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Trovato CM, Capriati T, Bolasco G, Campana C, Papa V, Mazzoli B, Zanna V, Marchili MR, Basso MS, Maggiore G, Diamanti A. Five-Year Inpatient Management of Teenagers With Anorexia Nervosa: Focus on Nutritional Issues. J Pediatr Gastroenterol Nutr 2022; 74:674-680. [PMID: 35149647 DOI: 10.1097/mpg.0000000000003410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES In patients with Anorexia Nervosa (AN) malnutrition can lead to life-long nutritional treatments. The refeeding process can combine natural feeding (NF) with specific nutritional strategies, including oral nutritional supplements (ONS) and nasogastric feeding (NGF). Aims of the present study were to assess the efficacy of hospital protocol and identify the most effective inpatient nutritional strategies for weight restoration. METHODS All patients hospitalized from April 2015 to April 2020 were enrolled. According to hospital protocol, NF was proposed to all patients; ONS were combined with NF if caloric intake was <70% of the requirements and NGF was added if caloric intake did not reach 30% in the first week from admission. RESULTS Overall, 186 patients [M = 20; median age 14 (interquartile range 1316)] were included. Nutritional issues were the main indication to admission (56.6%). A significant effect of combination treatment, with a shorter duration of hospitalization when using ONS with NGF in addition to NF was found (ß: -20.28 [95% confidence interval -34.92:-5.65], P < 0.001). Only one patient showed a significant but limited increase of liver enzymes. CONCLUSIONS We provide a safe and effective standardized protocol to treat the malnutrition of teenagers with AN in an inpatient setting. Malnutrition was the most important cause of admission, and more than half of the patients admitted were severely malnourished. The combination of NF, ONS, and NGF was the most effective strategy to achieve the weight restoration; however, this result should be validated on larger series of patients treated with NGF and NF.
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Affiliation(s)
| | | | | | | | | | | | - Valeria Zanna
- the Department of Neuroscience, Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry
| | | | - Maria Sole Basso
- the Hepatology Gastroenterology and Nutrition Unit, I.R.C.C.S. Bambino Gesti Children's Hospital, Rome, italy
| | - Giuseppe Maggiore
- Gastroenterology and Nutritional Rehabilitation Unit
- the Hepatology Gastroenterology and Nutrition Unit, I.R.C.C.S. Bambino Gesti Children's Hospital, Rome, italy
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McKay AKA, Peeling P, Pyne DB, Tee N, Whitfield J, Sharma AP, Heikura IA, Burke LM. Six Days of Low Carbohydrate, Not Energy Availability, Alters the Iron and Immune Response to Exercise in Elite Athletes. Med Sci Sports Exerc 2021; 54:377-387. [PMID: 34690285 DOI: 10.1249/mss.0000000000002819] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To quantify the effects of a short-term (6-day) low carbohydrate (CHO) high fat (LCHF), and low energy availability (LEA) diet on immune, inflammatory, and iron-regulatory responses to exercise in endurance athletes. METHODS Twenty-eight elite male race walkers completed two 6-day diet/training phases. During phase 1 (Baseline), all athletes consumed a high CHO/energy availability (CON) diet (65% CHO and ~ 40 kcal·kg-1 fat free mass (FFM)·day-1). In phase 2 (Adaptation), athletes were allocated to either a CON (n = 10), LCHF (n = 8; <50 g·day-1 CHO and ~ 40 kcal·kg-1 FFM·day-1), or LEA diet (n = 10; 60% CHO and 15 kcal·kg-1 FFM·day-1). At the end of each phase, athletes completed a 25 km race walk protocol at ~75% VO2max. On each occasion, venous blood was collected before and after exercise for interleukin-6, hepcidin, cortisol and glucose concentrations, as well as white blood cell counts. RESULTS The LCHF athletes displayed a greater IL-6 (p = 0.019) and hepcidin (p = 0.011) response to exercise after Adaptation, compared to Baseline. Similarly, post-exercise increases in total white blood cell counts (p = 0.026) and cortisol levels (p < 0.001) were larger compared to Baseline following LCHF Adaptation. Decreases in blood glucose concentrations were evident post-exercise during Adaptation in LCHF (p = 0.049), whereas no change occurred in CON or LEA (p > 0.05). No differences between CON and LEA were evident for any of the measured biological markers (all p > 0.05). CONCLUSION Short-term adherence to a LCHF diet elicited small yet unfavorable iron, immune, and stress responses to exercise. In contrast, no substantial alterations to athlete health were observed when athletes restricted energy availability compared to athletes with adequate energy availability. Therefore, short-term restriction of CHO, rather than energy, may have greater negative impacts on athlete health.
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Affiliation(s)
- Alannah K A McKay
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia Western Australian Institute of Sport, Mt Claremont, WA, Australia School of Human Sciences (Exercise and Sport Science). The University of Western Australia, Crawley, WA, Australia Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia Triathlon Australia, Burleigh Heads, Australia Canadian Sport Institute - Pacific, Victoria, British Columbia, Canada Exercise Science, Physical & Health Education, University of Victoria British Columbia, Canada
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High serum ferritin levels are associated with a reduced periodontium in women with anorexia nervosa. Eat Weight Disord 2020; 25:1763-1770. [PMID: 31845211 DOI: 10.1007/s40519-019-00832-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/10/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Impaired oral health is a well-known complication in individuals with eating disorders, although this is difficult to identify by mental health professionals. The aim of this study was to evaluate the relationship between routine blood parameters and two oral health outcomes (dental erosion, reduced periodontium) in women with eating disorders. METHODS A face-to-face interview and a clinical oral examination were carried out in a cohort of 70 women from an addiction and psychiatry hospital unit. Biochemical and hematological parameters were collected in medical records at admission. Biological factors associated with a generalized reduced periodontium (≥ 30% of sites with clinical attachment loss ≥ 3 mm) and dental erosion [a basic erosive wear examination (BEWE) score ≥ 3] were determined by logistic regression models. RESULTS Forty-five women with either anorexia nervosa (n = 27) or bulimia nervosa (n = 18) were included in the study. None of the women had active periodontitis or other inflammatory comorbidity. Women with ≥ 30% of sites with clinical attachment loss ≥ 3 mm and those with a BEWE score ≥ 3 were older than women that did not exhibit a generalized reduced periodontium or dental erosion (37.1 ± 10.4 versus 28.8 ± 7.4, p < 0.01 and 35.2 ± 9.7 versus 28.1 ± 7.8, p = 0.01), respectively. After adjustments for age and duration of eating disorder, high serum ferritin levels were associated with a generalized reduced periodontium [OR (95%CI) = 1.04 (1.01; 1.07)]. No association was found between biological factors and dental erosion. CONCLUSION Serum ferritin levels together with age may be helpful to mental health professionals in screening patients with eating disorders for adequate referral to a dentist. LEVEL III Evidence obtained from a case-control analytic study.
