Interpreting the complete blood count in anorexia nervosa

Medical and Psychiatric Characteristics of Patients Hospitalized for Severe Restrictive Eating Disorders: Analysis of 545 Consecutive Patients with Severe Anorexia Nervosa or Avoidant/Restrictive Food Intake Disorder

BACKGROUND

People with severe eating and feeding disorders regularly require hospitalization due to complications inherent to their disease, though formal training regarding this care is limited.

METHODS

This retrospective study included 545 patients with severe anorexia nervosa (AN) or avoidant restrictive food intake disorder hospitalized in a medical stabilization unit between 2018 and 2021. Biometrics were obtained throughout hospitalization. Nutrition was increased until patients were gaining 0.2 kg/day.

RESULTS

Average admission body mass index was 13 kg/m2 with diagnoses of 46% AN-R (restricting), 39% AN-BP (binge-purge), and 15% avoidant restrictive food intake disorder. Average daily Kcals by discharge were 3343 for females and 3962 for males; 26% required nasogastric feeding. Hypoglycemia was common until day 7, correlated with elevated liver function tests and low prealbumin. Liver function tests were abnormal in 31% of patients. Refeeding hypophosphatemia developed in 26% of patients starting day 2 and was associated with lower body mass index. Hypokalemia appeared on admission among 39%, twice as common in patients diagnosed with AN-BP. Initial electrocardiograms were abnormal in 50% of patients, usually sinus bradycardia. Average QTc was normal, but only 14% prolonged. Bone density testing revealed 70% osteoporosis. History of suicide attempts were present in 19%, while 76% and 50% presented with anxiety and depressive disorders, respectively.

CONCLUSIONS

Given the inextricability of medical complications from severe eating and feeding disorders, familiarity among consult-liaison psychiatrists with the prevalence of frequently observed abnormal findings can inform consultation, prevent adverse events, prevent unnecessary intervention, and facilitate weight restoration and medical stabilization.

Serum peripheral markers for inflammation in adolescents with anorexia nervosa

BACKGROUND

There is a limited number of studies comparing the levels of inflammation in adolescent patients with anorexia nervosa (AN) and healthy controls based on complete blood count and platelet parameters.

METHODS

This study is a retrospective cross-sectional analysis of 53 drug-naive patients with AN and 53 healthy controls.

RESULTS

Significant differences were observed for WBC (white blood cell), neutrophil, MCV (mean corpuscular volume), MCH (mean corpuscular haemoglobin) and neutrophils/lymphocytes ratio (NLR) between the study groups. Patients with AN had lower WBC, neutrophiles and NLR values. But there was no difference between the groups in terms of inflammation-related platelet parameters. A strong positive correlation between BMI (body mass index) and PLT (platelet), PCT (plateletcrit) was determined in the patient group (r = 0.454, p = 0.001; r = 0.386, p = 0.007). Inflammation-related parameters may increase as BMI increases with nutrition and weight restoration.

CONCLUSIONS

The present study provides further evidence for level of inflammation in these patients does not increase during the acute period, unlike other mental diseases.

Clinical and Peripheral Biomarkers in Female Patients Affected by Anorexia: Does the Neutrophil/Lymphocyte Ratio (NLR) Affect Severity?

Anorexia Nervosa (AN) is a disabling disorder characterized by extreme weight loss and frequent chronicization, especially in its most severe forms. This condition is associated with a pro-inflammatory state; however, the role of immunity in symptom severity remains unclear. Total cholesterol, white blood cells, neutrophils, lymphocytes, platelets, iron, folate, vitamin D and B12 were dosed in 84 female AN outpatients. Mildly severe (Body Mass Index-BMI ≥ 17) versus severe (BMI < 17) patients were compared using one-way ANOVAs or χ² tests. A binary logistic regression model was run to investigate the potential association between demographic/clinical variables or biochemical markers and the severity of AN. Patients with severe anorexia (compared to mild forms) were older (F = 5.33; p = 0.02), engaged in more frequent substance misuse (χ² = 3.75; OR = 3.86; p = 0.05) and had a lower NLR (F = 4.12; p = 0.05). Only a lower NLR was predictive of severe manifestations of AN (OR = 0.007; p = 0.031). Overall, our study suggests that immune alterations may be predictive of AN severity. In more severe forms of AN, the response of the adaptive immunity is preserved, while the activation of the innate immunity may be reduced. Further studies with larger samples and a wider panel of biochemical markers are needed to confirm the present results.

Neutrophil-to-lymphocyte ratio (NLR) variations in relationship with childhood maltreatment in patients with anorexia nervosa: a retrospective cohort study

PURPOSE

Anorexia nervosa (AN) is a serious mental illness. It is frequently accompanied by a history of childhood maltreatment (CM) that may constitute a specific ecophenotype in patients with eating disorders necessitating special assessment and management. This retrospective study tested whether in patients with AN, CM-related chronic stress may manifest through low-grade inflammation reflected by an increase in white blood cell ratios (neutrophil-to-lymphocyte ratio, NLR, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio).

