinary management of these patients is therefore essential.
Collapse
Affiliation(s)
- Marie Guinhut
- Clinical Nutrition Unit, Raymond Poincaré Hospital, Garches, France; Paris-Descartes University, Paris, France.
| | - Jean-Claude Melchior
- Clinical Nutrition Unit, Raymond Poincaré Hospital, Garches, France; Paris-Saclay University, France
| | - Nathalie Godart
- Fondation de Santé des Etudiants de France, Paris, France; CESP, INSERM, UMR 1018, UVSQ, Université Paris-Saclay, Paris, France
| | - Mouna Hanachi
- Clinical Nutrition Unit, Raymond Poincaré Hospital, Garches, France; Paris-Saclay University, France
| |
Collapse
|
23
|
Abstract
Management of the high rates of medical and psychiatric complications, including self-harm and suicide, associated with anorexia nervosa requires regular clinical review. However, during the current pandemic, face-to-face clinical assessments carry the risk of infection and transmission in this vulnerable cohort already compromised by low weight and lowered immunity. This paper describes how one service has had to adapt usual care during the COVID-19 pandemic without contributing excessively to carer burden or compromising patient safety.
Collapse
|
24
|
Long ME, Mustonen AM, Zitzer NC, Byron JK, Wellman ML, Cianciolo RE, Hokamp JA. Persistent nonregenerative anemia in a 4-year-old cat. Vet Clin Pathol 2020; 49:11-16. [PMID: 32201969 DOI: 10.1111/vcp.12837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/06/2019] [Accepted: 08/19/2019] [Indexed: 12/28/2022]
Abstract
A 4-year-old male neutered domestic shorthair cat was presented to The Ohio State University College of Veterinary Medicine for a 2-month history of severe weight loss, lethargy, anemia, and bilaterally hyperechoic kidneys with loss of corticomedullary distinction as reported by the referring veterinarian. Relevant initial laboratory results included severe non-regenerative normocytic hypochromic anemia, increased blood urea nitrogen, minimally concentrated urine, proteinuria, and an increased urine protein:creatinine ratio. Cytologic evaluation of a bone marrow aspirate revealed a markedly hypocellular marrow with abundant mucinous material. Gelatinous marrow transformation (GMT) was confirmed histologically by the presence of mucinous material in the bone marrow that stained positive for Alcian blue but negative for periodic acid-Schiff. The cat died despite repeated blood transfusions and supportive care. Gelatinous marrow transformation, immune complex-mediated membranoproliferative glomerulonephritis, and gastrointestinal hemorrhage were observed on autopsy and histology. It is likely that the development of GMT was secondary to chronic kidney disease (CKD) and that CKD, GMT, and gastrointestinal hemorrhage contributed to the cat's non-regenerative anemia.
Collapse
Affiliation(s)
- Mackenzie E Long
- Department of Veterinary Biosciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, USA
| | - Allison M Mustonen
- Department of Veterinary Biosciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, USA
| | - Nina C Zitzer
- Department of Veterinary Biosciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, USA
| | - Julie K Byron
- Department of Veterinary Clinical Sciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, USA
| | - Maxey L Wellman
- Department of Veterinary Biosciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, USA
| | - Rachel E Cianciolo
- Department of Veterinary Biosciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, USA
| | - Jessica A Hokamp
- Department of Veterinary Biosciences, The Ohio State University College of Veterinary Medicine, Columbus, OH, USA
| |
Collapse
|
25
|
Mantel Ä, Hirschberg AL, Stephansson O. Association of Maternal Eating Disorders With Pregnancy and Neonatal Outcomes. JAMA Psychiatry 2020; 77:285-293. [PMID: 31746972 PMCID: PMC6902173 DOI: 10.1001/jamapsychiatry.2019.3664] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE The prevalence of eating disorders is high among women of reproductive age, yet the association of eating disorders with pregnancy complications and neonatal health has not been investigated in detail, to our knowledge. OBJECTIVE To investigate the relative risk of adverse pregnancy and neonatal outcomes for women with eating disorders. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study included all singleton births included in the Swedish Medical Birth Register from January 1, 2003, to December 31, 2014. A total of 7542 women with eating disorders were compared with 1 225 321 women without eating disorders. Statistical analysis was performed from January 1, 2018, to April 30, 2019. Via linkage with the national patient register, women with eating disorders were identified and compared with women free of any eating disorder. Eating disorders were further stratified into active or previous disease based on last time of diagnosis. MAIN OUTCOMES AND MEASURES The risk of adverse pregnancy outcomes (hyperemesis, anemia, preeclampsia, and antepartum hemorrhage), the mode of delivery (cesarean delivery, vaginal delivery, or instrumental vaginal delivery), and the neonatal outcomes (preterm birth, small and large sizes for gestational age, Apgar score <7 at 5 minutes, and microcephaly) were calculated using Poisson regression analysis to estimate risk ratios (RRs). Models were adjusted for age, parity, smoking status, and birth year. RESULTS There were 2769 women with anorexia nervosa (mean [SD] age, 29.4 [5.3] years), 1378 women with bulimia nervosa (mean [SD] age, 30.2 [4.9] years), and 3395 women with an eating disorder not otherwise specified (EDNOS; mean [SD] age, 28.9 [5.3] years), and they were analyzed and compared with 1 225 321 women without eating disorders (mean [SD] age, 30.3 [5.2] years). All subtypes of maternal eating disorders were associated with an approximately 2-fold increased risk of hyperemesis during pregnancy (anorexia nervosa: RR, 2.1 [95% CI, 1.8-2.5]; bulimia nervosa: RR, 2.1 [95% CI, 1.6-2.7]; EDNOS: RR, 2.6 [95% CI, 2.3-3.0]). The risk of anemia during pregnancy was doubled for women with active anorexia nervosa (RR, 2.1 [95% CI, 1.3-3.2]) or EDNOS (RR, 2.1 [95% CI, 1.5-2.8]). Maternal anorexia nervosa was associated with an increased risk of antepartum hemorrhage (RR, 1.6 [95% CI, 1.2-2.1]), which was more pronounced in active vs previous disease. Women with anorexia nervosa (RR, 0.7 [95% CI, 0.6-0.9]) and women with EDNOS (RR, 0.8 [95% CI, 0.7-1.0]) were at decreased risk of instrumental-assisted vaginal births; otherwise, there were no major differences in mode of delivery. Women with eating disorders, all subtypes, were at increased risk of a preterm birth (anorexia nervosa: RR, 1.6 [95% CI, 1.4-1.8]; bulimia nervosa: RR, 1.3 [95% CI, 1.0-1.6]; and EDNOS: RR, 1.4 [95% CI, 1.2-1.6]) and of delivering neonates with microcephaly (anorexia nervosa: RR, 1.9 [95% CI, 1.5-2.4]; bulimia nervosa: RR, 1.6 [95% CI, 1.1-2.4]; EDNOS: RR, 1.4 [95% CI, 1.2-1.9]). CONCLUSIONS AND RELEVANCE The findings of this study suggest that women with active or previous eating disorders, regardless of subtype, are at increased risk of adverse pregnancy and neonatal outcomes and may need increased surveillance in antenatal and delivery care.
