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Schuster K, Staffeld A, Zimmermann A, Böge N, Lang S, Kuhla A, Frintrop L. Starvation in Mice Induces Liver Damage Associated with Autophagy. Nutrients 2024; 16:1191. [PMID: 38674881 PMCID: PMC11053507 DOI: 10.3390/nu16081191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/03/2024] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
Anorexia nervosa (AN) induces organ dysfunction caused by malnutrition, including liver damage leading to a rise in transaminases due to hepatocyte damage. The underlying pathophysiology of starvation-induced liver damage is poorly understood. We investigate the effect of a 25% body weight reduction on murine livers in a mouse model and examine possible underlying mechanisms of starvation-induced liver damage. Female mice received a restricted amount of food with access to running wheels until a 25% weight reduction was achieved. This weight reduction was maintained for two weeks to mimic chronic starvation. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were measured spectrophotometrically. Liver fat content was analyzed using an Oil Red O stain, and liver glycogen was determined using a Periodic acid-Schiff (PAS) stain. Immunohistochemical stains were used to investigate macrophages, proliferation, apoptosis, and autophagy. Starvation led to an elevation of AST and ALT values, a decreased amount of liver fat, and reduced glycogen deposits. The density of F4/80+ macrophage numbers as well as proliferating KI67+ cells were decreased by starvation, while apoptosis was not altered. This was paralleled by an increase in autophagy-related protein staining. Increased transaminase values suggest the presence of liver damage in the examined livers of starved mice. The observed starvation-induced liver damage may be attributed to increased autophagy. Whether other mechanisms play an additional role in starvation-induced liver damage remains to be investigated.
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Affiliation(s)
- Katharina Schuster
- Institute of Anatomy, Rostock University Medical Center, 18057 Rostock, Germany; (K.S.); (A.Z.); (S.L.)
| | - Anna Staffeld
- Institute of Anatomy, Rostock University Medical Center, 18057 Rostock, Germany; (K.S.); (A.Z.); (S.L.)
| | - Annelie Zimmermann
- Institute of Anatomy, Rostock University Medical Center, 18057 Rostock, Germany; (K.S.); (A.Z.); (S.L.)
| | - Natalie Böge
- Institute of Anatomy, Rostock University Medical Center, 18057 Rostock, Germany; (K.S.); (A.Z.); (S.L.)
| | - Stephan Lang
- Institute of Anatomy, Rostock University Medical Center, 18057 Rostock, Germany; (K.S.); (A.Z.); (S.L.)
| | - Angela Kuhla
- Rudolf-Zenker-Institute for Experimental Surgery, Medical University Rostock, 18057 Rostock, Germany
| | - Linda Frintrop
- Institute of Anatomy, Rostock University Medical Center, 18057 Rostock, Germany; (K.S.); (A.Z.); (S.L.)
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Samodova D, Hoel A, Hansen TH, Clausen L, Telléus GK, Marti HP, Pedersen O, Støving RK, Deshmukh AS. Plasma proteome profiling reveals metabolic and immunologic differences between Anorexia Nervosa subtypes. Metabolism 2024; 152:155760. [PMID: 38104923 DOI: 10.1016/j.metabol.2023.155760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/19/2023]
Abstract
AIMS/HYPOTHESIS Anorexia Nervosa (AN) is a severe psychiatric disorder of an unknown etiology with a crude mortality rate of about 5 % per decade, making it one of the deadliest of all psychiatric illnesses. AN is broadly classified into two main subtypes, restricting and binge/purging disorder. Despite extensive research efforts during several decades, the underlying pathophysiology of AN remains poorly understood. In this study, we aimed to identify novel protein biomarkers for AN by performing a proteomics analysis of fasting plasma samples from 78 females with AN (57 restrictive and 21 binge/purge type) and 70 healthy controls. METHODS Using state-of-the-art mass spectrometry-based proteomics technology in conjunction with an advanced bioinformatics pipeline, we quantify >500 plasma proteins. RESULTS Differential expression analysis and correlation of proteomics data with clinical variables led to identification of a panel of novel protein biomarkers with potential pathophysiological significance for AN. Our findings demonstrate evidence of a humoral immune system response, altered lipid metabolism and potential alteration of plasma cells in AN patients. Additionally, we stratified AN patients based on the quantified proteins and suggest a potential autoimmune nature in the restrictive subtype of AN. CONCLUSIONS/INTERPRETATION In summary, on top of biomarkers of AN subtypes, this study provides a comprehensive map of plasma proteins that constitute a resource for further studies of the pathophysiology of AN.
