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Mohammedsaeed W, El Shikieri AB. Cardiometabolic Risk Factors among Women with Eating Disorders in Saudi Arabia. J Nutr Metab 2024; 2024:5953893. [PMID: 38867850 PMCID: PMC11168801 DOI: 10.1155/2024/5953893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 04/16/2024] [Accepted: 04/22/2024] [Indexed: 06/14/2024] Open
Abstract
Objective To assess selected cardiometabolic risk factors among Saudi women with eating disorders. Methods An epidemiological, cross-sectional study included women aged between 18 and 50 years with eating disorders (EDs). Women with chronic diseases, pregnant, or lactating were excluded. The weight and height were measured for the calculation of the body mass index (BMI). Fasting blood samples were drawn for the analysis of blood sugar, glycated haemoglobin, lipid profile, albumin, haemoglobin, and C-reactive levels. The atherogenic dyslipidemia index (AIP) was also calculated. Results Patients (n = 100) were enrolled. Fasting blood glucose levels were critically low among women with anorexia nervosa (AN) and bulimia nervosa (BN) but normal among those with binge eating disorders (BEDs). All women with ED suffered from anaemia based on their haemoglobin levels as well as dyslipidemia, hypoalbuminaemia, and high C-reactive protein levels. Women with AN had low cardiovascular (CV) risks based on their normal AIP values. However, women with BN and BED had intermediate CV risks. On average, women with AN suffered from severe thinness and those with BN had normal BMIs, whereas those with BED were overweight. Women (90%) with BN and BED were overweight and/or obese. Conclusion Women with ED had a high risk of cardiovascular diseases defined by their hypoalbuminaemia, dyslipidemia, anaemia, and high AIP levels. Dietitians and psychiatrists are advised to collaborate in assessing the potential risk of having eating disorders to provide counselling sessions to women on healthy balanced diets and their effect on health.
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Affiliation(s)
- Walaa Mohammedsaeed
- Department of Clinical Laboratory Sciences, Faculty of Applied Medical Science at Taibah University, Madinah, Saudi Arabia
| | - Ahlam B. El Shikieri
- Department of Clinical Nutrition, College of Applied Medical Sciences, Taibah University, Medina, Saudi Arabia
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Romero-Márquez JM, Novo-Rodríguez M, Novo-Rodríguez C, Siles-Guerrero V, Herrera-Montes I, Navarro-Pelayo FG, López-de-la-Torre-Casares M, Muñoz-Garach A. Bioelectrical Impedance Vector Analysis, Nutritional Ultrasound ®, and Handgrip Strength as Innovative Methods for Monitoring Critical Anorexia Nervosa Physical Recovery: A Pilot Study. Nutrients 2024; 16:1539. [PMID: 38794777 PMCID: PMC11123858 DOI: 10.3390/nu16101539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Eating disorders (EDs) manifest as persistent disruptions in eating habits or related behaviors, significantly impacting physical health and psychosocial well-being. Nutritional assessment in ED patients is crucial for monitoring treatment efficacy. While dual-energy X-ray absorptiometry (DEXA) remains standard, interest in alternative methods such as bioelectrical impedance vector analysis (BIVA) and Nutritional Ultrasound® (NU) has risen due to their affordability and portability. Additionally, hand dynamometry offers a user-friendly approach to assessing grip strength (HGS), indicative of nutritional status. A prospective study was carried out to evaluate the utility of BIVA, NU®, and HGS in 43 female AN patients. Measurements were taken at baseline and hospital discharge. A total of 41 patients completed the study. After the intervention, numerous BIVA-related parameters such as fat (3.5 ± 2 kg vs. 5.3 ± 2.7 kg, p < 0.001) and free fat mass (33.9 ± 3.8 kg vs. 37.5 ± 4.1 kg, p < 0.001) were partially restored. Similarly, Nutritional Ultrasound® showed promising results in assessing body composition changes such as total abdominal fat tissue (0.5 ± 0.3 cm vs. 0.9 ± 0.3 cm, p < 0.05). In the same way, rectus femoris cross-sectional area values correlated with clinical outcomes such as free fat mass (0.883, p < 0.05) and appendicular muscle mass (0.965, p < 0.001). HGS reached the normality percentile after the intervention (21.6 ± 9.1 kg vs. 25.9 ± 12.3 kg, p < 0.05), demonstrating a significant association between grip strength and body composition parameters such as free fat mass (0.658, p < 0.001) and appendicular muscle mass (0.482, p < 0.001). Incorporating BIVA-, NU®-, and HGS-enhanced nutritional assessment into the treatment of AN patients offers cost-effective, portable, and non-invasive alternatives to DEXA. These techniques offer valuable insights into changes in body composition and nutritional status, which, in turn, facilitate treatment monitoring and contribute to improved patient outcomes.