Collapse
Affiliation(s)
- Ängla Mantel
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Theme Children’s and Women’s Health, Pregnancy Care and Delivery, Karolinska University Hospital, Stockholm, Sweden
| | - Angelica Lindén Hirschberg
- Division of Obstetrics and Gynecology, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden,Gynecology and Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Stephansson
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden,Division of Obstetrics and Gynecology, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
26
|
Extreme anorexia nervosa: medical findings, outcomes, and inferences from a retrospective cohort. J Eat Disord 2020; 8:25. [PMID: 32582446 PMCID: PMC7310519 DOI: 10.1186/s40337-020-00303-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/21/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Extreme anorexia nervosa (AN) is defined as a BMI < 15 kg/m2 in those meeting DSM-V diagnostic criteria for AN. This study seeks to define the frequency of medical complications in this group of patients in order to help inform the care of individuals < 65% ideal body weight who seek treatment for their extreme eating disorders. METHODS Through retrospective chart review and computerized data collection, we obtained the baseline characteristics and medical findings of 281 adult patients, with AN restricting and binge-purge subtypes, admitted to the ACUTE unit for medical stabilization between May 2013 and August 2018. RESULTS In this population, with a mean admitting BMI of 12.1 kg/m2 (range = 7.5-15.7), 56% admitted with bradycardia, 45% demonstrated increased liver function tests (LFTs) on admission, 64% admitted with leukopenia, 47% with anemia, and 20% presented with thrombocytopenia. During admission, 38% developed hypoglycemia, 35% developed refeeding hypophosphatemia, nearly 33% of patients developed edema, and low bone mineral density was diagnosed in almost 90% of the patients. Highly elevated LFTs (>3x upper limits of normal) predicted hypoglycemia, and low BMI predicted refeeding hypophosphatemia (p = .001). CONCLUSIONS Although conclusions drawn from the findings presented in this descriptive study must be tempered by relevant clinical judgement, these findings showcase that patients with extreme AN are at significantly increased risk for many serious medical complications secondary to their state of malnutrition and also with initial refeeding.
Collapse
|
27
|
Abstract
Eating disorders affect a significant number of individuals across the life span and are found among all demographic groups (including all genders, socioeconomic statuses, and ethnicities). They can cause malnutrition, which can have significant effects on every organ system in the body. Cardiovascular complications are particularly dangerous and cause eating disorders to have the highest mortality rate of all mental illnesses. This article outlines the medical assessment and treatment of malnutrition due to disordered eating.
Collapse
Affiliation(s)
- Rebecka Peebles
- Eating Disorder Assessment and Treatment Program, The Children's Hospital of Philadelphia, Perelman School of Medicine at The University of Pennsylvania, Roberts Center for Pediatric Research, 2716 South Street, Room 14360, Philadelphia, PA 19146, USA.
| | - Erin Hayley Sieke
- The Children's Hospital of Philadelphia, 3401 Civic Center Boulevard 9NW55, Philadelphia, PA 19104, USA
| |
Collapse
|
28
|
Abstract
Anorexia nervosa and bulimia nervosa are mental illnesses with associated complications affecting all body systems with arguably the highest mortality of all mental health disorders. A comprehensive medical evaluation is an essential first step in the treatment of anorexia nervosa and bulimia nervosa. Weight restoration and cessation of purging behaviors are often essential components in the management of medical complications of these illnesses.
Collapse
Affiliation(s)
- Dennis Gibson
- ACUTE @ Denver Health, 777 Bannock Street, Denver, CO 80204, USA; Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA
| | - Cassandra Workman
- Eating Recovery Center, 7351 East Lowry Boulevard, Suite 200, Denver, CO 80230, USA
| | - Philip S Mehler
- ACUTE @ Denver Health, 777 Bannock Street, Denver, CO 80204, USA; Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Pl, Aurora, CO, 80045, USA; Eating Recovery Center, 7351 East Lowry Boulevard, Suite 200, Denver, CO 80230, USA.
| |
Collapse
|
29
|
Hariz A, Hamdi MS, Boukhris I, Boujelbène N, Azzabi S, Khalfallah N. Gelatinous Transformation of Bone Marrow in a Patient with Anorexia Nervosa: An Uncommon but Reversible Etiology. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1449-1452. [PMID: 30523242 PMCID: PMC6293863 DOI: 10.12659/ajcr.911287] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 07/21/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND Anorexia nervosa is a relatively frequently encountered eating disorder. Beyond its psychiatric significance, it is associated with multiple hematological features such as cytopenia. It can be related to gelatinous transformation of the bone marrow. CASE REPORT We describe the case of a 20-year-old male admitted for rapid involuntarily weight loss. He presented with extreme bradycardia with a heart rate of 30 beats per minute with recent psychomotor impairment. Routine laboratory tests showed pancytopenia, and cytolysis on liver function tests. Cardiac investigations did not reveal abnormalities except for sinus bradycardia. Bone marrow aspirate revealed hypo-cellular marrow with infiltration by gelatinous substance. In addition, bone marrow biopsy showed fat cell atrophy along with loss of hematopoietic elements in areas of gelatinous transformation. During the patient's hospital stay, he had a restrictive oral diet. Thus, after consulting with a psychiatric specialist, a diagnosis of anorexia nervosa complicated with gelatinous transformation of bone marrow, bradycardia, and acute hepatitis was made. After psychiatric treatment and nutritional care, the patient regained weight, had a normal heart rate and normal liver function tests, and his full blood count and bone marrow examination were within normal range. CONCLUSIONS Gelatinous transformation of bone marrow can be the revealing feature of anorexia nervosa and some potentially reversible associations might prove life threatening if misdiagnosed. Furthermore, lack of suspicion can lead to unwarranted investigations increasing the cost incurred in healthcare delivery. Our patient had 3 systems involved: cardiac, hepatic, and hematological systems. Gelatinous transformation of bone marrow, although a rare condition, must be considered in such patients.
