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Approximately 0.5% to 1% of college-aged women have anorexia nervosa and most of them live in the community. However, few clinical data exist regarding community-dwelling women with anorexia nervosa. The objective of this study was to determine the prevalences of common medical findings for these women.
Cross-sectional, community-based study of 214...
Context in source publication
Context 1
... signs are shown in Table 3. Of the 214 partici- pants, 43% had heart rates below normal (60 beats per minute), 17% had heart rates of less than 50 beats per minute, and 1% had heart rates less than 40 beats per minute; 15% had systolic blood pressures less than 90 mm Hg and 2% had diastolic blood pressures less than 50 mm Hg; and 22% had hypothermia, as defined by tem- perature below 36°C. ...
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Case:
A 25-year-old woman with chronic anorexia nervosa and depression presented with sudden weakness and fatigue. Psychosocial history was notable for binge-starve cycles over the past year and a decline in overall well-being. Vitals on presentation were notable for hypothermia, hypotension, and bradycardia. Initial exam was significant for emaci...
Citations
... In line with the results of the present study, Miller et al. reported the prevalence of anemia in American anorexia nervosa woman (17-45 years) as 38.6% [18]. Also, in another related study conducted in the USA, the prevalence of anemia in men was 56.36% [23]. ...
... ;Table 1)[16][17][18][19][20][21][22][23]. The maximum prevalence of anemia in anorexia nervosa patients was associated with the study of Sabel et al. in the German population as 83% (calculated based on the hematocrit level)[16] and the lowest value was detected among Italian female patients reported by Filippo et al., as 16.7% (calculated based on the hemoglobin level) [17]. ...
Background
Anorexia nervosa (AN) is a mental disorder characterized by severe loss of appetite and low nutrient intake. Along with many complications, the anorexia nervosa eventually disrupts hematogenesis and the occurrence of anemia. Thus, the present study aimed to investigate the global prevalence of anemia in anorexia nervosa patient.
Methods
Systematic searching was applied (by August 10, 2024) in databases of PubMed, Scopus, WoS, ScienceDirect, Embase, and the Google Scholar search engine. Selected investigations were imported to the EndNote Citation Management Software and duplicate papers were merged. Following consideration of inclusion and exclusion criteria (during primary and secondary screening) relevant papers were selected and underwent validation. Finally, eligible papers were selected for data extraction and meta-analysis (CMA v.2). The I2 index was used for heterogeneity assessment, and the Random Effect Model was used for meta-analysis. The results were categorized based on hematocrit and hemoglobin levels, and study type, and meta-regression was also applied for sample size and year of paper publication.
Results
In the review of 9 eligible studies, the global prevalence of anemia in anorexia nervosa patient was found to be 44.8% (95%CI:25.7–65.7). Also, this value was detected in 48% (95%CI:19.9–77.4) and 43.4% (95%CI:18.6-72) based on hematocrit and hemoglobin levels, respectively. Meta-regression analysis showed that following the increase in sample size and year of paper publication, the global prevalence of anemia in Anorexia nervosa patient decreased and increased, respectively.
Conclusion
A relatively high prevalence of anemia in individuals with anorexia nervosa requires proper attention to the regular blood monitoring and laboratory evaluations of the patients.
... The skeletal effects of these hormonal imbalances are evident in the compromised bone microarchitecture of individuals with AN. Approximately 90% of women with AN exhibit BMD values more than 1 SD below the mean for their age [100,101]. Adolescents with AN display reduced cortical thickness, increased porosity, and impaired trabecular connectivity, structural deficits that persist into adulthood and significantly elevate fracture risks [102,103]. Weight recovery remains the cornerstone of treatment and often leads to notable improvements in BMD [104]. ...
Childhood obesity represents a multifaceted challenge to bone health, influenced by a combination of endocrine, metabolic, and mechanical factors. Excess body fat correlates with an increase in bone mineral density (BMD) yet paradoxically elevates fracture risk due to compromised bone quality and increased mechanical loading on atypical sites. Additionally, subjects with syndromic obesity, as well as individuals with atypical nutritional patterns, including those with eating disorders, show bone fragility through unique genetic and hormonal dysregulations. Emerging evidence underscores the adverse effects of new pharmacological treatments for severe obesity on bone health. Novel drugs, such as glucagon-like peptide-1 (GLP-1) receptor agonists, and bariatric surgery demonstrate potential in achieving weight loss, though limited evidence is available regarding their short- and long-term impacts on skeletal health. This review provides a comprehensive analysis of the mechanisms underlying the impact of childhood obesity on bone health. It critically appraises evidence from in vitro studies, animal models, and clinical research in children with exogenous obesity, syndromic obesity, and eating disorders. It also explores the effects of emerging pharmacological and surgical treatments for severe obesity on skeletal integrity, highlights prevention strategies, and identifies research gaps.