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Affiliation(s)
- Jose M. Romero-Márquez
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Foundation for Biosanitary Research of Eastern Andalusia—Alejandro Otero (FIBAO), 18012 Granada, Spain
| | - María Novo-Rodríguez
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Foundation for Biosanitary Research of Eastern Andalusia—Alejandro Otero (FIBAO), 18012 Granada, Spain
| | - Cristina Novo-Rodríguez
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Granada Biosanitary Research Institute (Ibs. Granada), 18014 Granada, Spain
| | - Víctor Siles-Guerrero
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
| | - Isabel Herrera-Montes
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
| | | | - Martín López-de-la-Torre-Casares
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Granada Biosanitary Research Institute (Ibs. Granada), 18014 Granada, Spain
| | - Araceli Muñoz-Garach
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Granada Biosanitary Research Institute (Ibs. Granada), 18014 Granada, Spain
- Network Biomedical Research Center Physiopathology of Obesity and Nutrition (CiberOBN), Carlos III Health Institute, 28029 Madrid, Spain
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Maunder K, Molloy E, Jenkins E, Hayden J, Adamis D, McNicholas F. Anorexia Nervosa in vivo cytokine production: a systematic review. Psychoneuroendocrinology 2023; 158:106390. [PMID: 37769539 DOI: 10.1016/j.psyneuen.2023.106390] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/17/2023] [Accepted: 09/12/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION The underlying psychobiology that contributes to Anorexia Nervosa (AN) onset and disease progression remains unclear. New research is emerging suggesting a possible link between inflammation and a variety of mental illnesses. Alterations of cytokines may play a role in the pathogenesis of AN. Some studies have found differences in the cytokine profile of those with AN compared to healthy controls, but results are heterogeneous. The aim of this work was to systematically review existing studies investigating in-vivo cytokine production in those with AN before and after weight restoration compared to controls. METHODS A comprehensive literature search of four electronic databases (PubMed, PsychInfo, EMBASE and CINAH) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify human in-vivo studies investigating the relationship between AN and cytokine production. Data extracted from included studies related to population characteristics (e.g. age, gender, mean mBMI/%IBW), cytokine measurement and relevant findings. Confounding factors (e.g. smoking status, co-morbid mental illness, menstruation status) were also collected. RESULTS 36 studies were eligible for this systematic review of which the majority were conducted in Europe (77.8%) and involved female subjects (97.2%). Those with AN ranged in age from 13 to 47 years and had an illness duration of 3 months to 24 years. 15 candidate cytokines and 3 receptors were identified (TNF-alpha, IL-6, IL-1B, CRP, IL-2, IL-7, IL-10, IFN-γ, TNF-R2, IL-1 α, IL-15, TNF-R1, IL-17, IL-18, TGF-B1, IL-12, IL-6R and TGF-B2) exploring in-vivo levels in patients with AN and comparing to controls. TNF-alpha and IL-6 were the most extensively studied with IL-6 being significantly elevated in 4 out of 8 (50%) of longitudinal studies when comparing AN patients at baseline compared to post weight restoration. Following weight restoration, there was no difference in IL-6 levels when comparing to HC in 7 of 8 (87.5%) longitudinal studies examined. CONCLUSIONS The most promising cytokine potentially involved in the pathogenesis of AN appears to be IL-6, and possibly TNF-alpha pathways. The heterogeneity of clinical and methodology factors impedes the generalizability of results. Future studies may wish to address these methodological shortcomings as alterations in cytokine levels in AN could act as therapeutic targets assisting with weight restoration and psychopathology and may offer diagnostic potential.
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Affiliation(s)
- K Maunder
- University College Dublin, Ireland; Children's Health Ireland - Crumlin Hospital, Ireland; Lucena Clinic, St. John of God Community Services, Ireland.