Collapse
Affiliation(s)
- Anis Hariz
- Department of Internal Medicine B, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
- Research Laboratory of Kidney Diseases (LR00SP01), Charles Nicolle Hospital, Tunis, Tunisia
| | - Mohamed Salah Hamdi
- Department of Internal Medicine B, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - Imen Boukhris
- Department of Internal Medicine B, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - Nadia Boujelbène
- University of Tunis El Manar, Tunis, Tunisia
- Department of Anatomic Pathology and Cytopathology, Institute Salah Azaïz, Tunis, Tunisia
| | - Samira Azzabi
- Department of Internal Medicine B, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| | - Narjess Khalfallah
- Department of Internal Medicine B, Charles Nicolle Hospital, Tunis, Tunisia
- University of Tunis El Manar, Tunis, Tunisia
| |
Collapse
|
30
|
Gormez A, Kurtulmus A, Kirpinar I. Iron metabolism and haematological changes in anorexia nervosa: an adult case report. Eat Weight Disord 2018; 23:395-398. [PMID: 28378272 DOI: 10.1007/s40519-017-0377-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 02/27/2017] [Indexed: 11/25/2022] Open
Affiliation(s)
- Aynur Gormez
- Department of Psychiatry, Istanbul Medeniyet University, Istanbul, Turkey
| | - Ayse Kurtulmus
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey.
| | - Ismet Kirpinar
- Department of Psychiatry, Bezmialem Vakif University, Istanbul, Turkey
| |
Collapse
|
31
|
Takeshima M, Ishikawa H, Kitadate A, Sasaki R, Kobayashi T, Nanjyo H, Kanbayashi T, Shimizu T. Anorexia nervosa-associated pancytopenia mimicking idiopathic aplastic anemia: a case report. BMC Psychiatry 2018; 18:150. [PMID: 29801443 PMCID: PMC5970484 DOI: 10.1186/s12888-018-1743-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 05/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with anorexia nervosa (AN) often present with pancytopenia. In most cases described in the literature, AN with pancytopenia demonstrates gelatinous marrow transformation (GMT), which is a typical bone marrow feature of malnutrition. Differentiation of AN-associated pancytopenia from other types of pancytopenia, especially idiopathic aplastic anemia (IAA), has not been studied. We encountered a case of pancytopenia in a patient with AN and relatively poor nutritional status, whose hematological findings mimicked those of IAA, specifically fatty bone marrow and absence of GMT. CASE PRESENTATION The patient was a 32-year-old woman with poorly controlled AN. At 31 years of age, her body mass index (BMI) had fallen from 17.0 kg/m2 to below 13.8 kg/m2. The patient presented with ongoing fatigue and thus was examined by a hematologist. Hematological findings were consistent with IAA: peripheral blood tests revealed pancytopenia, whereas the bone marrow displayed fatty replacement without GMT. Despite the absence of bone marrow features typically seen in malnutrition, the patient's hematological abnormalities had manifested after a decrease in body weight. Thus, although the bone marrow findings indicated IAA, we considered that the nutritional etiology of pancytopenia could not be thoroughly ruled out. Using nutritional therapy alone, the hematological abnormalities improved as BMI increased to 16.5 kg/m2. The final diagnosis was pancytopenia secondary to malnutrition because pancytopenia and fatty bone marrow improved after implementation of nutritional therapy alone. CONCLUSIONS The present case is the first documented case of AN with pancytopenia for which bone marrow examination confirmed fatty marrow without any evidence of GMT. IAA and pancytopenia secondary to malnutrition can present the same clinical findings. This case is significant because it suggests a need to differentiate between malnutrition and IAA.
Collapse
Affiliation(s)
- Masahiro Takeshima
- Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1,Hondo, Akita City, Akita, 010-8543, Japan.
| | - Hiroyasu Ishikawa
- 0000 0001 0725 8504grid.251924.9Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1,Hondo, Akita City, Akita 010-8543 Japan ,Department of Neuropsychiatry, Nakadori Rehabilitation Hospital, 6-1-58, Nakadori, Akita City, Akita 010-0001 Japan
| | - Akihiro Kitadate
- 0000 0004 0378 2140grid.414927.dDivision of Hematology/Oncology, Department of Medicine, Kameda General Hospital, 929 Higashi-chou, Kamogawa City, Chiba 296-8602 Japan
| | - Ryo Sasaki
- Department of Neuropsychiatry, Akita City Hospital, 4-30, Matsuoka-machi, Kawamoto, Akita City, Akita 010-0933 Japan
| | - Takahiro Kobayashi
- 0000 0001 0725 8504grid.251924.9Department of Hematology, Nephrology and Rheumatology, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita City, Akita 010-8543 Japan
| | - Hiroshi Nanjyo
- 0000 0001 0725 8504grid.251924.9Division of Clinical Pathology, Akita University Graduate School of Medicine, 1-1-1, Hondo, Akita City, Akita 010-8543 Japan
| | - Takashi Kanbayashi
- 0000 0001 0725 8504grid.251924.9Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1,Hondo, Akita City, Akita 010-8543 Japan
| | - Tetsuo Shimizu
- 0000 0001 0725 8504grid.251924.9Department of Neuropsychiatry, Akita University Graduate School of Medicine, 1-1-1,Hondo, Akita City, Akita 010-8543 Japan
| |
Collapse
|
32
|
Bleeding frequency and characteristics among hematologic malignancy inpatient rehabilitation patients with severe thrombocytopenia. Support Care Cancer 2018; 26:3135-3141. [PMID: 29594490 DOI: 10.1007/s00520-018-4160-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 03/12/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To identify the frequency and characteristics of bleeding complications during acute inpatient rehabilitation of hematologic malignancy patients with severe thrombocytopenia. DESIGN Retrospective descriptive analysis. SETTING Comprehensive cancer center acute inpatient rehabilitation unit. PARTICIPANTS Consecutive hematologic malignancy patients with a platelet count of less than or equal to 20,000/microliter (μL) on the day of acute inpatient rehabilitation admission from 1/1/2005 through 8/31/2016. INTERVENTIONS Medical records were retrospectively analyzed for demographic, laboratory, and medical data. Patients were rehabilitated using the institutional exercise guidelines for thrombocytopenic patients. MAIN OUTCOME MEASURES Bleeding events noted in the medical record. RESULTS Out of 135 acute inpatient rehabilitation admissions, 133 unique patients were analyzed with a total of 851 inpatient rehabilitation days. The mean platelet count was 14,000/μL on the day of admission and 22,000/μL over the course of the rehabilitation admission. There were 252 days of inpatient rehabilitation where patients had less than 10,000/μL platelets. A total of 97 bleeding events were documented in 77/135 (57%) admissions. Of the 97 bleeding events, 72 (74%), 14 (14%), and 11 (11%) were considered to be of low, medium, and high severity, respectively. There were 4/97 (4%) bleeding events that were highly likely attributable to physical activity but only 1/4 was considered high severity. Bleeding rates were .09, .08, .17, and .37 for > 20,000, 15-20,000, 10-15,000, and < 10,000/μL mean platelet counts respectively (p = .003). Forty-four percent of patients were transferred back to the primary acute care service with infection being the most common reason for transfer. CONCLUSIONS This study is the first to examine exercise-related bleeding complications during acute inpatient rehabilitation in severely thrombocytopenic hematologic cancer patients. Bleeding rates increased with lower platelet counts. However, using the exercise guidelines for severely thrombocytopenic patients, the risk of severe exercise-related bleeding events was low.