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Affiliation(s)
- Diana Samodova
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - August Hoel
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Tue Haldor Hansen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark
| | - Loa Clausen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Gry Kjaersdam Telléus
- Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark; Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Hans-Peter Marti
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | - Oluf Pedersen
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark; Center for Clinical Metabolic Research, Gentofte University Hospital, Copenhagen, Denmark
| | - Rene Klinkby Støving
- Center for Eating Disorders and Research Unit for Medical Endocrinology, Odense University Hospital, Mental Health Services in the Region of Southern Denmark, Denmark; Clinical Institute, University of Southern Denmark, Department of Endocrinology and Center for Eating Disorders, Odense University Hospital, J. B. Winsløws Vej 4, 5000 Odense, Denmark.
| | - Atul Shahaji Deshmukh
- Novo Nordisk Foundation Center for Basic Metabolic Research, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen, Denmark.
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Tsutsumi M, Okamoto N, Tesen H, Kijima R, Yoshimura R. Choosing Appropriate Nutritional Therapy for Patients With Anorexia Nervosa Exhibiting Liver Dysfunction: A Case Report. Cureus 2024; 16:e54332. [PMID: 38500915 PMCID: PMC10945030 DOI: 10.7759/cureus.54332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/20/2024] Open
Abstract
Anorexia nervosa (AN) presents with a variety of physical complications such as hypoglycemia, electrolyte abnormalities, and dehydration associated with starvation, requiring rapid weight gain through nutritional therapy. However, despite nutritional therapy, patients are at risk of many serious medical complications, including hypoglycemia, hypophosphatemia, edema, and liver damage. Starvation has been found to cause hepatocyte injury with mild-to-severe increases in liver enzyme levels, and distinguishing between autophagy and refeeding syndrome is important for treatment strategies. Herein, we report a rare case of sudden liver injury after the initiation of nutritional therapy in a patient with AN. A 35-year-old woman was admitted to our hospital for the treatment of weight loss due to AN. Nutritional therapy was initiated at 600 kcal/day and increased to 1500 kcal/day on the 21st day of admission. On the 22nd day after admission, rapid liver injury was observed, with an aspartate aminotransferase level of 141 U/L and an alanine aminotransferase level of 221 U/L. After the exclusion of refeeding syndrome, since there was no evidence of hypokalemia, hypophosphatemia, or fatty liver disease based on blood tests and abdominal echography, we diagnosed starvation-induced hepatocyte autophagy, and she was treated with the same calories. Her liver dysfunction gradually improved thereafter. This case report highlights the clinical utility of identifying the etiology of hepatic dysfunction in patients with AN. Clinicians must make appropriate decisions regarding continuing or reducing nutritional therapy based on relevant tests when patients with AN develop liver dysfunction after the initiation of nutritional therapy.
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Affiliation(s)
- Motoharu Tsutsumi
- Psychiatry, University of Occupational and Environmental Health, Kitakyushu, JPN
| | - Naomichi Okamoto
- Psychiatry, University of Occupational and Environmental Health, Kitakyushu, JPN
| | - Hirofumi Tesen
- Psychiatry, University of Occupational and Environmental Health, Kitakyushu, JPN
| | - Reoto Kijima
- Psychiatry, University of Occupational and Environmental Health, Kitakyushu, JPN
| | - Reiji Yoshimura
- Psychiatry, University of Occupational and Environmental Health, Kitakyushu, JPN
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Dönmez RB, Demirel TN, Bilgin C, Tarhan N, Örkçü Ö, Ceylan Z, Guleken Z. Comparative and Predictive Analysis of Clinical and Metabolic Features of Anorexia Nervosa and Bulimia Nervosa. ADDICTION & HEALTH 2023; 15:230-239. [PMID: 38322479 PMCID: PMC10843349 DOI: 10.34172/ahj.2023.1466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 06/23/2023] [Indexed: 02/08/2024]
Abstract
Background Eating disorders have become increasingly prevalent over the years; the age at which they appear has decreased, and they can lead to serious illness or death. Therefore, the number of studies on the matter has increased. Eating disorders like anorexia nervosa (AN) and bulimia nervosa (BN) are affected by many factors including mental illnesses that can have serious physical and psychological consequences. Accordingly, the present study aimed to compare the clinical and metabolic features of patients with AN and BN and identify potential biomarkers for distinguishing between the two disorders. Methods Clinical data of 41 participants who sought treatment for eating disorders between 2012 and 2022, including 29 AN patients and 12 BN patients, were obtained from NPIstanbul Brain Hospital in Istanbul, Turkey. The study included the clinical variables of both outpatient and inpatient treatments. Principal component analysis (PCA) was utilized to gain insights into differentiating AN and BN patients based on clinical characteristics, while machine learning techniques were applied to identify eating disorders. Findings The study found that thyroid hormone levels in patients with AN and BN were influenced by non-thyroidal illness syndrome (NTIS), which could be attributed to various factors, including psychiatric disorders, substance abuse, and medication use. Lipid profile comparisons revealed higher triglyceride levels in the BN group (P<0.05), indicating increased triglyceride synthesis and storage as an energy source. Liver function tests showed lower levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in BN patients (P<0.05), while higher prolactin levels (P<0.05) suggested an altered hypothalamic-pituitary-gonadal axis. Imbalances in minerals such as calcium and magnesium (P<0.05) were observed in individuals with eating disorders. PCA effectively differentiated AN and BN patients based on clinical features, and the Naïve Bayes (NB) model showed promising results in identifying eating disorders. Conclusion The findings of the study provide important insights into AN and BN patients' clinical features and may help guide future research and treatment strategies for these conditions.