| | - E Molloy
- Children's Health Ireland - Crumlin Hospital, Ireland; Children's Health Ireland - Tallaght Hospital, Ireland; Trinity College Dublin, Ireland
| | - E Jenkins
- Children's Health Ireland - Temple Street Hospital, Ireland
| | - J Hayden
- Royal College of Surgeons Ireland, Ireland
| | - D Adamis
- National University of Galway, Ireland
| | - F McNicholas
- University College Dublin, Ireland; Children's Health Ireland - Crumlin Hospital, Ireland; Lucena Clinic, St. John of God Community Services, Ireland
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Keeler JL, Robinson L, Keeler-Schäffeler R, Dalton B, Treasure J, Himmerich H. Growth factors in anorexia nervosa: a systematic review and meta-analysis of cross-sectional and longitudinal data. World J Biol Psychiatry 2022; 23:582-600. [PMID: 34875968 DOI: 10.1080/15622975.2021.2015432] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Growth factors are signalling molecules that play roles in the survival, proliferation, migration, and differentiation of cells. Studies have found alterations in specific growth factors in anorexia nervosa (AN). METHODS This systematic review and meta-analysis examined articles from three databases, measuring growth factors in AN cross-sectionally and longitudinally, and in recovered AN (rec-AN) cross-sectionally. Random-effects meta-analyses were conducted for brain-derived neurotrophic factor (BDNF) and insulin growth factor-I (IGF-1) for cross-sectional and longitudinal studies. RESULTS A total of 82 studies were included: 56 cross-sectional (BDNF: n = 15; IGF-1: n = 41) and 24 longitudinal (BDNF: n = 5; IGF-1: n = 19) were meta-analysed and 20 studies were narratively synthesised. In cross-sectional analyses, BDNF and IGF-1 were lower in AN compared to controls, and BDNF was marginally greater in rec-AN compared to controls. In longitudinal meta-analyses, BDNF and IGF-1 increased from baseline to follow-up. Cross-sectional subgroup analyses revealed no differences in BDNF between controls and AN binge-eating/purging subtypes. CONCLUSIONS It is likely that the low BDNF and IGF-1 levels found in AN are consequences of starvation, which are reversible with weight restoration. The increase in BDNF and IGF-1 during therapeutic weight restoration might improve neuroplasticity, which is the basis of learning, and thus psychotherapeutic success.
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Affiliation(s)
- Johanna Louise Keeler
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lauren Robinson
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Bethan Dalton
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Hubertus Himmerich
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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Hussain AA, Hübel C, Hindborg M, Lindkvist E, Kastrup AM, Yilmaz Z, Støving RK, Bulik CM, Sjögren JM. Increased lipid and lipoprotein concentrations in anorexia nervosa: A systematic review and meta-analysis. Int J Eat Disord 2019; 52:611-629. [PMID: 30920679 PMCID: PMC6842568 DOI: 10.1002/eat.23051] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 01/07/2019] [Accepted: 01/07/2019] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Alterations in blood lipid concentrations in anorexia nervosa (AN) have been reported; however, the extent, mechanism, and normalization with weight restoration remain unknown. We conducted a systematic review and a meta-analysis to evaluate changes in lipid concentrations in acutely-ill AN patients compared with healthy controls (HC) and to examine the effect of partial weight restoration. METHOD A systematic literature review and meta-analysis (PROSPERO: CRD42017078014) were conducted for original peer-reviewed articles. RESULTS Forty-eight studies were eligible for review; 33 for meta-analyses calculating mean differences (MD). Total cholesterol (MD = 22.7 mg/dL, 95% CI = 12.5, 33.0), high-density lipoprotein (HDL; MD = 3.4 mg/dL, CI = 0.3, 7.0), low-density lipoprotein (LDL; MD = 12.2 mg/dL, CI = 4.4, 20.1), triglycerides (TG; MD = 8.1 mg/dL, CI = 1.7, 14.5), and apolipoprotein B (Apo B; MD = 11.8 mg/dL, CI = 2.3, 21.2) were significantly higher in acutely-ill AN than HC. Partially weight-restored AN patients had higher total cholesterol (MD = 14.8 mg/dL, CI = 2.1, 27.5) and LDL (MD = 16.1 mg/dL, CI = 2.3, 30.0). Pre- versus post-weight restoration differences in lipid concentrations did not differ significantly. DISCUSSION We report aggregate evidence for elevated lipid concentrations in acutely-ill AN patients compared with HC, some of which persist after partial weight restoration. This could signal an underlying adaptation or dysregulation not fully reversed by weight restoration. Although concentrations differed between AN and HC, most lipid concentrations remained within the reference range and meta-analyses were limited by the number of available studies.
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Affiliation(s)
- Alia Arif Hussain
- Eating Disorder Unit, Mental Health Center Ballerup, Copenhagen,University of Copenhagen,Corresponding author: Alia Arif Hussain, MD, Address: Mental Health Center – Ballerup, Eating Disorder Unit, Maglevaenget 2, DK-2750 Ballerup, Copenhagen, Denmark. Telephone: +45 23928333.