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Stiegel KR, Lash JG, Sun DC, Green DM, Harrington MA, Cahill CW. Analysis of Preoperative Screening Criteria for Total Joint Arthroplasty in a Veteran Population. J Arthroplasty 2020; 35:S119-S123. [PMID: 31924489 DOI: 10.1016/j.arth.2019.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 11/23/2019] [Accepted: 12/12/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study describes the experience of patients who initially failed total joint arthroplasty preoperative screening criteria but were subsequently optimized and underwent surgery. METHODS Time to optimization from the patients' initial clinic visit was recorded. Following surgery, patients' body mass index and lab work were tracked to determine whether they "relapsed" to their preoptimized state. Descriptive statistics determined (1) the length of time to meet screening criteria and (2) which screening criteria took the longest to optimize. RESULTS Only 11 of 84 patients (13%) required greater than 1 year to meet criteria. Most patients (76%) "relapsed" to their previous nonqualifying status after surgery; however, this reversion did not contribute significantly to an increased rate of complication in short-term follow-up (P = .4298). CONCLUSION Patients in this study were able to achieve preoperative screening criteria for total joint arthroplasty in less than 1 year. Relapsing after surgery does not appear to adversely affect clinical outcomes.
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Affiliation(s)
- Kelly R Stiegel
- Joseph Barnhart Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX
| | - Jonathan G Lash
- Joseph Barnhart Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX
| | - Daniel C Sun
- Joseph Barnhart Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX
| | - David M Green
- Joseph Barnhart Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX; Department of Orthopedic Surgery, Michael E. DeBakey Veterans Administration Hospital, Houston, TX
| | - Melvyn A Harrington
- Joseph Barnhart Department of Orthopedic Surgery, Baylor College of Medicine, Houston, TX
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Pires SAP, Soares JC, Luz AMBD, Moleiro P. OUTPATIENT ANALYTIC ASSESSMENT OF ANOREXIA NERVOSA - THE IMPORTANCE OF VENOUS BLOOD GASES. ACTA ACUST UNITED AC 2020; 38:e2018358. [PMID: 31939517 PMCID: PMC6958540 DOI: 10.1590/1984-0462/2020/38/2018358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 01/13/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate serum biochemical parameters' evolution, especially venous blood gas (VBG), in anorexia nervosa (AN), correlating with clinical parameters. METHODS Retrospective study including out-patient AN adolescents, between January 2014 and May 2017. Three evaluations were compared: t1) first consultation; t2) consultation with the lowest body mass index (BMI) z-score and t3) with the highest BMI z-score. RESULTS A total of 24 adolescents (87.5% females) were included, mean age of presentation of 14.9±1.7 years, onset of symptoms 6.4±3.2 months before the first visit. In t1, BMI z-score of -1.91±1.11 kg/m2 and ideal weight % of 84.3±9.2. Amenorrhea was present in 88%. In t2 the analytical alterations were: altered VBG in 100%, altered ferritin (72% elevated), altered thyroid function (53% with thyroxine decrease), dyslipidemia (31% elevation of high density lipoprotein, 25% hypercholesterolemia), elevation of urea (25%), elevation of alanine aminotransferase (14%), hypoglycemia (14%), anemia (9%). Respiratory acidosis was present in 91% in t1, 100% in t2 and 94% in t3. There was a significant decrease between t2 and t3 in mean pCO2 (57.2 versus 53.6 mmHg; p=0.009) and mean HCO3 (30.0 versus 28.8 mEq/L; p=0.023). CONCLUSIONS Respiratory acidosis and increased ferritin were common in this group. Respiratory acidosis was the most frequent abnormality with significant pCO2 and HCO3 variation in the recovery phase. VBG should be considered in AN evaluation, once it seems to be important in assessing the severity of the disease and its subsequent follow-up.
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Sebastiani G, Andreu-Fernández V, Herranz Barbero A, Aldecoa-Bilbao V, Miracle X, Meler Barrabes E, Balada Ibañez A, Astals-Vizcaino M, Ferrero-Martínez S, Gómez-Roig MD, García-Algar O. Eating Disorders During Gestation: Implications for Mother's Health, Fetal Outcomes, and Epigenetic Changes. Front Pediatr 2020; 8:587. [PMID: 33042925 PMCID: PMC7527592 DOI: 10.3389/fped.2020.00587] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: Eating disorders (EDs) have increased globally in women of childbearing age, related to the concern for body shape promoted in industrialized countries. Pregnancy may exacerbate a previous ED or conversely may be a chance for improving eating patterns due to the mother's concern for the unborn baby. EDs may impact pregnancy evolution and increase the risk of adverse outcomes such as miscarriage, preterm delivery, poor fetal growth, or malformations, but the knowledge on this topic is limited. Methods: We performed a systematic review of studies on humans in order to clarify the mechanisms underpinning the adverse pregnancy outcomes in patients with EDs. Results: Although unfavorable fetal development could be multifactorial, maternal malnutrition, altered hormonal pathways, low pre-pregnancy body mass index, and poor gestational weight gain, combined with maternal psychopathology and stress, may impair the evolution of pregnancy. Environmental factors such as malnutrition or substance of abuse may also induce epigenetic changes in the fetal epigenome, which mark lifelong health concerns in offspring. Conclusions: The precocious detection of dysfunctional eating behaviors in the pre-pregnancy period and an early multidisciplinary approach comprised of nutritional support, psychotherapeutic techniques, and the use of psychotropics if necessary, would prevent lifelong morbidity for both mother and fetus. Further prospective studies with large sample sizes are needed in order to design a structured intervention during every stage of pregnancy and in the postpartum period.
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Affiliation(s)
- Giorgia Sebastiani
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Vicente Andreu-Fernández
- Grup de Recerca Infancia i Entorn (GRIE), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Valencian International University (VIU), Valencia, Spain
| | - Ana Herranz Barbero
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Victoria Aldecoa-Bilbao
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Xavier Miracle
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Eva Meler Barrabes
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Arantxa Balada Ibañez
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Marta Astals-Vizcaino
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Silvia Ferrero-Martínez
- Hospital Sant Joan de Déu, Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - María Dolores Gómez-Roig
- Hospital Sant Joan de Déu, Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Oscar García-Algar
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain.,Grup de Recerca Infancia i Entorn (GRIE), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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Adipokines, cortisol and cytokine alterations in recent onset anorexia nervosa. A case-control study. ACTA ACUST UNITED AC 2019; 66:571-578. [PMID: 30981680 DOI: 10.1016/j.endinu.2019.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 02/07/2019] [Accepted: 02/12/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Psychological and neuroendocrine alterations are typical characteristics in anorexia nervosa patients. The role of adipokines and cytokines as mediators of body systems' adaptations to the patients' abnormal eating behavior is not well understood. The duration of disease seems to be a determinant of nutritional status and associated hormone changes. We aimed to assess whether alterations in adipokines, cytokines and cortisol do already exist in patients with a recent disease onset by means of a case-control study. METHODS Forty-one adolescent female patients on their first-episode and diagnosed with anorexia nervosa, were matched by age and socioeconomic status (SES) (1:1) with healthy girls. Leptin, soluble leptin receptor (sOB-R), adiponectin, cortisol, and the cytokines IL-1β, IL-2, IL-6 and TNF-α were examined. RESULTS The results showed reduced leptin and increased sOB-R and cortisol levels in AN patients. Adiponectin was also increased but opposite to the previous biomarkers did not correlate with BMI Z-score. Serum TNF-α and IL-2 showed significantly lower and higher values, respectively, in the AN patients than in the controls. Cortisol showed the strongest correlation with sOB-R (r=0.436; P=0.005). CONCLUSIONS Our study confirms previous findings on adipokine and cortisol alterations in AN patients, while overall cytokine results did not show a clear disruption in AN patients with short disease duration. The results highlight the need to disentangle the role of the sOB-R in the interactions between leptin and cortisol secretion.
