Associations between low body weight, weight loss, and medical instability in adults with eating disorders.

OBJECTIVE: The physical complications of atypical anorexia nervosa remain understudied, with most studies completed in adolescents. This study seeks to examine the impact of various weight measures as predictors of medical instability in a large cohort of adult eating disorder patients. METHODS: In this retrospective cohort study, the impact of admission body mass index (BMI), weight suppression, and recent weight loss (the rate of weight loss within the last 12 months) toward the development of medical complications of malnutrition were examined. Multivariable logistic regression assessed the association of binary clinical outcomes of interest with recent weight loss and weight suppression (adjusting for age, admission BMI, gender, and purging behaviors). Odds ratios (OR) and 99% confidence intervals were reported. RESULTS: Greater recent weight loss increased the odds of developing low prealbumin and reduced hand grip strength. A greater weight suppression was associated with increased likelihood of amenorrhea, reduced systolic blood pressure, nadir hemoglobin, and weekly weight gain upon nutritional rehabilitation. Lower admission BMI was predictive of all the medical outcomes examined, with the exception of bradycardia, and was generally the strongest predictor based on standardized coefficients. DISCUSSION: Recent weight loss and weight suppression are predictive of some of the physiologic changes of malnutrition, although low BMI is seemingly the greatest predictor for the development of these complications. These findings suggest that some patients with aggressive weight suppression and/or acute weight loss would benefit from medical stabilization, although this needs to be further defined. PUBLIC SIGNIFICANCE: In adults, low BMI seems to be a better predictor of medical complications than weight suppression or aggressive recent weight loss. In adults, greater weight suppression is associated with increased likelihood of amenorrhea, reduced systolic blood pressure, nadir hemoglobin, and weight gain upon nutritional rehabilitation.

A Multi-Disciplinary Approach to Managing End-Stage Renal Disease in Anorexia Nervosa: A Case Report.

Background: Renal dysfunction and electrolyte abnormalities are common complications of anorexia nervosa (AN), particularly in the binge-eating/purging type (AN-BP). Hypokalemic, or kaliopenic, nephropathy is an established clinical entity and a leading cause of end-stage renal disease (ESRD) in AN. Here, we present a case which demonstrates the difficulties of managing refeeding and nutrition in a psychiatrically and medically complex patient with severe AN-BP and ESRD most likely secondary to hypokalemic nephropathy. Case Report: A 54-year-old female with AN-BP that has resulted in chronic hypokalemia, with newly diagnosed ESRD on hemodialysis, presented to an eating disorder medical stabilization unit for weight restoration and treatment of the medical complications associated with her severe malnutrition and ESRD. She was admitted with a body mass index (BMI) of 15 kg/m2, serum potassium of 2.8 mmol/L and serum creatinine of 6.91 mg/dL. She had failed to gain weight in the outpatient setting while on hemodialysis. She initially denied having an eating disorder, but ultimately a history of excessive laxative abuse for many years, without primary physician follow up, was revealed. While she did not undergo a renal biopsy to confirm the etiology of her ESRD, given her history of long-standing hypokalemia and lack of other risk factors, her ESRD was presumed to be secondary to hypokalemic nephropathy. She required significant oversight from a multidisciplinary eating disorder treatment team to restore weight while also managing her ESRD. Conclusion: This case report highlights the complexity of managing ESRD in patients with AN who require weight restoration. A multidisciplinary team was vital to ensure this patient's adherence to treatment. With this case, we hope to raise awareness of the deleterious effect on the kidneys from prolonged hypokalemia, the elevated risk of poor renal outcomes in patients with AN-BP, and the danger of easy accessibility to over-the-counter stimulant laxatives.

A Case of Mitochondrial Neurogastrointestinal Encephalomyopathy with Metabolic Complications During Refeeding.

BACKGROUND Anorexia nervosa has been referred to as the "great pretender" of medicine and is often misdiagnosed. We present a rare genetic disorder that was misdiagnosed as anorexia nervosa. This case highlights the diagnosis of mitochondrial neurogastrointestinal encephalomyopathy in a patient with previously diagnosed anorexia nervosa, which was discovered due to the metabolic abnormalities and intolerance of nutrition encountered during refeeding. CASE REPORT A 24-year-old woman with a previous diagnosis of type 2 diabetes mellitus and psychogenic anorexia and recent diagnosis of avoidant restrictive food intake disorder presented to a medical stabilization unit for weight restoration and treatment of medical complications associated with extreme malnutrition. She reported being underweight her entire life, and had a body mass index of 12 kg/m2 for a year prior to admission. She reported a long-standing intolerance to enteral feeding and had not gained weight when prescribed parenteral nutrition. She reported a desire to gain weight and denied any body dysmorphia. Upon nutritional rehabilitation, the patient was found to have extreme insulin resistance, with serum glucose values exceeding 400 mg/dL, and multiple neurologic findings that were incongruent with the medical complications of anorexia nervosa. These metabolic abnormalities, with her physical examination findings, allowed for a diagnosis of mitochondrial neurogastrointestinal encephalomyopathy. CONCLUSIONS This case report highlights the clinical presentation of mitochondrial neurogastrointestinal encephalomyopathy, including the newly described extreme insulin resistance, and showcases the importance of avoiding confirmation bias and working through differential diagnoses that are inconsistent with a clinical presentation to arrive at the correct diagnosis.

A Comprehensive Review of Complications and New Findings Associated with Anorexia Nervosa.

Anorexia nervosa is a complex and deadly psychiatric disorder. It is characterized by a significant degree of both co-occurring psychiatric diseases and widespread physiological changes which affect nearly every organ system. It is important for clinicians to be aware of the varied consequences of this disorder. Given the high rate of mortality due to AN, there is a need for early recognition so that patients can be referred for appropriate medical and psychiatric care early in the course of the disorder. In this study, we present a comprehensive review of the recent literature describing medical findings commonly encountered in patients with AN. The varied and overlapping complications of AN affect pregnancy, psychological well-being, as well as bone, endocrine, gastrointestinal, cardiovascular, and pulmonary systems.