| | - Christopher Hübel
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Mathias Hindborg
- Eating Disorder Unit, Mental Health Center Ballerup, Copenhagen,University of Copenhagen
| | - Emilie Lindkvist
- Eating Disorder Unit, Mental Health Center Ballerup, Copenhagen,University of Copenhagen
| | - Annie Maria Kastrup
- Eating Disorder Unit, Mental Health Center Ballerup, Copenhagen,University of Copenhagen
| | - Zeynep Yilmaz
- Department of Psychiatry, University of North Carolina at Chapel Hill, USA,Department of Genetics, University of North Carolina at Chapel Hill, USA
| | - René Klinkby Støving
- Nutrition Clinic, Center for Eating Disorders, Odense University Hospital & Psychiatric Services in the Region of Southern Denmark. Uni. Southern Denmark
| | - Cynthia M. Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden,Nutrition Clinic, Center for Eating Disorders, Odense University Hospital & Psychiatric Services in the Region of Southern Denmark. Uni. Southern Denmark,Department of Nutrition, University of North Carolina at Chapel Hill, USA
| | - Jan Magnus Sjögren
- Eating Disorder Unit, Mental Health Center Ballerup, Copenhagen,University of Copenhagen
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Escudero CA, Potts JE, Lam PY, De Souza AM, Mugford GJ, Sandor GGS. Doppler Echocardiography Assessment of Aortic Stiffness in Female Adolescents with Anorexia Nervosa. J Am Soc Echocardiogr 2018; 31:784-790. [PMID: 29559196 DOI: 10.1016/j.echo.2018.01.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Indexed: 01/08/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) is associated with abnormalities in biomarkers of cardiovascular risk. Arterial stiffness, as measured by pulse-wave velocity (PWV), is also a risk factor for cardiovascular disease. The aims of this study were to determine the stiffness of the aorta in female adolescents with AN and to determine if either the severity or the type of AN was associated with PWV. METHODS This was a retrospective case-control study. Adolescent patients with a clinical diagnosis of AN were included. Aortic diameter and pulse-wave transit time over a portion of the thoracic aorta were measured using Doppler echocardiography, and PWV was calculated. RESULTS There were 94 female patients with AN and 60 adolescent female control subjects. There was no significant difference in age between patients with AN and control subjects (15.5 ± 1.7 vs 15.1 ± 2.6 years, P = .220). Body mass index (16.0 ± 2.4 vs 19.7 ± 2.7 kg/m2, P < .001) and body mass index percentile (9.4 ± 15.6 vs 45.5 ± 26.2, P < .001) were significantly lower for patients with AN than control subjects. PWV (443 ± 106 vs 383 ± 77 cm/sec, P < .001) was significantly higher in patients with AN than control subjects. Similar differences from control subjects were found in patients with AN with both lower and higher body mass index percentiles and also in patients with AN with the restrictive or the binge-purge subtype. CONCLUSIONS Female adolescents with AN have increased aortic stiffness compared with control subjects. This study suggests that patients with AN may be at increased risk for future cardiovascular disease. Future studies are required to determine the reversibility of these changes with weight restoration.
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Affiliation(s)
- Carolina A Escudero
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - James E Potts
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Pei-Yoong Lam
- Division of Adolescent Medicine, British Columbia Children's Hospital and Provincial Specialized Eating Disorders Program, Vancouver, British Columbia, Canada
| | - Astrid M De Souza
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Gerald J Mugford
- Memorial University of Newfoundland, Faculty of Medicine and Discipline of Psychiatry, St. John's, Newfoundland, Canada
| | - George G S Sandor
- Children's Heart Centre, British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
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Boisseau CL. Identification and management of eating disorders in gynecology: menstrual health as an underutilized screening tool. Am J Obstet Gynecol 2016; 215:572-578. [PMID: 27422054 DOI: 10.1016/j.ajog.2016.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 06/18/2016] [Accepted: 07/05/2016] [Indexed: 02/01/2023]
Abstract
Eating disorders are life-threatening conditions that disproportionately affect females, often during child-bearing years. Although the endocrinological and reproductive sequelae of these conditions often fall within the treatment purview of obstetrician-gynecologists, the assessment of eating pathology is challenging and often not part of routine clinical care. This commentary focuses on one of the common presenting symptoms of eating disorders in women, menstrual dysfunction, and discusses considerations for its clinical management in gynecology. Assessment of menstrual status provides a natural starting point for provider-patient discussion of disordered eating and weight behavior. Routine screening for eating disorders is critical and must be universal given the serious long-term consequences of these disorders.