Collapse
|
33
|
Oświęcimska J, Malczyk Ż, Szymlak A, Mikołajczak A, Ziora K, Zamlynski J, Machura E, Zajac P, Koczy B, Kasperska-Zajac A. Changes in Platelet Count and Size Indices in Adolescent Patients With Anorexia Nervosa. Clin Appl Thromb Hemost 2017; 23:562-566. [PMID: 28449596 DOI: 10.1177/1076029617705727] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The significance of platelet size indices has not been widely analyzed in anorexia nervosa (AN). It seems important to get more knowledge on the easily available indices of platelet function obtained by routine complete blood count analysis in patients with AN. We analyzed platelet count (PLT), platelet distribution width (PDW), and mean platelet volume using an automated blood cell counter in 25 females with AN and healthy age- and gender-matched nonatopic controls. Mean PLT was significantly lower in patients with AN than in the control group. Platelet distribution width values in patients with AN were significantly higher than those in the controls. Platelet distribution width values significantly correlated with the disease duration and rate of body weight loss in the anorectic patients. Anorexia nervosa in adolescents is associated with a decrease in PLT along with an increased PDW, which may be an indicator of dysregulated thrombopoiesis.
Collapse
Affiliation(s)
- Joanna Oświęcimska
- 1 Department of Paediatrics, SMDZ in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Żaneta Malczyk
- 1 Department of Paediatrics, SMDZ in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Agnieszka Szymlak
- 1 Department of Paediatrics, SMDZ in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Agata Mikołajczak
- 1 Department of Paediatrics, SMDZ in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Katarzyna Ziora
- 1 Department of Paediatrics, SMDZ in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Jacek Zamlynski
- 2 Department of Gynaecology, Obstetrics and Oncological Gynaecology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Bytom, Poland
| | - Edyta Machura
- 1 Department of Paediatrics, SMDZ in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| | - Piotr Zajac
- 3 Department of Trauma and Orthopaedics, District Trauma and Orthopaedic Hospital, Piekary Sląskie, Poland
| | - Bogdan Koczy
- 3 Department of Trauma and Orthopaedics, District Trauma and Orthopaedic Hospital, Piekary Sląskie, Poland
| | - Alicja Kasperska-Zajac
- 4 Clinical Department of Internal Diseases, Dermatology and Allergology, SMDZ in Zabrze, Medical University of Silesia in Katowice, Zabrze, Poland
| |
Collapse
|
34
|
Elegido A, Graell M, Andrés P, Gheorghe A, Marcos A, Nova E. Increased naive CD4 + and B lymphocyte subsets are associated with body mass loss and drive relative lymphocytosis in anorexia nervosa patients. Nutr Res 2017; 39:43-50. [PMID: 28385288 DOI: 10.1016/j.nutres.2017.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 12/12/2016] [Accepted: 02/03/2017] [Indexed: 12/12/2022]
Abstract
Anorexia nervosa (AN) is an atypical form of malnutrition with peculiar changes in the immune system. We hypothesized that different lymphocyte subsets are differentially affected by malnutrition in AN, and thus, our aim was to investigate the influence of body mass loss on the variability of lymphocyte subsets in AN patients. A group of 66 adolescent female patients, aged 12-17 years, referred for their first episode of either AN or feeding or eating disorders not elsewhere classified were studied upon admission (46 AN-restricting subtype, 11 AN-binge/purging subtype, and 9 feeding or eating disorders not elsewhere classified). Ninety healthy adolescents served as controls. White blood cells and lymphocyte subsets were analyzed by flow cytometry. Relationships with the body mass index (BMI) z score were assessed in linear models adjusted by diagnostic subtype and age. Leukocyte numbers were lower in AN patients than in controls, and relative lymphocytosis was observed in AN-restricting subtype. Lower CD8+, NK, and memory CD8+ counts were found in eating disorder patients compared with controls. No differences were found for CD4+ counts or naive and memory CD4+ subsets between the groups. Negative associations between lymphocyte percentage and the BMI z score, as well as between the B cell counts, naive CD4+ percentage and counts, and the BMI z score, were found. In conclusion, increased naive CD4+ and B lymphocyte subsets associated with body mass loss drive the relative lymphocytosis observed in AN patients, which reflects an adaptive mechanism to preserve the adaptive immune response.
Collapse
Affiliation(s)
- Ana Elegido
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN)-CSIC, C/José Antonio Novais 10, 28040, Madrid, Spain
| | - Montserrat Graell
- Eating Disorders Unit, Child and Adolescent Psychiatry and Psychology Department, Children University Hospital Niño Jesús, Av Menéndez Pelayo, 65, 28009 Madrid, Spain; CIBERSAM, Biomedical Research Networking Centre for Mental Health, Ministry of Health, Spain
| | - Patricia Andrés
- Eating Disorders Unit, Child and Adolescent Psychiatry and Psychology Department, Children University Hospital Niño Jesús, Av Menéndez Pelayo, 65, 28009 Madrid, Spain
| | - Alina Gheorghe
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN)-CSIC, C/José Antonio Novais 10, 28040, Madrid, Spain
| | - Ascensión Marcos
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN)-CSIC, C/José Antonio Novais 10, 28040, Madrid, Spain
| | - Esther Nova
- Immunonutrition Research Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN)-CSIC, C/José Antonio Novais 10, 28040, Madrid, Spain.