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Graell M, de Andrés P, Sepúlveda AR, Moreno A, Villaseñor Á, Faya M, Martínez‐Cantarero C, Gómez‐Martínez S, Marcos A, Morandé G, Nova E. The adolescent onset anorexia nervosa study (ANABEL): Design and baseline results. Int J Methods Psychiatr Res 2018; 27:e1739. [PMID: 30133037 PMCID: PMC6877151 DOI: 10.1002/mpr.1739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 06/05/2018] [Accepted: 07/16/2018] [Indexed: 11/06/2022] Open
Abstract
The anorexia nervosa adolescent longitudinal biomarker assessment study (ANABEL) is a 2-year longitudinal study. OBJECTIVE Evaluate several clinical, biochemical, immunological, psychological, and family variables and their interactions in adolescent onset eating disorders (EDs) patients and their 2-year clinical and biological outcome. This article illustrates the framework and the methodology behind the research questions, as well as describing general features of the sample. METHODS A longitudinal study of 114 adolescents with EDs seeking treatment was performed. Only adolescents were selected during 4 years (2009-2013). The variables were collected at different times: baseline, 6, 12, 18, and 24 months of the start of treatment. Diagnoses were completed through the semi-structured Kiddie-Schedule for Affective Disorders and Schizophrenia interview. RESULTS At baseline, the mean age was 15.11 (SD = 1.36). The mean ED duration was 10 months (SD = 5.75). The mean body mass index was 16.1 (SD = 1.8). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis at baseline for restrictive anorexia nervosa was 69.6%, 17.4% for purgative anorexia nervosa, and 24.3% for other specified feeding disorder. At 12 months, 19.4% were in partial remission, whereas at 24 months, 13.8% had fully recovered and 29.2% had partially recovered. CONCLUSIONS There was an acceptable physical and psychopathological improvement during the first year of treatment, with recovery being more evident during the first 6 months.
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Affiliation(s)
- Montserrat Graell
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM)España
| | - Patricia de Andrés
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
| | | | - Alba Moreno
- School of PsychologyAutonomous University of MadridMadridSpain
| | - Ángel Villaseñor
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
| | - Mar Faya
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
| | - Carmen Martínez‐Cantarero
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
| | - Sonia Gómez‐Martínez
- Immunonutrition Research Group, Department of Metabolism and NutritionInstitute of Food Science and Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC)MadridSpain
| | - Ascensión Marcos
- Immunonutrition Research Group, Department of Metabolism and NutritionInstitute of Food Science and Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC)MadridSpain
| | - Gonzalo Morandé
- Child and Adolescent Psychiatry and Psychology DepartmentHospital Infantil Universitario Niño JesúsMadridSpain
| | - Esther Nova
- Immunonutrition Research Group, Department of Metabolism and NutritionInstitute of Food Science and Technology and Nutrition (ICTAN), Spanish National Research Council (CSIC)MadridSpain
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Santos JAR, Zacca R, Fernandes RJ. Micronutrient Supplementation does not Change Complement System Response to Heavy Training. Sports Med Int Open 2017; 1:E113-E118. [PMID: 30539095 PMCID: PMC6226084 DOI: 10.1055/s-0043-111403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 04/06/2017] [Accepted: 05/04/2017] [Indexed: 12/24/2022] Open
Abstract
AbstractWe aimed to examine the micronutrient supplementation effect on complement system activity after heavy training. 24 male firefighters were randomly divided into supplemented and placebo groups, and tested for immunology-related parameters using venous blood samples in the fasting state pre- and post-5 weeks of nutritional supplementation. C3 and C4 complement components were determined in a nephelometer from immune complexes formed through specific human antisera and total haemolytic complement activity (CH100) was determined by enzyme immunoassay. Differences between pre- and post-supplementation were observed only for CH100 on placebo group (p=0.004; mean diff −26.92; 95%CI −43.58 to −10.25) and no interaction, treatment or time effects were observed for C3 and C4. Although interaction accounted for 8.8% of the total variance in CH100 (with time effect pre- vs post-accounting for 19.5% of the total variance), the treatment effect (supplemented vs placebo) was not significant. The absence of effects on the complement system response to supplementation during heavy training could be justified by the fact that: (i) nutritional supplements do not improve humoral innate immunity in well-fed subjects; (ii) selected supplements unlikely improve the innate immune system in situations of adequate nutritional status; and/or (iii) selected doses of supplementation were not sufficient to elicit immune changes.
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Affiliation(s)
| | - Rodrigo Zacca
- University of Porto, Faculty of Sport, Cifi2d, Porto, Portugal
| | - Ricardo J Fernandes
- University of Porto, Faculty of Sport, Cifi2d, Porto, Portugal.,University of Porto, Labiomep, Porto, Portugal
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Achamrah N, Coëffier M, Rimbert A, Charles J, Folope V, Petit A, Déchelotte P, Grigioni S. Micronutrient Status in 153 Patients with Anorexia Nervosa. Nutrients 2017; 9:nu9030225. [PMID: 28257095 PMCID: PMC5372888 DOI: 10.3390/nu9030225] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 02/23/2017] [Accepted: 02/27/2017] [Indexed: 02/06/2023] Open
Abstract
Micronutrient status in Anorexia Nervosa (AN) has been poorly documented and previous data are often contradictory. We aimed to assess micronutrient status in a large population of AN patients. The relationships between micronutrient status and body composition were also determined. Anthropometric, biochemical parameters and body composition data were collected at referral in 153 patients with AN (28.5 ± 11 years). At least one trace element deficit was observed in almost half of patients; the most frequent was selenium deficit (40% of patients). At least one vitamin deficit was observed in 45.7% of patients, mostly vitamin A and B9. Albumin, transthyretin and CRP were within normal range in most patients. No correlations were found between body composition and micronutrient status. Our study suggests that micronutrient status is often altered in AN patients, which may contribute to neuropsychiatric dysfunction. Monitoring of micronutrients and correction of deficits should be included in the routine care of AN patients.
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Affiliation(s)
- Najate Achamrah
- Nutrition Department, Rouen University Hospital, 76183 Rouen, France.
- INSERM Unit 1073, 76183 Rouen, France.
- Institute for Research and Innovation in Biomedicine, Normandie Université, 76183 Rouen, France.
- Clinical Investigation Centre CIC 1404 INSERM, 76183 Rouen, France.
| | - Moïse Coëffier
- Nutrition Department, Rouen University Hospital, 76183 Rouen, France.
- INSERM Unit 1073, 76183 Rouen, France.
- Institute for Research and Innovation in Biomedicine, Normandie Université, 76183 Rouen, France.
| | - Agnès Rimbert
- Nutrition Department, Rouen University Hospital, 76183 Rouen, France.
- INSERM Unit 1073, 76183 Rouen, France.