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Affiliation(s)
| | | | - Cem Bilgin
- Faculty of Medicine, Üsküdar University, Istanbul, Turkey
| | - Nevzat Tarhan
- Department of Physiatry, Üsküdar University, NP Hospital, Istanbul, Turkey
| | - Özden Örkçü
- Vocational School of Food Technology, Üsküdar University, Istanbul, Turkey
| | - Zeynep Ceylan
- Department of Industrial Engineering, Faculty of Engineering, Samsun University, Samsun, Turkey
| | - Zozan Guleken
- Department of Physiology, Faculty of Medicine, Gaziantep Islam Science and Technology University, Gaziantep, Turkey
- Medical College of Rzeszów University, Rzeszów, Poland
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Cuntz U, Quadflieg N, Voderholzer U. Health Risk and Underweight. Nutrients 2023; 15:3262. [PMID: 37513680 PMCID: PMC10383423 DOI: 10.3390/nu15143262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Anorexia nervosa is associated with a significant risk of morbidity and mortality. In clinical practice, health risk is assessed and estimated using routinely collected laboratory data. This study will develop a risk score using clinically relevant laboratory parameters. The related question is how to estimate the health risk associated with underweight using body weight, height and age. METHODS We used routinely collected laboratory parameters from a total of 4087 patients. The risk score was calculated on the basis of electrolytes, blood count, transaminases and LDH. The nine parameters used were summed as zlog-transformed values. Where appropriate, the scales were inverted so that high values represented higher risk. For statistical prediction of the risk score, weight/height and age reference values from the WHO, the CDC (Center of Disease Control) and representative studies of German children and adults (KIGGS and NNS) were used. RESULTS The score calculated from nine laboratory parameters already shows a convincing relationship with BMI. Among the weight measures used for height and age, the z-score from the CDC reference population emerged as the best estimate, explaining 34% of the variance in health risk measured by the laboratory score. The percentile rank for each age-specific median weight from the KIGGS/NNS still explained more than 31% of the variance. In contrast, percentiles explained less variance than BMI without age correction. CONCLUSIONS The score we used from routine laboratory parameters appears to be an appropriate measure for assessing the health risk associated with underweight, as measured by the quality of the association with BMI. For estimating health risk based on weight, height and age alone, z-scores and percentages of age-specific median weight, as opposed to percentiles, are appropriate parameters. However, the study also shows that existing age-specific BMI reference values do not represent risk optimally. Improved statistical estimation methods would be desirable.
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Affiliation(s)
- Ulrich Cuntz
- Center for Psychosomatic Medicine, Schoen Klinik Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany
- Forschungsprogramm für Psychotherapieevaluation im Komplexen Therapiesetting, Paracelsus Medizinische Universität, 5020 Salzburg, Austria
- Departamento de Enlace y Medicina Psicosomatica, Universidad Catolica, Santiago 8831314, Chile
| | - Norbert Quadflieg
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians Universität, 80336 Munich, Germany
| | - Ulrich Voderholzer
- Center for Psychosomatic Medicine, Schoen Klinik Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany
- Department of Psychiatry and Psychotherapy, Ludwig Maximilians Universität, 80336 Munich, Germany
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Muacevic A, Adler JR. Elevated Liver Enzymes in an Adult Male With Anorexia Nervosa: A Case Report. Cureus 2022; 14:e31367. [PMID: 36514589 PMCID: PMC9741840 DOI: 10.7759/cureus.31367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 11/13/2022] Open
Abstract
Anorexia nervosa is a prevalent eating disorder often accompanied by various medical complications, along with increased liver serum enzymes, especially transaminases. Here, we describe the case of an adult male patient admitted to a general hospital. The patient presented with malnourishment arising from AN and severely affected liver function tests.
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