| |
Collapse
|
35
|
Anorexia nervosa hyperactivity-induced ischemic colitis (ANHIC): a new cause of anaemia. Eat Weight Disord 2016; 21:507-510. [PMID: 27314583 DOI: 10.1007/s40519-016-0295-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022] Open
|
36
|
Malnutrition in Healthy Individuals Results in Increased Mixed Cytokine Profiles, Altered Neutrophil Subsets and Function. PLoS One 2016; 11:e0157919. [PMID: 27548305 PMCID: PMC4993519 DOI: 10.1371/journal.pone.0157919] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 06/07/2016] [Indexed: 01/09/2023] Open
Abstract
Malnutrition is commonly associated with increased infectious disease susceptibility and severity. Whereas malnutrition might enhance the incidence of disease as well as its severity, active infection can in turn exacerbate malnutrition. Therefore, in a malnourished individual suffering from a severe infection, it is not possible to determine the contribution of the pre-existing malnutrition and/or the infection itself to increased disease severity. In the current study we focussed on two groups of malnourished, but otherwise healthy individuals: moderately malnourished (BMI: 18.4–16.5) and severely malnourished (BMI <16.5) and compared several immune parameters with those of individuals with a normal BMI (≥18.5). Our results show a similar haematological profile in all three groups, as well as a similar ratio of CD4+ and CD8+ T cells. We found significant correlations between low BMI and increased levels of T helper (Th) 1 (Interferon (IFN)-γ, (interleukin (IL)-2, IL-12), Th2 (IL-4, IL-5, IL-13), as well as IL-10, IL-33 and tumor necrosis factor-α, but not IL-8 or C reactive protein. The activities of arginase, an enzyme associated with immunosuppression, were similar in plasma, peripheral blood mononuclear cells (PBMC) and neutrophils from all groups and no differences in the expression levels of CD3ζ, a marker of T cell activation, were observed in CD4+ and CD8+T cells. Furthermore, whereas the capacity of neutrophils from the malnourished groups to phagocytose particles was not impaired, their capacity to produce reactive oxygen species was impaired. Finally we evaluated the frequency of a subpopulation of low-density neutrophils and show that they are significantly increased in the malnourished individuals. These differences were more pronounced in the severely malnourished group. In summary, our results show that even in the absence of apparent infections, healthy malnourished individuals display dysfunctional immune responses that might contribute to increased susceptibility and severity to infectious diseases.
Collapse
|
37
|
Shuttleworth E, Sharma S, Lal S, Allan PJ. Medical complications of anorexia nervosa. Br J Hosp Med (Lond) 2016; 77:287-93. [PMID: 27166107 DOI: 10.12968/hmed.2016.77.5.287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Anorexia nervosa is a psychiatric disorder with potential life-threatening medical sequelae. This article reviews the principal medical complications associated with anorexia nervosa, highlights associated diagnostic pitfalls and emphasizes the importance of a multidisciplinary approach to management.
Collapse
Affiliation(s)
- E Shuttleworth
- Specialty Trainee in Gastroenterology and General Internal Medicine in the Department of Gastroenterology, University Hospital of South Manchester, Manchester M23 9LT
| | - S Sharma
- Consultant Psychiatrist in the Priory Eating Disorder Services, The Priory Hospital Cheadle Royal, Cheadle
| | - S Lal
- Consultant Gastroenterologist in the Intestinal Failure Unit, Salford Royal Foundation NHS Trust, Salford
| | - P J Allan
- Consultant Gastroenterologist in the Department of Gastroenterology, John Radcliffe Hospital, Oxford
| |
Collapse
|
38
|
Hematological complications in anorexia nervosa. Eur J Clin Nutr 2016; 70:1305-1308. [PMID: 27436150 PMCID: PMC5107965 DOI: 10.1038/ejcn.2016.115] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 04/01/2016] [Accepted: 05/03/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVES Anemia, leukopenia and, although less frequently, thrombocytopenia are possible hematological complications of anorexia nervosa considered strictly secondary to chronic malnutrition. This is a retrospective study on the prevalence of these disorders in a large cohort of 318 female patients with AN (20.4±5.6 years, body mass index (BMI) 15.9±1.6 kg/m2), recruited in the Outpatient Unit for Malnutrition secondary to Eating Disorders at the Department of Clinical Medicine and Surgery, Federico II University Hospital, since February 1991 to December 2012. SUBJECTS/METHODS Patients were studied on an outpatient basis after obtaining medical history, clinical examination, routine hematobiochemical and endocrine tests, electrocardiography, psychiatric interview and bioelectrical impedance analysis and, in particular, phase angle determination. All patients with other comorbidities, in particular with mean corpuscular volume <80 fl, were excluded for suspected genetic alteration in the synthesis of hemoglobin. RESULTS Hematologic data showed that 16.7% of patients had anemia, 7.9% neutropenia and 8.9% thrombocytopenia. These abnormalities were strictly related to the duration of illness (P=0.028), and to protein energy malnutrition, in particular, BMI and phase angle (P<0.001). CONCLUSIONS Our study offers description of the incidence of hematologic defects in a selected and large sample of AN female patients, suggesting that its incidence is related to the degree and duration of protein energy malnutrition.
Collapse
|
39
|
Raevuori A, Lukkariniemi L, Suokas JT, Gissler M, Suvisaari JM, Haukka J. Increased use of antimicrobial medication in bulimia nervosa and binge-eating disorder prior to the eating disorder treatment. Int J Eat Disord 2016; 49:542-52. [PMID: 26875554 DOI: 10.1002/eat.22497] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 11/23/2015] [Accepted: 11/30/2015] [Indexed: 01/31/2023]
Abstract
OBJECTIVE We examined the use of antimicrobial medication as a proxy for infections in large patient cohort treated for binge-eating disorder (BED), bulimia nervosa (BN), and anorexia nervosa (AN) over the five-year period preceding eating disorder treatment. METHOD Patients (N = 1592) at the Eating Disorder Unit of Helsinki University Central Hospital between 2000 and 2010 were compared with matched general population controls (N = 6368). The study population was linked to the prescription data of antibacterial, antifungal and antiviral medication from the Register on Reimbursed Prescription Medicine. Data were analyzed using regression models. RESULTS Individuals with BN and BED had received more often antimicrobial medication prescriptions compared to their controls (OR: 1.7, 95% CI: 1.3-2.1; OR: 2.6, 95% CI: 1.4-4.6, respectively), while no significant difference emerged in AN (OR: 0.9, 95% CI: 0.7-1.0, p = 0.10). Of the main drug categories, the respective pattern was seen in antibacterial and antifungal medication, while increased use for antivirals appeared only in BN (OR: 1.6, 95% CI: 1.1-2.3). Measured with the mean number of prescriptions or mean Defined Daily Doses per individual, patients with BN, BED and males with AN had also higher total antimicrobial medication use. DISCUSSION Indicating increased infections, we found elevated use of antimicrobial medication in BN, BED and in males with AN. Infections may be consequence of hyperglycemia, weight gain, or dysregulation of intestinal microbiota associated with core eating disorder behaviors. Or the other way round; changes in intestinal microbiota due to infections, inflammation, or antibacterial medications might contribute to eating disorders in multiple ways. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:542-552).