... Anemia is a known complication of AN, primarily due to adaptive alterations in the bone marrow resulting from weight loss (Miller et al. 2005;Walsh, Blalock, and Mehler 2020). We found that AN was associated with a diagnosis of anemia both before and after AN diagnosis. ...
... AN affects almost every organ system (Gibson, Workman, and Mehler 2019;Westmoreland, Krantz, and Mehler 2016;Miller et al. 2005;Mehler and Brown 2015) due to low weight and malnourishment and adaptive compensatory changes in the body (Cost, Krantz, and Mehler 2020). Additionally, the decrease in risk with increasing follow-up time has been described previously (Steinhausen et al. 2022), as many conditions normalize with weight restoration (Cost, Krantz, and Mehler 2020). ...
Objective
This study investigates the overall pattern and timing of medical diagnoses up to 10 years before an anorexia nervosa (AN) diagnosis and explores differences before and after AN diagnosis aiming to improve early detection.
Method
In this nationwide population‐based cohort study, we included all patients diagnosed with incident AN from 1987 to 2018 ( n = 13,345) and a 1:10 age‐ and sex‐matched general population comparison cohort, using Danish health registries. Using conditional logistic regression, we calculated odds ratios (ORs) of medical diagnoses up to 10 years before AN diagnosis. Additionally, we calculated crude and adjusted hazard ratios (aHRs) for risk of medical diagnoses after AN diagnosis using Cox proportional hazards model.
Results
AN was associated with increased odds of any medical diagnosis up to 10 years before AN diagnosis: OR 1.3 [95% CI 1.2–1.3] and the odds increased during the 12 months preceding AN diagnosis: OR 1.6 [95% CI 1.5–1.7]. The medical diagnoses associated with the highest odds up to 10 years prior AN were malnutrition: OR 5.0 [95% CI 4.0–6.3] anemia: OR 2.9 [95% CI 2.3–3.6], amenorrhea: OR 2.7 [95% CI 2.3–3.2], and irritable bowel syndrome: OR 2.1 [95% CI 1.9–2.4]. The pre‐diagnosis pattern mirrored the post‐diagnosis pattern.
Conclusion
The similarity in diagnosis patterns before and after AN diagnosis suggests that many patients receive medical diagnoses for conditions potentially linked to AN‐related restricted eating, malnutrition and progressive weight loss even years prior to a formal AN diagnosis. Identifying these early conditions may enable earlier AN diagnosis and improve treatment outcomes.
... However, similar to the assessment of BMI, these methods do not provide a reliable reflection of the biological manifestations of the disease such as endocrine or electrolyte disturbances, which also directly influence therapeutic decisions. This is particularly relevant given the considerable prevalence of systemic complications in this population, including anemia, hyponatraemia and hypokalaemia, or elevated liver enzymes, which cannot be directly attributed only to the degree of undernutrition [62]. However, new reports are periodically published on potential new indicators of disease severity. ...
Introduction: Anorexia nervosa (AN) is a psychiatric disorder with a high mortality rate and significant prevalence in the paediatric population. Preliminary reports during the COVID-19 pandemic suggested an increased incidence of AN among children and adolescents. The objective of this study was to analyse new cases of AN before, during, and after the pandemic, with a particular focus on the physical manifestations of the disease. Methods: This single-centre, retrospective study included new AN cases from the hospital database of a regional paediatric hospital (a reference centre for AN) between 2013 and 2023. Data analysed included the duration of the disease, body mass index (BMI), weight loss, length of hospitalisation, laboratory markers (leukopenia, anaemia, hypoproteinaemia, hyperferritinaemia, hypophosphataemia, dyslipidaemia, and hypothyroxinaemia) and clinical features of malnutrition (such as amenorrhea bradycardia, pericardial effusion, and cortical/subcortical atrophy). Results: This study was conducted in a Polish regional hospital. We analysed 228 hospitalized female patients aged 10 to 18 years diagnosed with AN, focusing on clinical characteristics, biochemical markers, and the impact of the COVID-19 pandemic. The COVID-19 pandemic was shown to have a significant impact, with longer hospitalisations observed during and after the pandemic and a lower BMI on admission post-pandemic compared to pre-pandemic. In addition, nutritional treatment became more prevalent over time while biochemical markers such as anaemia, hypothyroidism, hypophosphataemia, and dyslipidaemia were statistically more common post-pandemic. Conclusions: This study demonstrates a significant impact of the COVID-19 pandemic on the clinical course and hospitalisation patterns of paediatric patients with AN. These findings suggest that the pandemic may have exacerbated disease severity and altered treatment approaches, emphasizing the need for enhanced clinical management and follow-up strategies for AN in the paediatric population during such health crises.