- Institute for Research and Innovation in Biomedicine, Normandie Université, 76183 Rouen, France.
| | - Jocelyne Charles
- Nutrition Department, Rouen University Hospital, 76183 Rouen, France.
| | - Vanessa Folope
- Nutrition Department, Rouen University Hospital, 76183 Rouen, France.
- INSERM Unit 1073, 76183 Rouen, France.
- Institute for Research and Innovation in Biomedicine, Normandie Université, 76183 Rouen, France.
| | - André Petit
- Nutrition Department, Rouen University Hospital, 76183 Rouen, France.
- INSERM Unit 1073, 76183 Rouen, France.
- Institute for Research and Innovation in Biomedicine, Normandie Université, 76183 Rouen, France.
| | - Pierre Déchelotte
- Nutrition Department, Rouen University Hospital, 76183 Rouen, France.
- INSERM Unit 1073, 76183 Rouen, France.
- Institute for Research and Innovation in Biomedicine, Normandie Université, 76183 Rouen, France.
| | - Sébastien Grigioni
- Nutrition Department, Rouen University Hospital, 76183 Rouen, France.
- INSERM Unit 1073, 76183 Rouen, France.
- Institute for Research and Innovation in Biomedicine, Normandie Université, 76183 Rouen, France.
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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.
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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.
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Wanby P, Berglund J, Brudin L, Hedberg D, Carlsson M. Increased ferritin levels in patients with anorexia nervosa: impact of weight gain. Eat Weight Disord 2016; 21:411-417. [PMID: 26830429 DOI: 10.1007/s40519-015-0246-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 11/12/2015] [Indexed: 01/12/2023] Open
Abstract
PURPOSE A few recent studies have found elevated ferritin levels in patients with anorexia nervosa (AN), indicating ferritin as a potential biomarker of disease severity. The purpose of this study was to study how body mass index (BMI) and changes in BMI affect plasma ferritin concentrations in Swedish patients with eating disorders. MATERIALS AND METHODS In a retrospective computer search from 2009 to 2014, 662 patients with an eating disorder were identified from more than 200,000 individuals with electronic medical records. Three hundred and eighty-nine patients (374 females and 15 males) were found to have at least one p-ferritin value with a corresponding BMI value. Patients with AN were compared to a combined group consisting of patients with bulimia nervosa (BN) and patients with an eating disorder not otherwise specified (EDNOS). RESULTS Patients with AN had lower BMI compared to the combined group of patients with other eating disorders (BMI = 16.5 ± 1.5, n = 77 vs. 21.0 ± 4.7, n = 312, p < 0.001). Patients with AN also had higher plasma ferritin levels (median 42 μg/L (range 3.3-310) vs. 31 μg/L (range 2.8-280); p < 0.001). As BMI increased in patients with AN, ferritin levels decreased (from a median of 40 μg/L (7-400) to 26 (4-170), n = 47; p < 0.001). DISCUSSION Measuring ferritin in patients with AN could be valuable in monitoring improvements of nutritional status, but the full clinical value of following ferritin in individual patients has yet to be determined. The study also shows how research can benefit from electronically captured clinical data using electronic health records.
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Affiliation(s)
- P Wanby
- Department of Internal Medicine, Section of Endocrinology, County Hospital of Kalmar, 391 85, Kalmar, Sweden.
| | - J Berglund
- University Hospital of Linköping, Linköping, Sweden
| | - L Brudin
- Department of Clinical Physiology, County Hospital of Kalmar, Kalmar, Sweden
| | - D Hedberg
- Department of IT-Administration, County Council of Kalmar, Kalmar, Sweden
| | - M Carlsson
- Department of Clinical Chemistry, County Hospital of Sweden, Kalmar, Sweden
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Truong A, Hanna MH, Moghadamyeghaneh Z, Stamos MJ. Implications of preoperative hypoalbuminemia in colorectal surgery. World J Gastrointest Surg 2016; 8:353-362. [PMID: 27231513 PMCID: PMC4872063 DOI: 10.4240/wjgs.v8.i5.353] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 01/07/2016] [Accepted: 03/09/2016] [Indexed: 02/06/2023] Open
Abstract
Serum albumin has traditionally been used as a quantitative measure of a patient’s nutritional status because of its availability and low cost. While malnutrition has a clear definition within both the American and European Societies for Parenteral and Enteral Nutrition clinical guidelines, individual surgeons often determine nutritional status anecdotally. Preoperative albumin level has been shown to be the best predictor of mortality after colorectal cancer surgery. Specifically in colorectal surgical patients, hypoalbuminemia significantly increases the length of hospital stay, rates of surgical site infections, enterocutaneous fistula risk, and deep vein thrombosis formation. The delay of surgical procedures to allow for preoperative correction of albumin levels in hypoalbuminemic patients has been shown to improve the morbidity and mortality in patients with severe nutritional risk. The importance of preoperative albumin levels and the patient’s chronic inflammatory state on the postoperative morbidity and mortality has led to the development of a variety of surgical scoring systems to predict outcomes efficiently. This review attempts to provide a systematic overview of albumin and its role and implications in colorectal surgery.
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Solmi M, Veronese N, Manzato E, Sergi G, Favaro A, Santonastaso P, Correll CU. Oxidative stress and antioxidant levels in patients with anorexia nervosa: A systematic review and exploratory meta-analysis. Int J Eat Disord 2015; 48:826-41. [PMID: 26311090 DOI: 10.1002/eat.22443] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To systematically review and meta-analyze oxidative stress and antioxidant markers in anorexia nervosa (AN). METHODS Electronic PubMed search from database inception until 12/31/2013. Out of 1062 hits, 29 studies comparing oxidative stress/antioxidant markers between patients with AN and healthy controls (HCs) with a total of 1,729 participants (AN = 895, HCs = 834) were eligible. Data about oxidative stress and antioxidant markers, independent of their source, were extracted. We calculated random effects standardized mean differences (SMDs) as effect size measures for outcomes reported in ≥5 studies; others were summarized descriptively. RESULTS Compared to HCs, AN patients showed significantly higher apolipoprotein B (ApoB) levels (studies = 7; n = 551; SMD = 0.75; p = .0003, I(2) = 74%), with higher age being associated with higher ApoB (Coefficient: 0.61 ± 0.15, p < .0001), whereas BMI (p = .15) and measurement method (p = .70) did not moderate the results. Serum albumin levels were similar between AN and HCs (studies = 13; n = 509; SMD =-0.19; 95%CI: -0.62 to 0.24; p = .38; I(2) = 81%), with neither age (p = .84) nor BMI (p = .52) being significant moderators. Lower superoxide dismutase levels were reported in 2 studies, while findings for vitamin A and its metabolites were inconclusive. In single studies, patients with AN had significantly higher catalase and nitric oxide (NO) parameter levels (platelet NO, exhaled NO and nitrites), such as lower glutathione and free cysteine levels, compared to HCs. DISCUSSION AN appears to be associated with some markers of increased oxidative stress. Additional research is needed to discern whether oxidative stress is a potential cause or effect of AN, and whether treatments improving oxidative stress could be useful in AN.
