Despite the seriously undernourished state of patients with anorexia nervosa (AN) and bulimia nervosa (BN), controversial findings have been published regarding some aspects of the immune system that are otherwise impaired in more typical types of malnutrition, such as protein-energy malnutrition. In general, adaptation processes seem to occur enabling immune function to be preserved during long periods of the illness. However, cell-mediated immunity is usually altered in AN and BN as reflected by lymphocyte subset counts and the response to delayed hypersensitivity tests. Regarding the helper=cytotoxic T cell ratio (CD4:CD8), an immunological marker of the nutritional status, the results of our studies on AN and BN patients showed that the duration of the eating disorder and the time when appropriate treatment is achieved are likely contributors to the alteration of this ratio. Despite these findings, it has been repeatedly pointed out that anorexic patients seem to be free of common viral infections at least until the most advanced stages of debilitation. Some hypotheses that could explain the lack of infection symptoms are reviewed. Cytokines and the altered acute phase response to infection, as well as cortisol and leptin, are considered to be potential factors involved in the adaptation processes occurring in these syndromes. Further progress in the knowledge of the psychoneuroendocrine -immune interactions established in AN and BN will be relevant to the understanding of the aetiology and maintenance mechanisms of these pathologies.

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The aim of this study was to examine and identify the psychological, clinical and sociodemographic factors associated with emotional well-being by type of caregiver. A cross-sectional study was conducted among 185 primary caregivers and 92 secondary caregivers of patients with an eating disorder using the Hospital Anxiety and Depression Scale, the Experience of Caregiving Inventory and the Eating Disorders Symptom Impact Scale. According to a multiple regression analysis, a total of four models were obtained accounting for 42%-47% of the variance in emotional well-being. The variable that accounted for most of the variance of emotional well-being in three of the models was the impact of nutrition. Improving aspects of the relationships with the patients reduced anxiety and depression levels in primary caregivers. Similarly, a positive personal experience reduced depression in secondary caregivers. A higher education level was associated with decreased anxiety levels in both types of caregivers. Specific family interventions including both types of caregivers may be useful for providing emotional and adaptive personal coping skills.

Objective: Profound osteopenia is a serious complication of anorexia nervosa (AN). The aim of this work was to study the effect of prolonged AN on lumbar spine bone mineral density (BMD) and to determine whether oral estrogen administration prevents bone loss in women with this disorder. Subjects and Methods: Thirty-eight amenorrheic women with AN (mean age: 17.3 years) were treated with estrogen (50 mg of ethinyl estradiol) and gestagen (0.5 mg of norgestrel) during 1 year. Clinical variations, biochemical indices and BMD were studied at three different time points, including after a period of amenorrhea of at least 12 months ðn ¼ 38Þ, after the administration of estrogens for 1 year ðn ¼ 22Þ, and after a 1-year follow-up period ðn ¼ 12Þ. Results: Initial mean BMD was significantly lower than normal (22:1^0:8 S.D.) and less than 22.5 S.D. below normal in 38% of the women with AN. The estrogen-treated group had no significant change in BMD even after the follow-up period and partial recovery of weight. Estradiol and total IGF-I levels were significantly lower throughout the study. All subjects had normal thyroxine (T 4 ) and TSH levels and calcium metabolism. However, total tri-iodothyronine (T 3 ) was decreased in all anorexic subjects in the first and second study points and were within normal limits after the follow-up period. Conclusions: (1) Estrogen replacement alone cannot prevent progressive osteopenia in young women with AN. (2) Other factors, such as the loss of weight, the duration of the amenorrhea and the low levels of total insulin-like growth factor-I (IGF-I) could contribute to the loss of bone mass in women with this disorder.