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Gaudiani JL, Mehler PS. Rare medical manifestations of severe restricting and purging: "Zebras," missed diagnoses, and best practices. Int J Eat Disord 2016; 49:331-44. [PMID: 26592986 DOI: 10.1002/eat.22475] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Medical problems that arise due to severe restricting and/or purging may be misdiagnosed or suboptimally treated, from outpatient clinics to top medical hospitals. A symptom may be presumed to be a psychological manifestation of the eating disorder and inappropriately dismissed for further medical evaluation. Alternatively, a detailed medical workup may be performed, overlooking a classic relationship between starvation and a physical finding, which delays referral to eating disorder care. This review article focuses on rare medical issues (also called "zebras" in medical training), diagnoses that may be missed in patients with eating disorders, and best practices for management, organized by organ system. METHOD A PubMed search was performed, using search terms "eating disorder," "anorexia nervosa," and "bulimia nervosa" in combination with different words for each organ system and known medical manifestations of severe eating disorders, with high quality and relevant studies from the past 20 years cited. DISCUSSION Adults with eating disorders may present with extreme organ dysfunction and atypical signs and symptoms of typical medical problems. Timely diagnosis, risk awareness, appropriate treatment, and avoidance of harm are all vital. With judicious management and nutritional rehabilitation, most of these complications will significantly improve or resolve. ©
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Affiliation(s)
- Jennifer L Gaudiani
- Department of Medicine, University of Colorado, Denver, Colorado.,ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado
| | - Philip S Mehler
- Department of Medicine, University of Colorado, Denver, Colorado.,ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado.,Eating Recovery Center, Denver, Colorado
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9
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Solmi M, Veronese N, Favaro A, Santonastaso P, Manzato E, Sergi G, Correll CU. Inflammatory cytokines and anorexia nervosa: A meta-analysis of cross-sectional and longitudinal studies. Psychoneuroendocrinology 2015; 51:237-52. [PMID: 25462897 DOI: 10.1016/j.psyneuen.2014.09.031] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/17/2014] [Accepted: 09/30/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Although inflammation is increasingly implicated in psychiatric disorders, less is known about its role in anorexia nervosa (AN), an illness with low body mass index (BMI). METHODS We performed a systematic PubMed literature search until 12/31/2013 and meta-analyzed cross-sectional and longitudinal studies comparing circulating pro- and anti-inflammatory cytokines between patients with anorexia nervosa (AN) and healthy controls (HCs) (1) before and (2) after weight gain, and (3) within AN patients before and after weight gain. Standardized mean differences (SMDs)± 95% confidence intervals (CIs) for results from ≥ 2 studies were calculated. RESULTS Of 999 initial hits, 22 studies with 924 participants (AN=512, HCs=412) were eligible. Compared to HCs, tumor necrosis factor (TNF)-alpha (SMD=0.35, 95%CI=0.09-0.61, p=0.008), interleukin (IL)1-beta (SMD=0.51, 95%CI=0.18-0.84, p=0.003), IL-6 (SMD=0.43, 95%CI=0.11-0.76, p=0.009), and TNF-receptor-II (SMD=0.42, 95%CI:0.07-0.78, p=0.02) were significantly elevated in AN, while C-reactive protein (SMD=-0.53, 95%CI=-.77, -0.28, p<0.0001) and IL-6 receptor (SMD=-0.85, 95%CI=-1.33, -0.36, p=0.0006) were significantly decreased. No differences were found for TNF-receptor I and TGF-β. Across a subset of eight longitudinal studies (AN=152, HCs=129), significant weight gain (baseline BMI=15.4 ± 1.5, endpoint BMI=18.2 ± 1.6, p<0.0001) was not associated with significant changes in TNF-α, IL-6 and IL1-β. However, after weight gain, IL-6 was not different anymore compared to HCs (SMD=0.06, 95%CI=-0.32, 0.45, p=0.75). In meta-regression, shorter illness duration (p=0.0008), but not younger age (p=0.71) significantly moderated greater IL-6 levels. CONCLUSION Despite abnormally low BMI, AN seems to be associated with increased inflammatory cytokines. Whether specific elevated cytokines represent trait or state markers of AN, and whether they could be treatment targets requires further study.
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Affiliation(s)
- Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Nicola Veronese
- Department of Medicine-DIMED, Geriatrics Section, University of Padova, Padova, Italy
| | - Angela Favaro
- Department of Neurosciences, University of Padova, Padova, Italy
| | | | - Enzo Manzato
- Department of Medicine-DIMED, Geriatrics Section, University of Padova, Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine-DIMED, Geriatrics Section, University of Padova, Padova, Italy
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, NorthShore-Long Island Jewish Health System, Glen Oaks, NY, USA; Hofstra North Shore LIJ School of Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Albert Einstein College of Medicine, Bronx, NY, USA.