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Affiliation(s)
- Marco Solmi
- Department of Neurosciences, University of Padova, via Giustiniani, Padova, Italy
| | - Nicola Veronese
- Department of Medicine- DIMED, University of Padova, Geriatrics Section, via Giustiniani, Padova, Italy
| | - Enzo Manzato
- Department of Medicine- DIMED, University of Padova, Geriatrics Section, via Giustiniani, Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine- DIMED, University of Padova, Geriatrics Section, via Giustiniani, Padova, Italy
| | - Angela Favaro
- Department of Neurosciences, University of Padova, via Giustiniani, Padova, Italy
| | - Paolo Santonastaso
- Department of Neurosciences, University of Padova, via Giustiniani, Padova, Italy
| | - Christoph U Correll
- Department of Psychiatry, the Zucker Hillside Hospital, Glen Oaks, New York.,Hofstra North Shore LIJ School of Medicine, Hempstead, New York.,The Feinstein Institute for Medical Research, Manhasset, New York.,Albert Einstein College of Medicine, Bronx, New York
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Tamura A, Minami K, Tsuda Y, Yoshikawa N. Total parenteral nutrition treatment efficacy in adolescent eating disorders. Pediatr Int 2015; 57:947-53. [PMID: 26016952 DOI: 10.1111/ped.12717] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 02/16/2015] [Accepted: 03/06/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Management of adolescent patients with severe eating disorders who refuse treatment for weight loss is complicated. Nutritional rehabilitation is most important during the growth period; thus, strong support in the form of total parenteral nutrition (TPN) as soon as possible is necessary in severe cases. No studies involving detailed, long-term follow up have evaluated biochemical markers and gonadotropin in patients undergoing TPN treatment. METHODS Twenty-five adolescent female patients admitted to hospital received TPN immediately, and biochemical marker and gonadotropin levels were measured and analyzed. If subsequent weight gain was observed, TPN treatment was gradually reduced and stopped. RESULTS No patients dropped out of the study. A significant increase in weight was observed during hospitalization (average, 8.0 kg). Under this treatment, serum total bilirubin was significantly decreased at 3 months, total cholesterol was significantly decreased at 2 months, and alkaline phosphatase (ALP) was significantly increased at 3 and 6 months. Follicle-stimulating hormone response significantly preceded both luteinizing hormone response and appetite recovery. After this treatment, nine of the 25 patients were readmitted for recurrence of appetite loss. Two patients required additional TPN treatment, but seven immediately recovered their appetite after hospitalization without TPN treatment. Bodyweight gain per day was significantly lower and ALP on admission was significantly higher in patients with than without recurrence. CONCLUSIONS Most patients had a remarkable recovery of appetite without refusal behaviors and without evidence of malnutrition after admission. Nutrition maintenance with TPN support is particularly important during the growth period.
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Affiliation(s)
- Akira Tamura
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Koichi Minami
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
| | - Yuuko Tsuda
- Department of Pediatrics, Wakayama Medical University, Wakayama, Japan
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Lee JL, Oh ES, Lee RW, Finucane TE. Serum Albumin and Prealbumin in Calorically Restricted, Nondiseased Individuals: A Systematic Review. Am J Med 2015; 128:1023.e1-22. [PMID: 25912205 DOI: 10.1016/j.amjmed.2015.03.032] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/13/2015] [Accepted: 03/16/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE Undernutrition is often suspected in patients when serum albumin or prealbumin levels are low. We asked whether these measures are indeed low in undernourished people if no inflammatory illness is present. METHODS We did a systematic review to identify otherwise healthy subjects who were severely nutrient-deprived due to poor access to food or unwillingness to eat. We excluded children and pregnant women. We tabulated available measures of nutrient intake, anthropometry, serum albumin and prealbumin, and, when available, changes in these measures during nutritional intervention. RESULTS In otherwise healthy subjects, serum albumin and prealbumin levels remained normal despite marked nutrient deprivation until the extremes of starvation, that is, body mass index <12 or more than 6 weeks of starvation. CONCLUSIONS In these otherwise healthy subjects, serum albumin and prealbumin levels are not "markers of nutritional status." The "markers" failed to identify subjects with severe protein-calorie malnutrition until extreme starvation. That is, they failed to identify healthy individuals who would benefit from nutrition support, becoming abnormal only when starvation was already obvious. In contrast, serum albumin and prealbumin levels are known to fall promptly with injury or illness regardless of nutrient intake. They are negative acute-phase reactants. When these measures are low in sick patients, this cannot be assumed to reflect nutritional deprivation. Decisions about nutrition support should be based on evidence of meaningful benefit from this treatment rather than on assessment of "nutritional markers."
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Affiliation(s)
- Jessica L Lee
- Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Esther S Oh
- Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Rebecca W Lee
- Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Thomas E Finucane
- Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, Md.
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Gaudiani JL, Sabel AL, Mehler PS. Low prealbumin is a significant predictor of medical complications in severe anorexia nervosa. Int J Eat Disord 2014; 47:148-56. [PMID: 24375513 DOI: 10.1002/eat.22233] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 11/20/2013] [Accepted: 11/26/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Prealbumin levels have been proven to correlate with hospital length of stay, wound healing, infection rates, and mortality in adults hospitalized for medical or surgical purposes, or those who have chronic illnesses. Little is known about the utility of prealbumin evaluation in adults with severe anorexia nervosa (AN). METHOD We retrospectively evaluated prealbumin levels, along with numerous other clinical parameters relevant to illness acuity and early refeeding outcomes, in 132 adults with AN admitted for definitive inpatient medical stabilization from October 1, 2008 to December 31, 2012. Per clinical protocol, prealbumin was checked on admission and approximately weekly thereafter until discharge. RESULTS Patients had a median age of 28 years old, a mean admission body mass index (BMI) of 12.9 kg/m(2) (S.D. 6.1), and 89% of patients were women. A total of 47% of patients had a low prealbumin at the time of admission. By discharge, 77% of patients had normalized their prealbumin levels. Patients with low admission prealbumin levels had a threefold increased risk of refeeding hypophosphatemia and a twofold increase in hypoglycemia compared with patients who had a normal admission prealbumin, independent of admission BMI. DISCUSSION A low serum prealbumin level appeared concurrent with other markers of serious medical compromise, and was associated with two potentially life threatening complications of early refeeding: hypophosphatemia and hypoglycemia. The cause of low prealbumin remains elusive. Prealbumin should be checked in patients with severe AN prior to initiating weight restoration, as low levels may be an important harbinger of early refeeding complications.
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Affiliation(s)
- Jennifer L Gaudiani
- Department of Medicine, University of Colorado Denver, Denver, Colorado; ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado
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Nemba K, Lewis B, Watson H, Hoiles K, Zhang G, Forbes D. Serum ferritin and nutritional status: insights from an eating disorders clinic population. Arch Dis Child 2014; 99:221-4. [PMID: 24288135 DOI: 10.1136/archdischild-2012-303272] [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] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the relationship between serum ferritin and malnutrition in newly assessed patients at a paediatric eating disorders clinic. DESIGN This was a prospectively assessed clinical cohort study. SETTING Intake assessment clinic of a tertiary eating disorders service for children and adolescents. METHODS Clinical, anthropometric and laboratory features of children and adolescents were systematically measured. The relationship of serum ferritin to other clinical, anthropometric and laboratory measures was determined using linear regression. RESULTS A total of 121 female patients aged 9.5-17.6 years were included, with body mass index (BMI) z score -5.7 to 1.9 (median -1.3). Using multiple regression, serum ferritin was inversely associated with BMI z score (regression coefficient (β)=-0.234, 95% CI -0.413 to -0.055) and serum insulin-like growth factor 1 (IGF-1) (β=-0.476, 95% CI -0.884 to -0.068) and positively associated with alanine aminotransferase (β=0.357, 95% CI 0.055 to 0.659, controlling for age, pubertal stage and serum iron). CONCLUSIONS In malnourished adolescents with eating disorders increased serum ferritin is associated with lower BMI z score and serum IGF-1.