... The psychological distress experienced by individuals with AN often leads to social withdrawal, irritability, and mood disturbances such as anxiety and depression (3,4) Physically, AN can result in severe malnutrition, leading to a host of medical complications that affect various organ systems. Common physical symptoms include significant weight loss, bradycardia (slow heart rate), hypotension (low blood pressure), electrolyte imbalances, and amenorrhea (loss of menstrual periods) (5,6). These physiological changes can have lifethreatening consequences. ...
Background
Anorexia nervosa (AN) can significantly affect cognitive well-being. Cognitive remediation therapy (CRT) is regarded as one of the effective treatments for cognitive impairment in some mental illnesses such as schizophrenia, bipolar disorder, and attention deficit. For this reason, this systematic review and meta-analysis aim to assess the effectiveness of CRT in patients with AN.
Methods
We conducted a search of Medline, ClinicalTrials.gov, and the Cochrane Database of Systematic Reviews from the inception of each database through April 8, 2023. Randomized clinical trials evaluating the effectiveness of CRT in comparison to placebo or other psychological treatments in patients with AN were included. The quality of the studies was assessed using the revised Cochrane risk-of-bias tool. For meta-analysis, effect sizes were measured using mean difference (MD) utilizing the random-effects model and inverse variance (IV) technique. To evaluate the certainty of the evidence, we applied the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria. The study was registered in PROSPERO, ID: CRD42023411784.
Results
In the systematic review, six studies were included, of which four underwent meta-analysis. Among these, three trials encompassing 413 participants showed that CRT was associated with improved cognitive flexibility compared to control at the end of treatment (MD = -0.21, 95% CI [-0.44, 0.02], P=0.81, I² = 0%). In two trials with 143 patients, those who received CRT showed similar effects on the severity of AN symptoms compared to the control group in the self-reporting questionnaires: EDE-Q (MD = -0.25, 95% CI [-0.76, 0.27], P=0.77, I² = 0%) and EDEQOL (MD = -0.19, 95% CI [-0.41, 0.03], P=0.84, I² = 0%).
Conclusion
CRT did not show a statistically significant difference compared to the control group in improving abstract thinking skills and quality of life in individuals with AN. That indicates that CRT’s efficacy remains inconclusive. Further research with larger, more diverse samples is needed to determine its long-term effects and potential benefits.
Systematic review registration
PROSPERO, identifier CRD42023411784.
... Moreover, patients with EDs may present a broad spectrum of complications, which tend to be particularly serious in patients with AN [12]. Existing literature shows that a more severe clinical course may be associated with a chronic ED [13]. A study of 41 patients treated in a specialized ED unit in Chile found that the clinical severity of the disorder was associated with a delay in finding treatment [14]. ...
Background
Eating disorders (EDs) are associated with high morbidity and mortality, affecting predominantly young people and women. A delay in starting treatment is associated with chronic and more severe clinical courses; however, evidence on barriers and facilitators of access to care in Latin America is scarce. We aimed to identify barriers and facilitators of ED treatment in Chile from the perspective of patients, relatives, and health professionals.
Methods
Qualitative approach through semi-structured interviews with patients, their relatives, and health professionals. Participants were recruited from two ED centers in Santiago, Chile (one public and one private). Analysis was mainly based on Grounded Theory, using MAXQDA software.
Results
40 interviews were conducted (n = 22 patients, 10 relatives, and 8 health professionals). The mean age of patients was 21.8 years, while the mean duration of untreated ED was 91.4 months (median 70 months). Five categories emerged with intersections between them: patient (P), family and social environment (FSE), health professionals (HP), healthcare system (HCS), and social and cultural context (SCC). Relevant barriers appeared within these categories and their intersections, highlighting a lack of professional knowledge or expertise, cultural ignorance or misinformation regarding EDs, and patient’s ego-syntonic behaviors. The main facilitators were patients’ and relatives’ psychoeducation, recognition of symptoms by family members, and parents taking the initiative to seek treatment.
Conclusions
This study provides information regarding access to treatment for patients living with EDs in Chile. A practical public health approach should consider the multi-causality of delay in treatment and promoting early interventions.