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10
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Ko A, Kim H, Han CJ, Kim JM, Chung HW, Chang N. Association between high sensitivity C-reactive protein and dietary intake in Vietnamese young women. Nutr Res Pract 2014; 8:445-52. [PMID: 25110566 PMCID: PMC4122718 DOI: 10.4162/nrp.2014.8.4.445] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Revised: 03/24/2014] [Accepted: 04/10/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND/OBJECTIVES High sensitivity C-reactive protein (hsCRP) is a strong independent predictor of future cardiovascular disease (CVD) risk. We evaluated the relationship between hsCRP and dietary intake in apparently healthy young women living in southern Vietnam. SUBJECTS/METHODS Serum hsCRP was measured and dietary intake data were obtained using the 1-day 24-hour recall method in women (n = 956; mean age, 25.0 ± 5.7 years) who participated in the International Collaboration Study for the Construction of Asian Cohort of the Korean Genome and Epidemiology Study (KoGES) in 2011. RESULTS Women in the high risk group (> 3 mg/L) consumed fewer fruits and vegetables, total plant food, potassium, and folate than those in the low risk group (< 1 mg/L). A multiple regression analysis after adjusting for covariates revealed a significant negative association between hsCRP and fruit and vegetable consumption. A logistic regression analysis showed that the odds ratio (OR) of having a high hsCRP level in women with the highest quartiles of consumption of fruits and vegetables [OR, 0.391; 95% confidence interval (CI), 0.190-0.807], potassium [OR, 0.425; 95% CI, 0.192-0.939] and folate [OR, 0.490; 95% CI, 0.249-0.964] were significantly lower than those in the lowest quartiles. CONCLUSIONS These results suggest that, in young Vietnamese women, an increased consumption of fruit and vegetables might be beneficial for serum hsCRP, a risk factor for future CVD events.
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Affiliation(s)
- Ahra Ko
- Department of Nutritional Science and Food Management, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, Korea
| | - Hyesook Kim
- Department of Nutritional Science and Food Management, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, Korea
| | - Chan-Jung Han
- Department of Nutritional Science and Food Management, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, Korea
| | - Ji-Myung Kim
- Food and Nutrition Major, Division of Food Science and Culinary Arts, Shinhan University, Gyeonggi 483-777, Korea
| | - Hye-Won Chung
- Department of Obstetrics and Gynecology, Ewha Womans University School of Medicine, Seoul 158-710, Korea
| | - Namsoo Chang
- Department of Nutritional Science and Food Management, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul 120-750, Korea
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Goldstein JM, Handa RJ, Tobet SA. Disruption of fetal hormonal programming (prenatal stress) implicates shared risk for sex differences in depression and cardiovascular disease. Front Neuroendocrinol 2014; 35:140-58. [PMID: 24355523 PMCID: PMC3917309 DOI: 10.1016/j.yfrne.2013.12.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 10/31/2013] [Accepted: 12/04/2013] [Indexed: 12/19/2022]
Abstract
Comorbidity of major depressive disorder (MDD) and cardiovascular disease (CVD) represents the fourth leading cause of morbidity and mortality worldwide, and women have a two times greater risk than men. Thus understanding the pathophysiology has widespread implications for attenuation and prevention of disease burden. We suggest that sex-dependent MDD-CVD comorbidity may result from alterations in fetal programming consequent to the prenatal maternal environments that produce excess glucocorticoids, which then drive sex-dependent developmental alterations of the fetal hypothalamic-pituitary-adrenal (HPA) axis circuitry impacting mood, stress regulation, autonomic nervous system (ANS), and the vasculature in adulthood. Evidence is consistent with the hypothesis that disruptions of pathways associated with gamma aminobutyric acid (GABA) in neuronal and vascular development and growth factors have critical roles in key developmental periods and adult responses to injury in heart and brain. Understanding the potential fetal origins of these sex differences will contribute to development of novel sex-dependent therapeutics.
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Affiliation(s)
- J M Goldstein
- Departments of Psychiatry and Medicine, Harvard Medical School, Boston, MA, USA; Brigham and Women's Hospital (BWH), Connors Center for Women's Health & Gender Biology, 1620 Tremont St. BC-3-34, Boston, MA 02120, USA; BWH, Departments of Psychiatry and Medicine, 1620 Tremont St. BC-3-34, Boston, MA 02120, USA.
| | - R J Handa
- Department of Basic Medical Sciences, University of Arizona College of Medicine, 425 N. Fifth Street, Phoenix, AZ 85004, USA
| | - S A Tobet
- Department of Biomedical Sciences and School of Biomedical Engineering, Colorado State University, 1617 Campus Delivery, Fort Collins, CO 80523, USA
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12
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Bergström I, Crisby M, Engström AM, Hölcke M, Fored M, Jakobsson Kruse P, Of Sandberg AM. Women with anorexia nervosa should not be treated with estrogen or birth control pills in a bone-sparing effect. Acta Obstet Gynecol Scand 2013; 92:877-80. [PMID: 23682675 DOI: 10.1111/aogs.12178] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 05/13/2013] [Indexed: 11/27/2022]
Abstract
Eating disorders are prevalent, serious conditions that affect mainly young women. An early and enduring sign of anorexia is amenorrhea. There is no evidence for benefits of hormone therapy in patients with anorexia; however, hormone medication and oral contraceptives are frequently prescribed for young women with anorexia as a prevention against and treatment for low bone mineral density. The use of estrogens may create a false picture indicating that the skeleton is being protected against osteoporosis. Thus the motivation to regain weight, and adhere to treatment of the eating disorder in itself, may be reduced. The most important intervention is to restore the menstrual periods through increased nutrition. Hormone and oral contraceptive therapy should not be prescribed for young women with amenorrhea and concurrent eating disorders.