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Affiliation(s)
- Kuria Nemba
- Gastroenterology Department, Princess Margaret Hospital for Children, , Perth, Western Australia, Australia
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Nova E, Marcos A. Immunocompetence to assess nutritional status in eating disorders. Expert Rev Clin Immunol 2014; 2:433-44. [DOI: 10.1586/1744666x.2.3.433] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Palma RFM, Santos JED, Ribeiro RPP. Evolução nutricional de pacientes com transtornos alimentares: experiência de 30 anos de um Hospital Universitário. REV NUTR 2013. [DOI: 10.1590/s1415-52732013000600006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJETIVO: Descrever a evolução do estado nutricional e dos parâmetros bioquímicos de pacientes com anorexia nervosa e bulimia nervosa internados para tratamento durante seguimento em serviço especializado. MÉTODOS: Foram revisados todos os prontuários dos pacientes em seguimento pelo serviço de 1982 a 2011, que foram internados para tratamento. Dados sociodemográficos, peso, altura e exames bioquímicos foram coletados no início e final da internação. RESULTADOS: No período referido, 83 pacientes com diagnóstico de anorexia ou bulimia nervosa foram internados para tratamento. A maioria era do sexo feminino (95,2%) raça branca (94,0%), solteira (76,0%) e sem filhos (78,3%). O diagnóstico predominante foi de anorexia nervosa (85,5%), sobretudo em seu tipo restritivo (54,2%). O índice de massa corporal médio dos pacientes adultos (n=41) evoluiu de 16,53±4,9 para 17,47±4,3kg/m² (p<0,05). Para as crianças e adolescentes (n=38), passou de 13,78±2,57 para 15,11±2,99kg/m² (p<0,05). Os valores médios da maioria dos parâmetros bioquímicos estavam dentro do limite da normalidade e, apenas o betacaroteno, manteve-se em níveis médios acima da normalidade no início e final da internação. Os valores de albumina, hematócrito, lipoproteína de alta densidade e potássio melhoraram ao final da internação (p<0,05). CONCLUSÃO: A hospitalização integral, apesar das dificuldades e da complexidade inerentes ao tratamento dos transtornos alimentares, considerando-se principalmente a resistência frente à recuperação do peso, pode proporcionar melhoria no estado nutricional e normalização de diversos parâmetros bioquímicos.
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Tran J, Story C, Moore D, Metz M. Unexpected increased ferritin concentration in patients with anorexia nervosa. Ann Clin Biochem 2013; 50:504-6. [PMID: 23897102 DOI: 10.1177/0004563213490289] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Ferrie S, Allman-Farinelli M. Commonly Used “Nutrition” Indicators Do Not Predict Outcome in the Critically Ill. Nutr Clin Pract 2013; 28:463-84. [DOI: 10.1177/0884533613486297] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Suzie Ferrie
- Royal Prince Alfred Hospital, Sydney, Australia
- University of Sydney, Sydney, Australia
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Mocchegiani E, Romeo J, Malavolta M, Costarelli L, Giacconi R, Diaz LE, Marcos A. Zinc: dietary intake and impact of supplementation on immune function in elderly. AGE (DORDRECHT, NETHERLANDS) 2013; 35:839-60. [PMID: 22222917 PMCID: PMC3636409 DOI: 10.1007/s11357-011-9377-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2011] [Accepted: 12/21/2011] [Indexed: 05/07/2023]
Abstract
The diet in the elderly does not provide a sufficient level of nutrients needed to maintain an adequate healthy status leading to micronutrient deficiencies and impaired immune response with subsequent development of degenerative diseases. Nutrient "zinc" is a relevant micronutrient involved in maintaining a good integrity of many body homeostatic mechanisms, including immune efficiency, owing to its requirement for the biological activity of many enzymes, proteins and for cellular proliferation and genomic stability. Old people aged 60-65 years and older have zinc intakes below 50% of the recommended daily allowance on a given day. Many causes can be involved: among them, altered intestinal absorption, inadequate mastication, psychosocial factors, drugs interactions, altered subcellular processes (zinc transporters (Zip and ZnT family), metallothioneins, divalent metal transporter-1). Zinc supplementation may remodel the immune alterations in elderly leading to healthy ageing. Several zinc trials have been carried out with contradictory data, perhaps due to incorrect choice of an effective zinc supplementation in old subjects showing subsequent zinc toxic effects on immunity. Old subjects with specific IL-6 polymorphism (GG allele carriers; named C-) are more prone for zinc supplementation than the entire old population, in whom correct dietary habits with foods containing zinc (Mediterranean diet) may be sufficient in restoring zinc deficiency and impaired immune response. We summarise the main causes of low zinc dietary intake in elderly reporting an update on the impact of zinc supplementation upon the immune response also on the basis of individual IL-6 polymorphism.
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Affiliation(s)
- Eugenio Mocchegiani
- Ctr. Nutrition and Ageing, Italian National Research Centres on Ageing (INRCA), Via Birarelli 8, 60121, Ancona, Italy.
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Abstract
In anorexia nervosa, under-nutrition and weight regulatory behaviours such as vomiting and laxative abuse can lead to a range of biochemical problems. Hypokalaemia is the most common electrolyte abnormality. Metabolic alkalosis occurs in patients who vomit or abuse diuretics and acidosis in those misusing laxatives. Hyponatraemia is often due to excessive water ingestion, but may also occur in chronic energy deprivation or diuretic misuse. Urea and creatinine are generally low and normal concentrations may mask dehydration or renal dysfunction. Abnormalities of liver enzymes are predominantly characterized by elevation of aminotransferases, which may occur before or during refeeding. The serum albumin is usually normal, even in severely malnourished patients. Amenorrhoea is due to hypogonadotrophic hypogonadism. Reduced concentrations of free T4 and free T3 are frequently reported and T4 is preferentially converted to reverse T3. Cortisol is elevated but the response to adrenocorticotrophic hormone is normal. Hypoglycaemia is common. Hypercholesterolaemia is a common finding but its significance for cardiovascular risk is uncertain. A number of micronutrient deficiencies can occur. Other abnormalities include hyperamylasaemia, hypercarotenaemia and elevated creatine kinase. There is an increased prevalence of eating disorders in type 1 diabetes and the intentional omission of insulin is associated with impaired metabolic control. Refeeding may produce electrolyte abnormalities, hyper- and hypoglycaemia, acute thiamin depletion and fluid balance disturbance; careful biochemical monitoring and thiamin replacement are therefore essential during refeeding. Future research should address the management of electrolyte problems, the role of leptin and micronutrients, and the possible use of biochemical markers in risk stratification.