METHODS

Participants (N = 206) were enrolled at an eating disorder daycare unit in Montpellier, France, from March 2013 and January 2020. CM was assessed using the childhood trauma questionnaire (CTQ). The Eating Disorder Examination Questionnaire (EDE-Q) and the MINI were used to assess AN severity and the other clinical characteristics, respectively.

RESULTS

NLR was higher in patients with AN and history of CM (p = 0.029) and in patients with AN and history of emotional abuse (p = 0.021), compared with patients with AN without history of CM. In multivariate analysis, emotional abuse (β = 0.17; p = 0.027) contributed significantly to NLR variability.

CONCLUSION

In patients with AN, NLR is a low-grade inflammation marker that is influenced by various sociodemographic, clinical and biological factors. It is more directly affected by some CM types, especially emotional abuse, than by the presence/absence of CM history. Future studies should focus on mediators between CM and increased inflammation, such as interoceptive awareness, emotional dysregulation, food addiction, and stress sensitization.

LEVEL OF EVIDENCE

III. Evidence obtained from well-designed cohort or case-control analytic studies.

Restrictive type and infectious complications might predict nadir hematological values among individuals with anorexia nervosa during the refeeding period: a retrospective study

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.

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

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.

Opinion on the Optimal Histologic Evaluation of the Bone Marrow in Nonclinical Toxicity Studies

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].

Pharmacological treatment of eating disorders, comorbid mental health problems, malnutrition and physical health consequences

The pharmacological treatment of patients with an eating disorder (ED) often includes medications to treat their ED, comorbid mental health problems, malnutrition and the physical health problems resulting from it. The currently approved pharmacological treatment options for EDs are limited to fluoxetine for bulimia nervosa (BN) and - in some countries - lisdexamfetamine for binge eating disorder (BED). Thus, there are no approved pharmacological options for anorexia nervosa (AN), even though study results for olanzapine and dronabinol are promising. Topiramate might be an additional future option for the treatment of BN and BED. Selective serotonin reuptake inhibitors (SSRI), mirtazapine and bupropion could be considered for the treatment of comorbid unipolar depression. However, AN and BN are contraindications for bupropion. For ED patients with a manic episode, we recommend olanzapine in AN and risperidone in BN and BED; whereas for bipolar depression, olanzapine (plus fluoxetine) seems appropriate in AN and lamotrigine in BN and BED. Acute anxiety or suicidality may warrant benzodiazepine treatment with lorazepam. Proton-pump inhibitors, gastroprokinetic drugs, laxatives and hormones can alleviate certain physical health problems caused by EDs. Therapeutic drug monitoring, pharmacogenomic testing, a more restrictive use of "pro re nata" (PRN) medication, an interdisciplinary treatment approach, shared decision making (SDM) and the formulation of common treatment goals by the patients, their family or carers and clinicians could improve treatment success and safety. Novel genetic, immunological, microbiome and brain imaging research as well as new pharmacological developments like the use of psychedelics, stimulants, novel monoaminergic drugs, hormone analogues and drugs which enhance the effects of psychotherapy may extend our therapeutic options in the near future.

Extreme anorexia nervosa: medical findings, outcomes, and inferences from a retrospective cohort

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.

Medical Complications of Eating Disorders in Youth

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.

Treatment with granulocyte colony-stimulating factor in the refeeding phase of anorexia nervosa complicated with severe neutropenia and sepsis: a case report

Leukopenia is frequently observed in patients with anorexia nervosa (AN). However, serious infectious diseases are infrequent in patients with AN. We present the case of a 13-year-old girl with AN complicated with severe neutropenia and sepsis upon refeeding. Her body mass index was 11 kg/m² and her absolute neutrophil count (ANC) was 1555/µL on admission. After the initiation of refeeding, her ANC gradually declined to 346/µL. High fever occurred and a blood culture tested positive for Enterobacter cloacae. Although fever subsided with administration of antibiotics, human recombinant granulocyte colony-stimulating factor (G-CSF) was administered to improve her severe neutropenia. After administration of G-CSF, initially for 5 days and again for 3 days, her ANC became normal and stable. The combination of neutropenia and low body mass index may contribute to severe bacterial infection. Usually, hematological abnormalities such as neutropenia improve spontaneously with the recovery of nutritional status in AN patients. Therefore, it is difficult to determine the indication for treatment with G-SCF. Although a careful consideration is required, treatment with G-CSF is effective in AN patients with sepsis caused by severe neutropenia.