Collapse
Affiliation(s)
- Anu Raevuori
- Clinicum, Department of Public Health, University of Helsinki, Finland.,Department of Adolescent Psychiatry, Helsinki University Central Hospital, Helsinki, Finland.,Institute of Clinical Medicine, Child Psychiatry, University of Turku, Finland.,Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| | | | - Jaana T Suokas
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.,Department of Psychiatry, Helsinki University Central Hospital, Finland
| | - Mika Gissler
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland
| | - Jaana M Suvisaari
- Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland.,Department of Social Psychiatry, Tampere School of Public Health, Finland
| | - Jari Haukka
- Clinicum, Department of Public Health, University of Helsinki, Finland.,Department of Mental Health and Substance Abuse Services, National Institute for Health and Welfare, Helsinki, Finland
| |
Collapse
|
40
|
Westmoreland P, Krantz MJ, Mehler PS. Medical Complications of Anorexia Nervosa and Bulimia. Am J Med 2016; 129:30-7. [PMID: 26169883 DOI: 10.1016/j.amjmed.2015.06.031] [Citation(s) in RCA: 218] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 06/19/2015] [Accepted: 06/19/2015] [Indexed: 11/19/2022]
Abstract
Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical complications associated with the weight loss and malnutrition of anorexia nervosa, as well as from the purging behaviors that characterize bulimia nervosa. No body system is spared from the adverse sequelae of these illnesses, especially as anorexia nervosa and bulimia nervosa become more severe and chronic. We review the medical complications that are associated with anorexia nervosa and bulimia nervosa, as well as the treatment for the complications. We also discuss the epidemiology and psychiatric comorbidities of these eating disorders.
Collapse
Affiliation(s)
| | - Mori J Krantz
- Cardiology Division, Denver Health Medical Center, Denver, Colo; Department of Medicine, University of Colorado Health Sciences Center, Denver
| | - Philip S Mehler
- Eating Recovery Center of Denver, Denver, Colo; Department of Medicine, University of Colorado Health Sciences Center, Denver; ACUTE at Denver Health, Denver Health Medical Center, Denver, Colo.
| |
Collapse
|
41
|
[Gelatinous transformation of the bone marrow: A retrospective monocentric case series of 12 patients]. Rev Med Interne 2015; 37:448-52. [PMID: 26632481 DOI: 10.1016/j.revmed.2015.10.349] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 07/01/2015] [Accepted: 10/24/2015] [Indexed: 11/24/2022]
Abstract
PURPOSE Gelatinous bone marrow transformation is a rare complication of unknown pathogenesis related to several underlying diseases. It is described as a focal loss of hematopoietic cells and a deposition of eosinophilic gelatinous substance rich in hyaluronic acid. We report a retrospective monocentric study followed by a literature review. METHODS We have identified 12 patients with gelatinous transformation from 1999 to 2014. Clinical, biological and cytological data were collected. RESULTS A bone marrow aspirate was performed for mild to severe pancytopenia (50%), less frequently for monocytopenia. Mean haemoglobin was 10.4g/dL, platelets 126.9G/L and leucocytes 3.82G/L. Gelatinous transformation was found in all patients. We have identified three hematologic malignancies, three cancers, three severe infections, two anorexia nervosa and one kidney injury. Ten patients had undernutrition, 9 out of the 12 patients died within a year due to advanced underlying disease and comorbidities. CONCLUSION Gelatinous bone marrow transformation is found in various situations of severe undernutrition including anorexia nervosa, advanced cancers or severe sepsis, especially in HIV infection. The deposition of hyaluronic acid probably reduces haematopoiesis. Due to a complex inflammatory process, it alters the hematopoietic microenvironment and the bone marrow stroma. Severe undernutrition and other mechanisms are reviewed in this study. Gelatinous degeneration is still a rare disorder, indicative of an advanced underlying disease; its recognition could help guide investigations.
Collapse
|
42
|
[Blunted erythropoietic response in the anemia of anorexia nervosa]. Med Clin (Barc) 2015; 145:433-5. [PMID: 26049959 DOI: 10.1016/j.medcli.2015.03.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Revised: 03/13/2015] [Accepted: 03/19/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE The cause of the anemia in anorexia nervosa (AN) has not been fully ascertained. Ferritin, folate and cobalamin values are usually within normal ranges. Anemia does not have a relationship with bone marrow changes and erythropoietin (EPO) levels have not been investigated. The objective of this study was to evaluate the EPO response in a small group of AN patients. PATIENTS AND METHODS EPO levels were measured in serum samples of 41 female AN patients (11 with anemia, and 30 with normal blood cell count). The adequacy of EPO response was assessed by comparing the increase observed in a group of normal weight patients with anemia. RESULTS EPO concentrations in anemic AN patients were higher than in non-anemic: 20.63mU/mL (4.04-28.46) vs 8.7mU/mL (3.9-20.93), P=.0088, but the increase in EPO was lower than expected (27.85mU/mL [17.7-118.9]), P=.014. BMI and the difference between actual and expected EPO were inversely correlated. CONCLUSIONS Inadequate EPO response may partly explain anemia in AN, but further studies are necessary.
Collapse
|
43
|
Frølich J, Palm CVB, Støving RK. To the limit of extreme malnutrition. Nutrition 2015; 32:146-8. [PMID: 26520917 DOI: 10.1016/j.nut.2015.08.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 08/13/2015] [Accepted: 08/27/2015] [Indexed: 11/27/2022]
Abstract
Extreme malnutrition with body mass index (BMI) as low as 10 kg/m(2) is not uncommon in anorexia nervosa, with survival enabled through complex metabolic adaptations. In contrast, outcomes from hunger strikes and famines are usually fatal after weight loss to about 40% below expected body weight, corresponding to BMI 12 to 13 kg/m(2) in adults. Thus, many years of adaptation in adolescent-onset anorexia nervosa, supported by supplements of vitamins and treatment of intercurrent diseases, may allow survival at a much lower BMI. However, in the literature only a few cases of survival in patients with BMI <9 kg/m(2) have been described. We report on the case of a 29-y-old woman who was successfully treated in a specialized unit. She had a BMI of 7.8 kg/m(2). To our knowledge, this level of extreme malnutrition has not previously been reported. The present case emphasizes the importance of adherence to guidelines to decrease refeeding complications.