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Affiliation(s)
- Anthony P Winston
- Eating Disorders Unit, Woodleigh Beeches Centre, Warwick Hospital, Warwick, UK
- Health Sciences Research Institute, University of Warwick, Coventry, UK
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Papillard-Marechal S, Sznajder M, Hurtado-Nedelec M, Alibay Y, Martin-Schmitt C, Dehoux M, Westerman M, Beaumont C, Chevallier B, Puy H, Stheneur C. Iron metabolism in patients with anorexia nervosa: elevated serum hepcidin concentrations in the absence of inflammation. Am J Clin Nutr 2012; 95:548-54. [PMID: 22301927 DOI: 10.3945/ajcn.111.025817] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Only a few studies based on small cohorts have been carried out on iron status in anorexia nervosa (AN) patients. OBJECTIVE The aim of this study was to evaluate the role of hepcidin in hyperferritinemia in AN adolescents. DESIGN Twenty-seven adolescents hospitalized for AN in the pediatric inpatient unit of Ambroise Paré Academic Hospital were enrolled in the study. The control group comprised 11 patients. Hematologic variables and markers of iron status, including serum hepcidin, were measured before and after nutritional rehabilitation. RESULTS The mean age of patients was 14.4 y. Except for 2 AN patients and 1 control patient, all patients presented normal hemoglobin, vitamin B-12, and folate concentrations. Markers of inflammation and cytokines were normal throughout the study. None of the muscular lysis markers were elevated. Most AN patients had normal serum iron concentrations on admission. Serum ferritin concentrations were significantly higher in patients than in control subjects (198 compared with 49 μg/L, respectively; P < 0.001). The median hepcidin concentration was significantly higher in AN patients than in the control group (186.5 compared with 39.5 μg/L, respectively; P = 0.002). There was a highly significant correlation between ferritinemia and serum hepcidin concentrations (P < 0.0001). After nutritional rehabilitation, a significant reduction was observed (P = 0.004) in serum ferritin. Serum hepcidin analyzed in a smaller number of patients also returned to within the normal range. CONCLUSIONS Hepcidin and ferritin concentrations were higher in the serum of AN patients, without any evidence of iron overload or inflammation. These concentrations returned to normal after nutritional rehabilitation. These results suggest that nutritional stress induced by malnourishment in the hepatocyte could be yet another mechanism that regulates hepcidin.
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Flierl MA, Gaudiani JL, Sabel AL, Long CS, Stahel PF, Mehler PS. Complement C3 serum levels in anorexia nervosa: a potential biomarker for the severity of disease? Ann Gen Psychiatry 2011; 10:16. [PMID: 21542928 PMCID: PMC3110119 DOI: 10.1186/1744-859x-10-16] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 05/04/2011] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Anorexia nervosa carries the highest mortality rate of any psychiatric disorder. Even the most critically ill anorexic patients may present with normal 'standard' laboratory values, underscoring the need for a new sensitive biomarker. The complement cascade, a major component of innate immunity, represents a driving force in the pathophysiology of multiple inflammatory disorders. The role of complement in anorexia nervosa remains poorly understood. The present study was designed to evaluate the role of complement C3 levels, the extent of complement activation and of complement hemolytic activity in serum, as potential new biomarkers for the severity of anorexia nervosa. PATIENTS AND METHODS This was a prospective cohort study on 14 patients with severe anorexia nervosa, as defined by a body mass index (BMI) <14 kg/m2. Serum samples were obtained in a biweekly manner until hospital discharge. A total of 17 healthy subjects with normal BMI values served as controls. The serum levels of complement C3, C3a, C5a, sC5b-9, and of the 50% hemolytic complement activity (CH50) were quantified and correlated with the BMIs of patients and control subjects. RESULTS Serum C3 levels were significantly lower in patients with anorexia nervosa than in controls (median 3.7 (interquartile range (IQR) 2.5-4.9) vs 11.4 (IQR 8.9-13.7, P <0.001). In contrast, complement activation fragments and CH50 levels were not significantly different between the two groups. There was a strong correlation between index C3 levels and BMI (Spearman correlation coefficient = 0.71, P <0.001). CONCLUSIONS Complement C3 serum levels may represent a sensitive new biomarker for monitoring the severity of disease in anorexia nervosa. The finding from this preliminary pilot study will require further investigation in future prospective large-scale multicenter trials.
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Affiliation(s)
- Michael A Flierl
- Department of Internal Medicine, Denver Health Medical Center, Denver, CO, USA.
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Nishida T, Sakakibara H. Association Between Underweight and Low Lymphocyte Count as an Indicator of Malnutrition in Japanese Women. J Womens Health (Larchmt) 2010; 19:1377-83. [DOI: 10.1089/jwh.2009.1857] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Tomoko Nishida
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hisataka Sakakibara
- Department of Nursing, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Vögele C, Hilbert A, Tuschen-Caffier B. Dietary restriction, cardiac autonomic regulation and stress reactivity in bulimic women. Physiol Behav 2009; 98:229-34. [DOI: 10.1016/j.physbeh.2009.05.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Revised: 05/21/2009] [Accepted: 05/22/2009] [Indexed: 11/26/2022]
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Kandhro GA, Kazi TG, Afridi HI, Kazi N, Baig JA, Arain MB, Sirajuddin, Shah AQ, Sarfraz RA, Jamali MK, Syed N. Effect of zinc supplementation on the zinc level in serum and urine and their relation to thyroid hormone profile in male and female goitrous patients. Clin Nutr 2009; 28:162-8. [PMID: 19250719 DOI: 10.1016/j.clnu.2009.01.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Revised: 12/23/2008] [Accepted: 01/26/2009] [Indexed: 11/15/2022]
Abstract
BACKGROUND & AIMS Zinc (Zn) is an essential element involved in many basic biochemical reactions in thyroid. The aims of present study is to evaluate the Zn status in biological samples and thyroid hormones levels in 60 goitrous male (GMPs) and 72 female patients (GFPs), before and after 6 months treatment with Zn supplementation and compared with non-goitrous subjects of both genders (M=106, F=120) of age range 16-30 years. METHODS The biological samples were analyzed for Zn concentration using flame atomic absorption spectrophotometer, following their microwave assisted acid digestion. Quality control for the methodology was established with certified samples and with those obtained by conventional wet acid digestion method on the same CRMs and real samples. RESULTS The results showed that the significantly lower mean values of Zn in serum, while high level urine samples of GMPs and GFPs were observed as compared to control subjects (p<0.005 and 0.007) respectively. The mean values of free triiodothyronine and thyroxin were found to be lower in goitrous patients of both genders than in the age matched healthy control (p<0.006 and 0.002) respectively, in contrast high mean values of thyroid stimulating hormone were detected in GMPs and GFPs (p<0.009). CONCLUSION It was observed that Zn status and serum thyroid hormone levels were improved in goitrous patients after six months treatment with Zn supplementation.
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Affiliation(s)
- Ghulam Abbas Kandhro
- National Centre of Excellence in Analytical Chemistry, University of Sindh, Jamshoro 76080, Sindh, Pakistan.
