Review article
Medical complications of eating disorders: an update

https://doi.org/10.1016/j.jadohealth.2003.07.002Get rights and content

Section snippets

Cardiac complications of eating disorders

Starvation can result in wasted cardiac muscle, sinus bradycardia, hypotension, and reduced left ventricular mass, associated with systolic dysfunction [5]. At a microscopic level, myofibrillar atrophy and destruction may result in decreased contractile force and cardiac output [6]. Patients with AN may complain of marked fatigue and have an attenuated blood pressure response to exercise with a reduction in maximal work capacity 7, 8. One-third may have mitral valve prolapse, from wasted

Refeeding syndrome

The risk for cardiac decompensation is highest during the initial stages of refeeding, when left ventricular mass and contractility are already compromised by chronic starvation in patients with AN. “Refeeding syndrome” refers to cardiovascular collapse and possible death that follows oral or parenteral intake of highly caloric nutrients, especially those high in glucose [6]. Delirium can occur during, or after, the second week of refeeding and may continue for several weeks 14, 18, 19. The

Renal abnormalities

Transient azotemia, decreased glomerular filtration rate, decreased concentrating ability, short periods of acute renal failure, and, more rarely, chronic renal failure have been noted in patients with eating disorders 23, 24, 25. Those patients experiencing higher percentages of weight reduction and low body mass index may be at risk for borderline decreases in renal function even with normal levels of serum creatinine [26]. Four adult patients (aged from 31 to 43 years) developed end stage

Water intoxication

Many patients with AN “water load,” either to blunt appetite by creating a sensation of fullness, to falsely elevate weight for medical visits, or in the misguided belief that consumption of water will purify the body and eliminate “toxins” and calories through the urine 25, 26. Water intoxication can cause severe hyponatremia and hypo-osmolality, which can produce cerebral edema, leading to ataxia, seizures, coma, and death 29, 30. As with many of the self-destructive behaviors of eating

Gastrointestinal and oropharyngeal effects

Gastrointestinal (GI) effects of starvation include: delayed gastric emptying, slowed gastrointestinal motility, abnormal esophageal motor activity, and abnormal hormonal and neurotransmitter functions 31, 32, 33, 34, 35, 36, 37. Prokinetic drugs such as cisapride or metochlopromide may relieve some of gastrointestinal symptoms, although the former is not currently used in the United States [38]. Gastrointestinal symptoms may persist after recovery from eating disorders [39], although they tend

Amenorrhea, osteopenia, and eating disorders: the Female Athlete Triad

The Female Athlete Triad refers to the inter-relatedness of amenorrhea, osteopenia, and disordered eating. Athletes with a healthy body image and no evidence of disordered eating may still have athletic amenorrhea. Athletic amenorrhea tends to occur most frequently in females who combine intense physical training with a low stable caloric intake working toward a desired lean body build, as is idealized in gymnastics, ballet, endurance running, or figure skating [47]. In the athletic female with

Hematologic effects

Pancytopenia can be seen in patients with eating disorders. In one study, a relative leukopenia occurred in 23% of patients who were in a state of starvation, caused primarily by increased margination of the white blood cells 21, 73. Accordingly, patients do not have increased susceptibility to infection. Anemia is less common than leukopenia owing to the high prevalence of amenorrhea; however, a microcytic anemia can be seen in vegetarian patients, and hemoglobin levels may be falsely elevated

Effects on the brain

Recent research has focused on the cerebral atrophy and loss of brain volume that accompanies AN 74, 75. In protracted cases of individuals with AN in a state of prolonged malnutrition, enlargement of the cortical sulci and cisterns, ventricular dilatation, and pituitary gland atrophy can occur [76]; these findings may, or may not, be reversible with recovery 75, 76, 78, 79. Some patients may have concomitant cerebral and cerebellar atrophy [80]. Hypothesized mechanisms to explain these

Other medical findings

Acquired pili torti, a structural hair defect that means “twisted hair,” has been seen in patients with AN [84]. This finding may be associated with malnutrition combined with excess intake of yellow vegetables and vitamins. Increased levels of serum carotene, retinyl esters, retinol, and retinoic acid were found in a series of 14 patients who demonstrated pili torti. Other dermatologic findings associated with starvation include alopecia, xerosis, hypertrichosis, and nail fragility [85].

An

Conclusion

The medical complications of eating disorders are significant and potentially irreversible and life-threatening. Moreover, careful explanation of the medical changes that occur when a patient has an eating disorder may help patients make positive changes. Further research is needed to clarify the role of hormone replacement therapy and the use of the bisphosphonates, DHEA, and other newer drugs to treat osteopenia in patients with eating disorders[77].