Plain English Summary
Eating disorders (EDs) may severely affect the daily functioning of people enduring them. A delay in starting treatment is associated with a disease that is more difficult to treat. To our knowledge, there are no published studies carried out in Latin America exploring factors influencing treatment initiation in EDs patients. This study aimed to identify facilitators of and barriers to treating patients with EDs in Chile. We interviewed patients (n = 22), their relatives (n = 10), and health professionals (n = 8) from a private and a public center in Santiago, Chile. Our analysis showed that the main barriers to starting treatment were the lack of professional knowledge in ED, the monetary cost of illness, and cultural misinformation. Facilitators were related to the role of the family in recognizing and addressing the disease while being educated in EDs by professionals. This study helps to provide data about treatment access in developing countries. While facilitators and barriers were similar to others reported in the literature, the untreated ED’s duration was longer. It is essential to address these barriers to provide access to treatment more efficiently and prevent severe and enduring forms of disease.
... Furthermore, our study revealed that all women with various EDs sufered from anaemia. Te prevalence of women with AN who had anaemia was nearly double their counterparts in Massachusetts previously researched by Miller and co-workers (72% versus 39%, respectively) [26]. Also, compared to the Australian women with AN and BN, patients in the current study had very low serum ferritin levels (AN � 68.2 versus 14; BN � 46 versus 21 μg/L, respectively) [27]. ...
... Although our study revealed that women with AN were severely underweight, their BMI (17.8 kgm −2 ) was higher than their counterparts in the outpatient clinics in other countries, such as Massachusetts (16.9 kgm −2 ) [26] and Naples (15.95 kgm −2 ) [21]. Similar fndings were shown among Australian patients. ...
... Our study showed that the prevalence of hypoalbuminaemia among women with AN was 4.6 times higher in our study (83%) than among American women (18%) [26]. In addition, Australian women with AN and BN had better albumin levels than our study groups (N � 46.3 versus 20 and BN � 45.5 versus 14.2 g/L, respectively) [27]. ...
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.
... CALERIE also reported changes in bone turnover markers, including a significant increase in the bone resorption marker, C-terminal telopeptide of type-I collagen (CTX), and a significant decrease in the bone formation marker alkaline phosphatase (ALPL) (14). With long-term pathological calorie restriction, as seen in women with anorexia nervosa-a psychiatric condition characterized by chronic, inappropriately low caloric intake-low BMD is observed in approximately 85% (15)(16)(17) and there is an increased risk of fracture (18)(19)(20). ...
Caloric restriction improves metabolic health but is often complicated by bone loss. We studied bone parameters in humans during a 10-day fast and identified candidate metabolic regulators of bone turnover. Pro-collagen 1 intact N-terminal pro-peptide (P1NP), a bone formation marker, decreased within 3 days of fasting. Whereas dual-energy x-ray absorptiometry measures of bone mineral density were unchanged after 10 days of fasting, high-resolution peripheral quantitative CT demonstrated remodeling of bone microarchitecture. Pathway analysis of longitudinal metabolomics data identified one-carbon metabolism as fasting dependent. In cultured osteoblasts, we tested the functional significance of one-carbon metabolites modulated by fasting, finding that methionine - which surged after 3 days of fasting - affected markers of osteoblast cell state in a concentration-dependent manner, in some instances exhibiting a U-shaped response with both low and high concentrations driving putative antibone responses. Administration of methionine to mice for 5 days recapitulated some fasting effects on bone, including a reduction in serum P1NP. In conclusion, a 10-day fast in humans led to remodeling of bone microarchitecture, potentially mediated by a surge in circulating methionine. These data support an emerging model that points to a window of optimal methionine exposure for bone health.
... Different results have been obtained in these studies depending on the severity of the disease or the parameters examined (Dalton et al., 2018;schaumberg et al., 2017;solmi et al., 2015). Other studies have evaluated the effects of restricted eating, rapid weight loss and chronic hunger, and biochemical and haematological changes after weight restoration (Miller et al., 2005;sabel et al., 2013). ...
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.
... Severe malnutrition induces widespread organ dysfunction associated with liver damage, such as hepatocyte injury [2]. This, in turn, can cause rises in the liver enzyme transaminases, namely alanine aminotransferase (ALT) and aspartate aminotransferase (AST), which can increase by up to 76% in AN patients [3][4][5][6]. These markers are commonly used to detect hepatocyte injury, as damaged hepatocyte membranes release liver enzymes into the bloodstream at high levels [7]. ...
... Nutrients 2024, 16, 1191 6 of 12 6.85 km ± 0.79 vs. SIH_chronic: 9.21 km ± 0.69, p ≤ 0.001, Figure 1B). ...
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.