Medical findings in 1,026 consecutive adult inpatient-residential eating disordered patients

OBJECTIVE

Eating disorders are associated with multiple medical complications. We report contemporary medical data, for newly admitted adult inpatient and residential level of care patients.

METHOD

Medical records of a transdiagnostic sample of 1,026 patients, with eating disorders, were retrospectively reviewed for the presence of a broad array of medical complications at time of admission. The prevalence of physiologically relevant medical complications was assessed across major eating disorder categories.

RESULTS

Of the patients, 93.6% were female, and they had an average age of 28.1 (SD = 10.1, range 17-69). The average admission body mass index was 16.1 (SD = 2.3). The prevalence of abnormal laboratory values varied by eating disorder subtype. In patients with anorexia nervosa-restricting subtype, 51.4% had low prealbumin, 36.1% were leukopenic, 34.3% had osteoporosis, 30.0% vitamin D deficiency, 16.8% metabolic alkalosis, 16.0% had hyponatremia, 14.2% hypokalemia, and 7.1% hypoglycemia. These patients had normal average QTc intervals. In patients with anorexia nervosa-binge purging subtype, 42.4% had hypokalemia, 33.3% metabolic alkalosis, osteoporosis in 21.1%, and they had longer QTc intervals (433.9 ms, p < .001). Only 6.0% of patients with anorexia nervosa had hypophosphatemia. Patients with bulimia nervosa demonstrated hypokalemia in 26.2%, and metabolic alkalosis in 23.4%; the QTc interval was longer than in AN-R patients (437.9 ms, p < .001), but still in the normal range.

DISCUSSION

Numerous medical complications are associated with severe eating disorders. As the severity increases, the number of complications increase and are related to the presence or absence of purging behaviors.

Changes in Platelet Count and Size Indices in Adolescent Patients With Anorexia Nervosa

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.

Increased naive CD4+ and B lymphocyte subsets are associated with body mass loss and drive relative lymphocytosis in anorexia nervosa patients

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.

Medical complications of anorexia nervosa and their treatments: an update on some critical aspects

Anorexia nervosa has the highest mortality rate of any psychiatric disorder. Many of the deaths are attributable to medical complications which arise as the malnutrition and weight loss worsens. Every body system may be adversely affected by anorexia nervosa. Yet, remarkably, most of the medical complications of anorexia nervosa are treatable and reversible with optimal medical care, as part of a multidisciplinary team who are often involved in the care of these patients. Herein, we will describe the medical complications of anorexia nervosa and their treatments.

Cerebral perfusion differences in women currently with and recovered from anorexia nervosa

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.

[Hematological changes in adolescent anorexia nervosa]

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.

Severe anorexia nervosa: outcomes from a medical stabilization unit

OBJECTIVE

We report data from the medical stabilization and refeeding of patients with severe anorexia nervosa admitted over a 15-month period.

METHOD

Through chart review and computerized data collection, we evaluated demographic and clinical data from 25 consecutive patients admitted to our medical stabilization unit from October 2008 to January 2010.

RESULTS

In this adult-patient population with a median body mass index (BMI) of 13.1 kg/m(2) (interquartile range, 11.0-14.4), 44% developed hypoglycemia, 76% had abnormal liver function, 83% had abnormal bone density, 45% developed refeeding hypophosphatemia, and 92% were hypothermic. Severe liver function abnormality predicted the development of hypoglycemia (p = 0.02, OR 9.78, CI: 1.55-61.65). No clinical features predicted hypophosphatemia, including admission BMI (p = 0.19), serum glucose level (p = 0.21), elevated liver function tests (p = 0.39 for AST), or initial amount of kilocalories consumed (p = 0.06).

DISCUSSION

Patients with the most severe cases of anorexia nervosa have a high prevalence of serious medical complications during initial refeeding.

Complement C3 serum levels in anorexia nervosa: a potential biomarker for the severity of disease?

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.

Assessment of anorexia nervosa in children and adolescents

Anorexia nervosa is a debilitating illness that affects mostly females and their families. Multiple physiologic disturbances are present and can be life-threatening. Nutritional rehabilitation is the foremost initial treatment goal. Assessment skills include understanding the physiologic, developmental, and psychiatric status of the individual as well as engagement of the family system. A comprehensive assessment that stimulates patient and family to successfully engage in treatment is the cornerstone of good clinical care for this highly disabling disorder.

Medical complications of bulimia nervosa and their treatments

OBJECTIVE

To present a cogent and practical review of the medical complications and their treatment in patients with bulimia nervosa.

METHOD

Thorough review of the medical literature from 1990 to current in regards to the medical complications of bulimia nervosa and the therapeutic intervention that are effective to treat them.

RESULTS

Extensive and detailed review of the medical complications of bulimia nervosa.