Respiratory functions in adolescents hospitalized for anorexia nervosa: A prospective study

Kerem, Nogah C.; Averin, Elvira; Riskin, Arieh; Tov, Nave; Srugo, Isaac; Kugelman, Amir

doi:10.1002/eat.20960

Cited by 13 publications

(11 citation statements)

References 28 publications

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“…Some studies reporte normal values, 24,25 while others report that changes in (venous) blood gases are frequent. 11,12 Different results may be related to different methodologies, namely related to age, disease phase (decompensated versus "stable"), and use of arterial versus venous blood gas analysis. Kerem et al 11 reported that mild respiratory acidosis is common in venous blood gas analysis in adolescents with recent diagnosis of AN and hospitalized for clinical stabilization (78% at admission and 35% at hospital discharge).…”

Section: Discussionmentioning

confidence: 99%

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Outpatient Analytic Assessment of Anorexia Nervosa — The Importance of Venous Blood Gases

Pires

Soares²,

Luz³

et al. 2020

Rev. paul. pediatr.

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Objective: To evaluate serum biochemical parameters’ evolution, especially venous blood gas (VBG), in anorexia nervosa (AN), correlating with clinical parameters. Methods: Retrospective study including out-patient AN adolescents, between January 2014 and May 2017. Three evaluations were compared: t1) first consultation; t2) consultation with the lowest body mass index (BMI) z-score and t3) with the highest BMI z-score. Results: A total of 24 adolescents (87.5% females) were included, mean age of presentation of 14.9±1.7 years, onset of symptoms 6.4±3.2 months before the first visit. In t1, BMI z-score of -1.91±1.11 kg/m2 and ideal weight % of 84.3±9.2. Amenorrhea was present in 88%. In t2 the analytical alterations were: altered VBG in 100%, altered ferritin (72% elevated), altered thyroid function (53% with thyroxine decrease), dyslipidemia (31% elevation of high density lipoprotein, 25% hypercholesterolemia), elevation of urea (25%), elevation of alanine aminotransferase (14%), hypoglycemia (14%), anemia (9%). Respiratory acidosis was present in 91% in t1, 100% in t2 and 94% in t3. There was a significant decrease between t2 and t3 in mean pCO2 (57.2 versus 53.6 mmHg; p=0.009) and mean HCO3 (30.0 versus 28.8 mEq/L; p=0.023). Conclusions: Respiratory acidosis and increased ferritin were common in this group. Respiratory acidosis was the most frequent abnormality with significant pCO2 and HCO3 variation in the recovery phase. VBG should be considered in AN evaluation, once it seems to be important in assessing the severity of the disease and its subsequent follow-up.

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Section: Discussionmentioning

confidence: 99%

“…1,8,11 Studies in hospitalized patients have shown that respiratory acidosis is also a common finding in AN. 11,12 However, blood gas analysis is not part of the routine laboratory evaluation of most centers, particularly in outpatient follow-up.…”

Section: Introductionmentioning

confidence: 99%

Outpatient Analytic Assessment of Anorexia Nervosa — The Importance of Venous Blood Gases

Pires

Soares²,

Luz³

et al. 2020

Rev. paul. pediatr.

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“…The authors are aware of only one study that reports surrogate data for sleep hypoventilation in the form of nocturnal pulse oximetry and capnography. This study, by Kerem et al, demonstrated no significant difference between patients with AN and HC nocturnal pulse oximetry and capnography [ 26 ]. Multiple studies have demonstrated reduced maximal inspiratory (MIP) and expiratory pressures (MEP) as markers of respiratory muscle weakness in severe AN [ 30 – 32 ].…”

Section: Human Studies On Effects Of Starvation On Lung Structure Fun...mentioning

confidence: 91%

“…The degree of hypercapnia correlated with their percentage of weight loss relative to IBW preceding admission. In a subsequent cohort of 16 patients, Kerem et al redemonstrated the presence of hypercapnia and mild respiratory acidosis on admission VBGs [ 26 ]. It should be noted that VBGs may not uncover all acid- base disorders and that ABGs provide a more accurate assessment of acid–base status.…”

