Prevalence and Predictors of Abnormal Liver Enzymes in Young Women with Anorexia Nervosa

Abstract

Objective-To determine the prevalence and predictors of abnormal liver enzyme levels in ambulatory young women with anorexia nervosa (AN).Study design-In this cross-sectional study of 53 females with AN, serum concentrations of liver enzymes and hormones were measured. Anthropometric, dietary, and body composition information was collected. Correlational analyses were performed between liver enzyme concentrations and these variables.Results-Elevated alanine aminotransferase (ALT) and gamma-glutamyltranspeptidase (GGT) levels were found in 14 subjects (26%) and 5 subjects (9%), respectively. ALT and GGT were inversely correlated with body mass index (r = −0.27 to −0.30, p ≤ 0.049) and percentage body fat (r = −0.36 to −0.47, p ≤ 0.007), but showed no relationship with lean body mass. Subjects with percentage body fat < 18% had higher ALT levels than those above this threshold (median 26.5 vs. 18.0 U/L, p = 0.01). Liver enzyme concentrations did not correlate with dietary variables, except for GGT and percentage of calories from protein (r = 0.28, p = 0.04).Conclusions-Serum ALT and GGT concentrations are inversely related to adiposity in young women with AN. Future studies are needed to determine if these liver enzyme elevation signify unrecognized, clinically relevant liver disease.Keywords eating disorders; adolescents; liver; malnutrition; alanine aminotransferase; gammaglutamyltranspeptidase Corresponding author: Catherine M. Gordon, MD, MSc, Divisions of Adolescent Medicine and Endocrinology, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02215, Tel: 617-355-8492, Fax: 617-730-0195, Email: catherine.gordon@childrens.harvard.edu For reprints, please contact the corresponding author, Catherine M. Gordon, MD, MSc. Edited by WFB Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. In this study, we sought to determine the prevalence and predictors of abnormal liver enzyme levels in ambulatory young women with AN. We hypothesized that individuals with more severe disease, as reflected by lower body mass index (BMI) and body fat, would be more likely to exhibit elevated ALT and gamma-glutamyltranspeptidase (GGT) levels. We also hypothesized that insulin resistance would be a predictor of abnormal ALT and GGT concentrations. We predicted that there would be a significant association between macronutrient caloric distribution and liver enzyme concentrations. Methods DesignThis study was a cross-sectional evaluation of data obtained from the baseline visit of a clinical bone density trial. SubjectsAdolescents and young women with AN were recruited from the Chil...

Associations of Elevated Liver Enzymes among Hospitalized Adolescents with Anorexia Nervosa

“…Previous investigations were limited to case studies 4,10 and studies with relatively small sample sizes, 12,13 and reported a wide range in the prevalence of elevated liver enzymes in AN, from 0% to 76%. Our reported prevalence of 37.0% on admission and 41.1% at any point during the hospitalization is in line with the second largest study on the topic, which reported a 43% prevalence at admission (n = 126).…”

“…The few studies of elevations in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels in AN are limited to case reports [4][5][6][7][8][9][10] and studies with small sample sizes, [11][12][13][14][15] with a wide range in the reported prevalence of elevated ALT/AST, from 0% to 76%. 11 In initial studies researchers found that elevated ALT/AST was associated with lower body mass index (BMI) 11,13 and decreased percentage body fat. 13 In univariate analyses of the largest study to date, elevated aminotransferases were associated with increased age, male sex, and the pure restrictive form (vs binge-eating/purging type); however, these associations did not hold in the multivariate analyses.…”

“…11 In initial studies researchers found that elevated ALT/AST was associated with lower body mass index (BMI) 11,13 and decreased percentage body fat. 13 In univariate analyses of the largest study to date, elevated aminotransferases were associated with increased age, male sex, and the pure restrictive form (vs binge-eating/purging type); however, these associations did not hold in the multivariate analyses. 11 More recent studies have suggested that elevated aminotransferase in AN may occur secondary to refeeding.…”

Laboratory Parameters and Appetite Regulators in Patients with Anorexia Nervosa

“…[30][31][32] While hepatocellular injuries are usually mild and spontaneously improve along with the amelioration of the nutritional state, several case reports have described severe hepatic failure due to eating disorders, some with fatal outcome. [33][34][35][36] Elevation of aminotransferases can indicate multiple organ failure.…”

“…38,39 Fong et al recently conducted a study to determine the prevalence and predictors of abnormal liver enzyme levels in young women with AN in an ambulatory setting. 30 They reported that elevated alanine aminotransferase (ALT) and gamma-glutamyl transpeptidase (GGT) levels were found in 26% and 9% of subjects, respectively. ALT and GGT levels were inversely correlated with BMI and percentage of body fat.…”