First page preview

First page preview
Click to open first page preview

References (87)

  • M.J. Mansfield et al.

    Growth in female gymnastsShould training decrease during puberty?

    J Pediatr

    (1993)
  • D. Stewart et al.

    Anorexia nervosa, bulimia, and pregnancy

    Am J Obstet Gynecol

    (1987)
  • N.H. Golden et al.

    Disturbances in growth hormone secretion and action in adolescents with anorexia nervosa

    J Pediatr

    (1994)
  • M. Rolla et al.

    Blockade of cholinergic muscarinic receptors by pirenzepine and GHRH-induced GH secretion in the acute and recovery phase of anorexia nervosa and atypical eating disorders

    Biol Psychiatry

    (1991)
  • D.K. Katzman et al.

    Cerebral gray matter and white matter volume deficits in adolescent females with anorexia nervosa

    J Pediatr

    (1996)
  • Identifying and treating eating disorders

    Pediatrics

    (2003)
  • E.S. Rome et al.

    Children and adolescents with eating disordersThe state of the art

    Pediatrics

    (2003)
  • R.E. Kreipe

    Eating disorders among children and adolescents

    Pediatr Rev

    (1995)
  • A.E. Becker et al.

    Eating disorders

    New Engl J Med

    (1999)
  • G. de Simone

    Cardiac abnormalities in young women with anorexia nervosa

    Br Heart J

    (1994)
  • D.D. Schocken et al.

    Weight loss and the heartEffects of anorexia and starvation

    Arch Intern Med

    (1989)
  • J. Einerson et al.

    Exercise response in females with anorexia nervosa

    Int J Eat Disord

    (1988)
  • D.S. Moodie

    Anorexia and the heart

    Postgrad Med

    (1987)
  • D.G. Meyers et al.

    Mitral valve prolapse in anorexia nervosa

    Ann Intern Med

    (1986)
  • M. Kollai et al.

    Cardiac vagal hyperactivity in adolescent anorexia nervosa

    Eur Heart J

    (1994)
  • P.D. Mehler et al.

    Medical complications of anorexia nervosa

    J Womens Health

    (1997)
  • R.E. Kreipe et al.

    Myocardial impairment resulting from eating disorders

    Pediatr Ann

    (1992)
  • C. Panagiotopoulos et al.

    Electrocardiographic findings in adolescents with eating disorders

    Pediatrics

    (2000)
  • A. Keys et al.

    Size and function of human heart at rest in semi-starvation and in subsequent rehabilitation

    Am J Physiol

    (1947)
  • R.A. Cooke et al.

    QT intervals in anorexia nervosa

    Br Heart J

    (1994)
  • S.M. Solomon et al.

    The refeeding syndromeA review

    J Parenter Enteral Nutr

    (1990)
  • E.S. Rome

    Eating disorders in adolescents and young adultsWhat's a primary care clinician to do?

    Cleve Clin J Med

    (1996)
  • D. Greenfield et al.

    Hypokalemia in outpatients with eating disorders

    Am J Psychiatry

    (1995)
  • A.W. Brotman et al.

    Renal disease and dysfunction in two patients with anorexia nervosa

    J Clin Psychiatry

    (1986)
  • E.M. Abdel-Rahman et al.

    End-stage renal disease (ESRD) in patients with eating disorders

    Clin Nephrol

    (1997)
  • M. Mira et al.

    Hypokalemia and renal impairment in patients with eating disorders

    Med J Aust

    (1984)
  • D. Sandy et al.

    Renal function in patients with eating disorders

    J Adolesc Health

    (2000)
  • S.J. Crow et al.

    Urine electrolytes as markers of bulimia nervosa

    Int J Eat Disord

    (2001)
  • P. Santonastaso et al.

    Water intoxication in anorexia nervosaA case report

    Int J Eat Disord

    (1998)
  • G. Stacher et al.

    Oesophageal and gastric motility disorders in patients categorised as having primary anorexia nervosa

    Gut

    (1986)
  • P.H. Robinson et al.

    Determinants of delayed gastric emptying in anorexia nervosa and bulimia nervosa

    Gut

    (1988)
  • W.R. Hutson et al.

    Gastric emptying in patients with bulimia nervosa and anorexia nervosa

    Am J Gastroenterol

    (1990)
  • T.D. Geraciotti et al.

    Impaired cholecystokinin secretion in bulimia nervosa

    N Engl J Med

    (1988)
  • Cited by (130)

    • Eating disorders

      2020, Present Knowledge in Nutrition: Clinical and Applied Topics in Nutrition
    • Eating Disorders in Children and Adolescents

      2020, Pediatric Gastrointestinal and Liver Disease, Sixth Edition
    View all citing articles on Scopus
    View full text