Section: Human Studies On Effects Of Starvation On Lung Structure Fun...mentioning

confidence: 99%

“…No difference in ABG Kerem et al [ 25 ] ± Prospective 16 AN 15 mBMI 15.5 kg/m2 12 F, 4 M PFTs: normal except decreased PEF. Other: Hypercapnia on admission Kerem et al [ 26 ] * Retrospective 45 AN-R 15 mBMI 15.2 kg/m2 37 F, 8 M Other: Mild respiratory acidosis observed in 78% of patients on admission Minano Garrido et al * [ 34 ] Prospective 18 AN-R, 5 AN-BP 25.6 mBMI 11.4 kg/m2 F PFTs: Reduced RMS and PEF, improved c̅ partial weight recovery. Imaging: None Murciano et al [ 33 ] * Prospective 15 AN N/a 63%IBW Not provided PFTs: reduced RMS, reduced FEV1 and VC improved at 30 days, nml lung volumes otherwise.…”

Section: Human Studies On Effects Of Starvation On Lung Structure Fun...mentioning

confidence: 99%

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Pulmonary complications of eating disorders: a literature review

2023

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The medical complications of eating disorders (EDs) have been described in the literature; however, the pulmonary system has historically been described as relatively spared from the ravages of eating disorders and thus neglected in the literature. Here we review the pulmonary complications that have been described in the literature, including the effects of starvation on the lungs of nutritionally deprived animals and patients with anorexia nervosa. There is clear evidence of weakness of respiratory muscles with starvation in both groups. However, there is discordance in the literature as to whether starvation results in “nutritional emphysema,” and if so, by what mechanism and at what degree of malnutrition it develops. We also explore the growing concern for the risk of non-tuberculosis mycobacterium infection as well as risk for pneumomediastinum and pneumothorax in patients with restrictive EDs. From the limited literature, it is clear the lungs, in fact, are not spared and that further research is needed to fully understand the full extent of pulmonary complications instigated by EDs.

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Momentary physiological indices related to eating disorders: A systematic and methodological review

Ralph‐Nearman,

Osborn,

Chang

et al. 2024

Euro Eating Disorders Rev

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Eating disorders (ED) are serious psychiatric illnesses, with no everyday support to intervene on the high rates of relapse. Understanding physiological indices that can be measured by wearable sensor technologies may provide new momentary interventions for individuals with ED. This systematic review, searching large databases, synthesises studies investigating peripheral physiological (PP) indices commonly included in wearable wristbands (heart rate [HR], heart rate variability [HRV], electrodermal activity [EDA], peripheral skin temperature [PST], and acceleration) in ED. Inclusion criteria included: (a) full peer‐reviewed empirical articles in English; (b) human participants with active ED; and (c) containing one of five wearable physiological measures. Kmet risk of bias was assessed. Ninety‐four studies were included (Anorexia nervosa [AN; N = 4418], bulimia nervosa [BN; N = 916], binge eating disorder [BED; N = 1604], other specified feeding and eating disorders [OSFED; N = 424], and transdiagnostic [N = 47]). Participants with AN displayed lower HR and EDA and higher HRV compared to healthy individuals. Those with BN showed higher HRV, and lower EDA and PST compared to healthy individuals. Other ED and Transdiagnostic samples showed mixed results. PP differences are indicated through various assessments in ED, which may suggest diagnostic associations, although more studies are needed to validate observed patterns. Results suggest important therapeutic potential for PP in ED, and larger studies including diverse participants and diagnostic groups are needed to fully uncover their role in ED.

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Respiratory functions in adolescents hospitalized for anorexia nervosa: A prospective study

Abstract: Adolescents with recent onset AN, admitted for medical stabilization, demonstrate hypercapnia despite normal PFTs, except for decreased PEFRs. These could result from decreased respiratory muscle strength and/or abnormal control of breathing.

Cited by 13 publications

References 28 publications

Outpatient Analytic Assessment of Anorexia Nervosa — The Importance of Venous Blood Gases

Outpatient Analytic Assessment of Anorexia Nervosa — The Importance of Venous Blood Gases

Pulmonary complications of eating disorders: a literature review

Momentary physiological indices related to eating disorders: A systematic and methodological review

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