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Affiliation(s)
- Ingrid Bergström
- Center of Osteoporosis, Karolinska University Hospital, Huddinge, Sweden.
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13
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Lawson EA, Fazeli PK, Calder G, Putnam H, Misra M, Meenaghan E, Miller KK, Klibanski A. Plasma sodium level is associated with bone loss severity in women with anorexia nervosa: a cross-sectional study. J Clin Psychiatry 2012; 73:e1379-83. [PMID: 23218167 PMCID: PMC3729037 DOI: 10.4088/jcp.12m07919] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 08/10/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Anorexia nervosa is a psychiatric disorder characterized by restrictive eating, low body weight, and severe bone loss. Recent data show a deleterious relationship between low circulating sodium levels and bone mass, and relative or absolute hyponatremia is a known complication of anorexia nervosa. Clinical studies of other medical conditions associated with hyponatremia suggest that detrimental effects of low sodium levels on health are seen even within the normal range. We hypothesized that women with anorexia nervosa and relatively low plasma sodium levels would have lower bone mineral density (BMD) than those with higher plasma sodium levels. METHOD In a cross-sectional study (January 1, 1997-December 31, 2009) of 404 women aged 17 to 54 years (mean ± standard error of the mean [SEM] age = 25.6 ± 0.3 years) who met DSM-IV criteria for anorexia nervosa, we measured BMD using dual-energy x-ray absorptiometry. Bone mineral density was compared in women with plasma sodium levels < 140 mmol/L (midpoint of normal range) versus those with plasma sodium levels ≥ 140 mmol/L and in women with hyponatremia (plasma sodium < 135 mmol/L) versus those without. The study was conducted at the Neuroendocrine Unit of Massachusetts General Hospital, Boston. RESULTS Women with plasma sodium levels < 140 mmol/L had significantly lower BMD and t and z scores versus those with plasma sodium levels ≥ 140 mmol/L at the anterior-posterior (AP) spine (mean ± SEM z scores = -1.6 ± 0.1 vs -1.3 ± 0.1, P = .004) and total hip (mean ± SEM z scores = -1.2 ± 0.1 vs -0.9 ± 0.1, P = .029). In a model controlling for age, BMI, psychiatric drug use, and disease duration, differences in BMD and t and z scores remained significant at the AP spine. Women with hyponatremia had significantly lower BMD and t and z scores versus those without hyponatremia at the AP spine (mean ± SEM z scores = -2.2 ± 0.3 vs -1.3 ± 0.1, P = .009), lateral spine (mean ± SEM z scores = -2.4 ± 0.4 vs -1.5 ± 0.1, P = .031), and total hip (mean ± SEM z scores = -2.5 ± 0.5 vs -1.0 ± 0.1, P < .0001). In a model controlling for age, BMI, psychiatric drug use, and disease duration, differences in BMD and z and t scores remained significant at all sites. CONCLUSIONS These data suggest that relative plasma sodium deficiency may contribute to anorexia nervosa-related osteopenia.
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Affiliation(s)
- Elizabeth A. Lawson
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Pouneh K. Fazeli
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Genevieve Calder
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Hannah Putnam
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Erinne Meenaghan
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Karen K. Miller
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114
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15
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Sezer S, Karakan Ş, Şaşak G, Tutal E, Özdemir Acar FN. Body Fat Percentage as a Risk Factor for Atherosclerosis but not for Inflammation for Hemodialysis Patients: Differences Between Genders. J Ren Nutr 2012; 22:490-8. [DOI: 10.1053/j.jrn.2011.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 08/09/2011] [Accepted: 09/01/2011] [Indexed: 11/11/2022] Open
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Morrison JA, Glueck CJ, Daniels SR, Wang P, Stroop DM, Horn PS. High-sensitivity C reactive protein: associations with cardiovascular risk factors and tracking in female adolescents and young adults. ISRN PEDIATRICS 2011; 2011:707206. [PMID: 22482065 PMCID: PMC3317078 DOI: 10.5402/2011/707206] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 12/30/2010] [Indexed: 11/23/2022]
Abstract
Objective. We assessed adolescent anthropometry, lipids, insulin, glucose, and blood pressures to identify factors associated with high-sensitivity C-reactive protein (hsCRP) and its tracking in young adults. Methods. Ten-year prospective study of 589 schoolgirls, 321 black, 268 white. Results. HsCRP did not differ (P > .08) by race or oral contraceptive use. HsCRP tracked from age 16 to 25 (r = 0.77), 16 to 26 (r = 0.50), 24 to 26 (r = 0.66), and 25 to 26 (r = 0.71), all P ≤ .02. By stepwise regression, at age 16, waist circumference accounted for 44.8% of hsCRP variance; BMI accounted for 33.1%, 34.4%, and 31.1% at ages 24, 25, and 26, P < .0001 for all. Changes in cholesterol and BMI were associated with change in hsCRP from age 24-26 (partial R(2) = 12.3% P < .0001, 6.6% P = .0012). Changes in BMI and triglyceride (partial R(2) = 8.5% P = .0001, 3.3%, P = .0045) were associated with change in hsCRP from age 25 to 26. Conclusions. HsCRP tracks from age 16 to 26, with BMI, waist circumference, and cholesterol as major determinants.