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Nova E, Lopez-Vidriero I, Varela P, Casas J, Marcos A. Evolution of serum biochemical indicators in anorexia nervosa patients: a 1-year follow-up study. J Hum Nutr Diet 2008; 21:23-30. [PMID: 18184391 DOI: 10.1111/j.1365-277x.2007.00833.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Long-term studies on the evolution of serum biochemical indicators in anorexia nervosa (AN) patients during treatment are lacking in the literature. Thus, a 1-year follow-up of serum biochemical parameters in a homogeneous group of AN patients was performed. METHODS Fourteen restricting-type AN patients were studied on admission to hospital, after 1 month of inpatient treatment and after 6 and 12 months after admission. RESULTS Red blood cell count (RBC) and haemoglobin, serum glucose, total protein and the enzyme activities aspartate aminotransferase (AST), alkaline phosphatase (AlP), lactate dehydrogenase (LDH) and creatine kinase (CK) were significantly lower in patients on admission than in the control group. Total protein, high-density lipoprotein cholesterol (HDL-c), AST, AlP and CK showed significant changes among time points (anova, P < 0.05). Significant correlations were found between the change in RBC, haemoglobin, haematocrit, and the change in weight and body mass index (r = 0.74-0.86; P < 0.01). High cholesterol and amylase activity were found at all time points. While AST, LDH and CK reached control values within 6 months of treatment, AlP was always lower. CONCLUSION Serum AlP, hypercholesterolaemia and RBC seem to need longer periods of treatment with further weight gain to fully normalize. Therefore, these parameters should be monitored in AN patients long-term follow-up.
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Affiliation(s)
- E Nova
- Departamento de Metabolismo y Nutrición, Instituto del Frío, CSIC, Madrid, Spain.
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Palova S, Charvat J, Masopust J, Klapkova E, Kvapil M. Changes in the plasma amino acid profile in anorexia nervosa. J Int Med Res 2007; 35:389-94. [PMID: 17593868 DOI: 10.1177/147323000703500314] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We evaluated and measured by high performance liquid chromatography the plasma amino acid levels in 11 female patients with anorexia nervosa during a period of significant loss of body weight, compared with 11 healthy age-matched controls. Total amino acid and total branched-chain amino acid levels were similar in both groups, however significantly higher levels of glycine and ornithine were found in anorexia nervosa patients, as well as significantly lower levels of leucine, tyrosine and lysine compared with controls. The glycine/valine and phenylalanine/tyrosine ratios were significantly higher in anorexia nervosa patients than in control subjects. The levels and ratios of other amino acids were within the normal range, with no significant differences between the two groups. Changes in the plasma amino acid profile in anorexia nervosa patients can be explained by chronic severe malnutrition and prolonged stress.
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Affiliation(s)
- S Palova
- Medical Department, Second Faculty of Medicine, Charles University, Prague, Czech Republic.
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Myron Johnson A, Merlini G, Sheldon J, Ichihara K. Clinical indications for plasma protein assays: transthyretin (prealbumin) in inflammation and malnutrition. Clin Chem Lab Med 2007; 45:419-26. [PMID: 17378745 DOI: 10.1515/cclm.2007.051] [Citation(s) in RCA: 116] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A large number of circumstances are associated with reduced serum concentrations of transthyretin (TTR), or prealbumin. The most common of these is the acute phase response, which may be due to inflammation, malignancy, trauma, or many other disorders. Some studies have shown a decrease in hospital stay with nutritional therapy based on TTR concentrations, but many recent studies have shown that concentrations of albumin, transferrin, and transthyretin correlate with severity of the underlying disease rather than with anthropometric indicators of hypo- or malnutrition. There are few if any conditions in which the concentration of this protein by itself is more helpful in diagnosis, prognosis, or follow up than are other clinical findings. In the majority of cases, the serum concentration of C-reactive protein is adequate for detection and monitoring of acute phase responses and for prognosis. Although over diagnosis and treatment of presumed protein energy malnutrition is probably not detrimental to most patients, the failure to detect other causes of decreased concentrations (such as serious bacterial infections or malignancy) of the so-called visceral or hepatic proteins could possibly result in increased morbidity or even mortality. In addition to these caveats, assays for TTR have a relatively high level of uncertainty ("imprecision"). Clinical evaluation--history and physical examination--should remain the mainstay of nutritional assessment.
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Affiliation(s)
- A Myron Johnson
- Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, NC 27410, USA.
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Abstract
BACKGROUND A randomized controlled trial of zinc supplementation in anorexia nervosa (AN) reported a two-fold increase of the rate of increase of body mass index (BMI) in the zinc group. Zinc is inexpensive, readily available and free of significant side effects. However, oral zinc supplementation is infrequently prescribed as an adjunctive treatment for AN. Understanding the mechanism of action of zinc may increase its use. HYPOTHESIS Low zinc intake, which is very common in AN, adversely affects neurotransmitters in various parts of the brain, including gamma-amino butyric acid (GABA) and the amygdala, which are abnormal in AN. Zinc supplementation corrects these abnormalities, resulting in clinical benefit in AN. CONCLUSIONS Oral administration of 14 mg of elemental zinc daily for 2 months in all patients with AN should be routine.
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Affiliation(s)
- C L Birmingham
- Eating Disorders Program, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
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Wärnberg J, Nova E, Moreno LA, Romeo J, Mesana MI, Ruiz JR, Ortega FB, Sjöström M, Bueno M, Marcos A. Inflammatory proteins are related to total and abdominal adiposity in a healthy adolescent population: the AVENA Study. Am J Clin Nutr 2006; 84:505-12. [PMID: 16960163 DOI: 10.1093/ajcn/84.3.505] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND In adults, obesity is characterized by a state of chronic low-grade inflammation accompanied by moderately high concentrations of acute phase inflammatory proteins. Recent results regarding C-reactive protein (CRP) point to a similar status in adolescents; however, studies of associations of the serum inflammatory proteins CRP, ceruloplasmin, and complement factors C3 and C4 with body fat distribution remain scarce. OBJECTIVE We aimed to establish the possible relations of serum inflammatory proteins with body fat estimates and body fat distribution in an apparently healthy adolescent population. DESIGN This report included 472 adolescents (248 males and 224 females) aged 13-18.5 y who were recruited from the Spanish cross-sectional multicenter AVENA Study for whom anthropometric and immunologic data were complete. The concentrations of the serum proteins and the in vitro production of cytokines (interleukin 6 and tumor necrosis factor alpha) by isolated and stimulated white blood cells were measured. Relations with anthropometric measurements were explored by using simple and partial correlations. RESULTS CRP, C3, and C4 were correlated with central obesity (as measured by waist circumference) and total body fat in both sexes (P < 0.01) and with ceruloplasmin in females only. After further adjustment for BMI, C3 remained independently associated with central obesity (P < 0.05). Production of the cytokines by white blood cells did not seem to be affected by an excess of body fat. CONCLUSIONS Total body fat seems to be associated with a chronic low-grade systemic inflammation in apparently healthy adolescents. Central obesity is independently associated with C3 concentrations, which makes this marker especially interesting for further studies of obesity-related diseases.
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Affiliation(s)
- Julia Wärnberg
- Immunonutrition Group, Department of Metabolism and Nutrition, Consejo Superior de Investigaciones Científicas, Madrid, Spain
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