Collapse
Affiliation(s)
- Jacob Frølich
- Centre for Eating Disorders, Department of Endocrinology, Odense University Hospital, Odense, Denmark.
| | | | - Rene K Støving
- Centre for Eating Disorders, Department of Endocrinology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
44
|
Sheng M, Lu H, Liu P, Thomas BP, McAdams CJ. Cerebral perfusion differences in women currently with and recovered from anorexia nervosa. Psychiatry Res 2015; 232:175-83. [PMID: 25795596 PMCID: PMC4417098 DOI: 10.1016/j.pscychresns.2015.02.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 12/19/2014] [Accepted: 02/19/2015] [Indexed: 12/26/2022]
Abstract
Anorexia nervosa is a serious psychiatric disorder characterized by restricted eating, a pursuit of thinness, and altered perceptions of body shape and size. Neuroimaging in anorexia nervosa has revealed morphological and functional alterations in the brain. A better understanding of physiological changes in anorexia nervosa could provide a brain-specific health marker relevant to treatment and outcomes. In this study, we applied several advanced magnetic resonance imaging (MRI) techniques to quantify regional and global cerebral blood flow (CBF) in 25 healthy women (HC), 23 patients currently with anorexia (AN-C) and 19 patients in long-term weight recovery following anorexia (AN-WR). Specifically, CBF was measured with pseudo-continuous arterial spin labeling (pCASL) MRI and then verified by a different technique, phase contrast (PC) MRI. Venous T2 values were determined by T2 relaxation under spin tagging (TRUST) MRI, and were used to corroborate the CBF results. These novel techniques were implemented on a standard 3T MRI scanner without any exogenous tracers, and the total scan duration was less than 10min. Voxel-wise comparison revealed that the AN-WR group showed lower CBF in bilateral temporal and frontal lobes than the AN-C group. Compared with the HC group, the AN-C group also showed higher CBF in the right temporal lobe. Whole-brain-averaged CBF was significantly decreased in the AN-WR group compared with the AN-C group, consistent with the PC-MRI results. Venous T2 values were lower in the AN-WR group than in the AN-C group, consistent with the CBF results. A review of prior work examining CBF in anorexia nervosa is included in the discussion. This study identifies several differences in the cerebral physiological alterations in anorexia nervosa, and finds specific differences relevant to the current state of the disorder.
Collapse
Affiliation(s)
- Min Sheng
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
| | - Hanzhang Lu
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, TX 75390, United States,Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
| | - Peiying Liu
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, TX 75390, United States,Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
| | - Binu P. Thomas
- Advanced Imaging Research Center, The University of Texas Southwestern Medical Center, Dallas, TX 75390, United States
| | - Carrie J. McAdams
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX 75390, United States,Corresponding author. Tel: +1 214 648 4145; fax: +1 214 648 5321. (C.J.McAdams)
| |
Collapse
|
45
|
MRI findings of serous atrophy of bone marrow and associated complications. Eur Radiol 2015; 25:2771-8. [PMID: 25773942 DOI: 10.1007/s00330-015-3692-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/06/2015] [Accepted: 02/23/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To report the MRI appearance of serous atrophy of bone marrow (SABM) and analyse clinical findings and complications of SABM. METHODS A retrospective search of MRI examinations of SABM was performed. Symptoms, underlying conditions, MRI findings, delay in diagnosis and associated complications were recorded. RESULTS We identified 30 patients (15 male, 15 female; mean age: 46 ± 21 years) with MRI findings of SABM. Underlying conditions included anorexia nervosa (n = 10), cachexia from malignant (n = 5) and non-malignant (n = 7) causes, massive weight loss after bariatric surgery (n = 1), biliary atresia (n = 1), AIDS (n = 3), endocrine disorders (n = 2) and scurvy (n = 1). MRI showed mildly hypointense signal on T1- weighted and hyperintense signal on fat-suppressed fluid-sensitive images of affected bone marrow in all cases and similar signal abnormalities of the adjacent subcutaneous fat in 29/30 cases. Seven patients underwent repeat MRI due to initial misinterpretation of bone marrow signal as technical error. Superimposed fractures of the hips and lower extremities were common (n = 14). CONCLUSIONS SABM occurs most commonly in anorexia nervosa and cachexia. MRI findings of SABM are often misinterpreted as technical error requiring unnecessary repeat imaging. SABM is frequently associated with fractures of the lower extremities. KEY POINTS • SABM occurs in several underlying conditions, most commonly anorexia nervosa and cachexia. • Abnormal marrow signal is often misinterpreted as technical error requiring unnecessary repeat imaging. • SABM is frequently associated with stress fractures. • Fractures in SABM can be obscured by marrow signal abnormality on MRI.
Collapse
|
46
|
Abstract
In contrast to other mental health disorders, eating disorders have a high prevalence of concomitant medical complications. Specifically, patients suffering from anorexia nervosa (AN) have a litany of medical complications which are commonly present as part of their eating disorders. Almost every body system can be adversely, affected by this state of progressive malnutrition. Moreover, some of the complications can have permanent adverse effects even after there is a successful program of nutritional rehabilitation and weight restoration. Within this article we will review all body systems affected by AN. There is also salient information about both, how to diagnose these medical complications and which are the likely ones to result in permanent sequelae if not diagnosed and addressed early in the course of AN. In a subsequent article, the definitive medical treatment for these complications will be presented in a clinically practical manner.
Collapse
Affiliation(s)
- Philip S Mehler
- Department of Medicine, University of Colorado Health Sciences Center, ACUTE at Denver Health, and Eating Recovery Center, Denver, CO - 777 Bannock Street, MC4000, Denver, CO 80204, 7351 E Lowry Blvd, Suite 200, Denver, CO 80230 USA
| | - Carrie Brown
- Department of Medicine, University of Colorado Health Sciences Center and ACUTE at Denver Health, Denver, CO - 777 Bannock Street, MC4000, Denver, CO 80204 USA
| |
Collapse
|
47
|
Foppiani L, Cascio C, Pinto V, Lo Pinto G. End-stage anorexia nervosa in a young man: multifaceted metabolic, endocrine and infectious derangements managed in an internal medicine setting. Eat Weight Disord 2014; 19:525-30. [PMID: 24821487 DOI: 10.1007/s40519-014-0127-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 04/10/2014] [Indexed: 10/25/2022] Open
Abstract
Anorexia nervosa (AN) in males is an overlooked disease which requires early diagnosis and proper treatment. Clinical presentation is often severe and the risk of death is not negligible. We report the case of a young man with a 1-year history of AN who was admitted to our internal medicine department for a dramatic malnutrition (BMI: 10.5 kg/m(2)). Several biochemical and hormonal alterations were ascertained. Partial parenteral nutrition and a balanced diet were started. Asymptomatic refeeding syndrome occurred and was managed by enhanced electrolyte parenteral supplementation. Many hematologic abnormalities (anaemia, leukopenia and thrombocytopenia) were present and worsened during the occurrence of sepsis which required hemotransfusions and targeted parenteral antibiotics with improvement of both clinical condition and hematologic parameters. Bone marrow aspiration and cytofluorimetric evaluation showed hyperplasia and dysplasia of erythroid lineage and reduction of myeloid lineage. Significant body weight gain (+17 % vs. admission) was obtained and the patient was discharged with stable cardiovascular parameters and referred to an eating disorders centre where is currently followed.