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Affiliation(s)
- John A Morrison
- Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA
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Ndiaye NC, Albuisson É, Colombet I, Chatellier G, Marteau JB, Dadé S, Siest G, Visvikis-Siest S. Parental precocious influences on offspring cardiovascular risk markers: an exploratory study in the STANISLAS Cohort. Per Med 2009; 6:343-352. [PMID: 29783507 DOI: 10.2217/pme.09.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Familial history of cardiovascular disease is acknowledged as a risk indicator in offspring. The aim of this study was to assess whether the cardiovascular risk factors in parents predicted the risk of their children developing cardiovascular disease in a French population: the STANISLAS Cohort, in which Caucasian biparental families with at least two siblings were followed for 5 years. Silent risk factors (blood pressure, lipid traits, glycemia, BMI and waist circumference) of children were compared according to their parents' risk status in a subsample of 693 families. All of these traits, with the exception of glucose, were significantly higher in children who had parents at a high risk than in children with parents at a low risk at the first health examination, and these results were confirmed again 5 years later at the second health examination. Thus, silent cardio-metabolic risk factors can be screened in children according to the risk status of their parents for early prevention. The influence of parents' variants on their offspring underlined the need to initiate familial prevention strategies, with a particular follow-up of young individuals between childhood and adolescence.
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Affiliation(s)
- Ndeye Coumba Ndiaye
- Université Henri Poincaré Nancy I - Faculté de Pharmacie, Équipe 'Génétique Cardiovasculaire' - 30 rue Lionnois, F-54000, Nancy, France.
| | - Éliane Albuisson
- Université Henri Poincaré Nancy I - Faculté de Pharmacie, Équipe 'Génétique Cardiovasculaire' - 30 rue Lionnois, F-54000, Nancy, France. .,Centre Hospitalier Universitaire, Nancy, France
| | - Isabelle Colombet
- Université Paris V, Paris, France.,Hôpital Européen Georges Pompidou, Paris, France
| | - Gilles Chatellier
- Université Paris V, Paris, France.,Hôpital Européen Georges Pompidou, Paris, France
| | - Jean-Brice Marteau
- Université Henri Poincaré Nancy I - Faculté de Pharmacie, Équipe 'Génétique Cardiovasculaire' - 30 rue Lionnois, F-54000, Nancy, France.
| | - Sébastien Dadé
- Université Henri Poincaré Nancy I - Faculté de Pharmacie, Équipe 'Génétique Cardiovasculaire' - 30 rue Lionnois, F-54000, Nancy, France.
| | - Gérard Siest
- Université Henri Poincaré Nancy I - Faculté de Pharmacie, Équipe 'Génétique Cardiovasculaire' - 30 rue Lionnois, F-54000, Nancy, France.
| | - Sophie Visvikis-Siest
- Université Henri Poincaré Nancy I - Faculté de Pharmacie, Équipe 'Génétique Cardiovasculaire' - 30 rue Lionnois, F-54000, Nancy, France.
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Endocrine abnormalities in anorexia nervosa. ACTA ACUST UNITED AC 2008; 4:407-14. [PMID: 18542109 DOI: 10.1038/ncpendmet0872] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 04/30/2008] [Indexed: 12/23/2022]
Abstract
Anorexia nervosa (AN) is a psychiatric disease associated with notable medical complications and increased mortality. Endocrine abnormalities, including hypogonadotropic hypogonadism, hypercortisolemia, growth hormone resistance and sick euthyroid syndrome, mediate the clinical manifestations of this disease. Alterations in anorexigenic and orexigenic appetite-regulating pathways have also been described. Decreases in fat mass result in adipokine abnormalities. Although most of the endocrine changes that occur in AN represent physiologic adaptation to starvation, some persist after recovery and might contribute to susceptibility to AN recurrence. In this Review, we summarize key endocrine alterations in AN, with a particular focus on the profound bone loss that can occur in this disease. Although AN is increasingly prevalent among boys and men, the disorder predominantly affects girls and women who are, therefore, the focus of this Review.
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