Collapse
Affiliation(s)
- Luca Foppiani
- Department of Internal Medicine, Galliera Hospital, Mura delle Cappuccine 14, 16128, Genoa, Italy,
| | | | | | | |
Collapse
|
48
|
Bühren K, Gärtner L, Kennes LN, Seitz J, Hagenah U, Herpertz-Dahlmann B. [Hematological changes in adolescent anorexia nervosa]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2014; 42:19-26. [PMID: 24365960 DOI: 10.1024/1422-4917/a000266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Hematological changes often occur in patients with acute anorexia nervosa (AN). However, the relationship between these disturbances and other clinical parameters remains unclear. METHOD Leucocyte, erythrocyte, and thrombocyte counts as well as hematocrit, hemoglobin, and differential blood counts were collected at admission and after weight restoration in 88 female adolescent patients with the diagnosis of AN according to DSM-IV. These were then compared to clinical parameters. RESULTS At admission, there were mild changes in the blood count, most of which, however, were reversible after weight gain. Patients with a greater weight loss, a lower age-adjusted BMI, and a history of taking psychotropic drugs were more likely to develop hematological abnormalities. CONCLUSIONS Although most of the hematological changes in adolescent patients with AN were mild, patients with high weight loss and/or low age-adjusted BMI as well as those on psychotropic medication should be monitored carefully in order to avoid severe medical complications. An altered immune function in adult patients with chronic AN might contribute to a higher rate of infections and thus to an increased mortality.
Collapse
Affiliation(s)
- Katharina Bühren
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters der Universitätsklinik der RWTH Aachen, Deutschland
| | - Laura Gärtner
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters der Universitätsklinik der RWTH Aachen, Deutschland
| | - Lieven N Kennes
- Institut für Medizinische Statistik, RWTH Aachen University, Deutschland
| | - Jochen Seitz
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters der Universitätsklinik der RWTH Aachen, Deutschland
| | - Ulrich Hagenah
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters der Universitätsklinik der RWTH Aachen, Deutschland
| | - Beate Herpertz-Dahlmann
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters der Universitätsklinik der RWTH Aachen, Deutschland
| |
Collapse
|
49
|
Alterations of selected iron management parameters and activity in food-restricted female Wistar rats (animal anorexia models). Eat Weight Disord 2014; 19:61-8. [PMID: 24136349 PMCID: PMC3961629 DOI: 10.1007/s40519-013-0078-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 10/04/2013] [Indexed: 12/20/2022] Open
Abstract
AIMS The aim of this study was to assess the influence of food-restricted diets (anorexia models) on iron management and activity of rats. MATERIALS AND METHODS 48 rats were divided into 6 groups: 1 control (K) and 5 testing groups (K/2, GI, GII, GIII, GIV). K was fed ad libitum. K/2 received half the portion of the diet of K. The other groups received 100% of the diet eaten by K, but with different models of food restriction: GI-1 day on, 1 day starvation; GII-2 days on, 2 days starvation; GIII-3 days on, 3 days starvation; and GIV-4 days on, 4 days starvation. As a result, all testing groups ate half of the diet consumed by the control group. The concentrations of iron in selected tissues, ferritin, and selected iron management parameters in blood were examined, as well as the animals' activities associated with food craving. RESULTS The animal anorexia models used in this study had a significant influence on the blood concentrations of hemoglobin (p < 0.01), hematocrit (p < 0.05), RBC (p < 0.05), iron levels in liver (p < 0.05), kidney (p < 0.001), and heart (p < 0.05), the serum ferritin concentration (p < 0.001) and the rats activity (p < 0.001); whereas there was no influence on the other parameters. Generally, the statistically negative effects of starvation models on iron management parameters and activity of animals were observed. However, these effects were dependent on the model of anorexia more than on the quantity of food intake. CONCLUSIONS The negative effect of food deprivation on iron deficiency and rat activities were observed in all groups; however, the strongest effect was noticed in those animals subject to chronic starvation. Acute deprivations caused the reduction of activity in the rats, however, chronic starvation caused an increase in the activity of the first phase of the experiment, followed by a decline in the subsequent phase. It is possible that stress and frustration as well as depression may be caused by insufficient food intake, and as a result, by iron deficiency in a diet similar to human anorexia. However, more animal/human comparison studies are necessary.
Collapse
|
50
|
Scanelli G, Gualandi M, Simoni M, Manzato E. Somatic involvement assessed through a cumulative score of clinical severity in patients with eating disorders. Eat Weight Disord 2014; 19:49-59. [PMID: 24078389 DOI: 10.1007/s40519-013-0065-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 08/31/2013] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To evaluate the overall somatic involvement in patients with eating disorders (EDs). METHODS The medical records of 206 patients (age 15-56 years, 96.1% females) with diagnosis of anorexia nervosa (AN, n = 63, 30.6%), bulimia nervosa (BN, n = 78, 37.9%), or eating disorder not otherwise specified (EDNOS, n = 65, 31.6 %) were analyzed. A cumulative score of clinical severity (SCS) was computed according to the presence of physical, instrumental, and laboratory abnormalities, as well as to their prognostic impact. Based on the tertile distribution of SCS, three levels of severity were defined: low, medium, and high. RESULTS A medium/high level of severity was found in 63% of the whole sample, 89% of AN, 49% of BN, and 55% of EDNOS. In the whole sample, the risk of medium/high SCS was significantly and inversely related to the body mass index (BMI) and to the lifetime minimum BMI. The severity level was significantly and positively associated with diagnosis of AN, duration of amenorrhea C1 year, and presence of ED-related symptoms. EDNOS patients showed a higher risk for increased SCS than BN patients, although not significantly. CONCLUSION The non-negligible frequency of a relevant somatic involvement in patients with EDNOS suggests that a transdiagnostic scoring system might be helpful to identify ED cases at risk of medical complications.
Collapse
|