Anorexia Nervosa (AN) is a severe eating disorder affecting 1 to 2.2 percent of young women . Characterized by an intense fear of becoming fat or gaining weight, individuals with anorexia nervosa severely restrict their caloric intake and/or engage in compensatory behaviors (purge vomiting, use of laxatives, over-exercise) to prevent weight gain.
Both the restricting subtype of AN (AN-R) and the binge-eating/purging subtype (AN-BP) can lead to serious and even life-threatening medical complications. In fact, the mortality rate for individuals with anorexia nervosa is up to 12 times higher than the general population .
While a myriad of health problems (both physical and psychological) have been reported among individuals with AN, one of the most concerning and life-threatening complications associated with anorexia nervosa is heart problems.
But although heart abnormalities are frequently reported among AN patients, the frequency, specific risk factors, and causes of heart concerns in anorexia nervosa have been largely under-investigated. A recent study conducted at Raymond Poincaré University Hospital, Garches, the largest specialized nutrition unit in France, sought to uncover the causes and frequency of heart abnormalities among severely malnourished patients.
Study Uncovers Heart Concerns in Anorexia Nervosa Patients
The French study involved 124 malnourished AN patients (all of whom had a BMI < 12 and were hospitalized for nutritional rehabilitation at Raymond Poincaré University Hospital, Garches) and a control group of 29 healthy individuals.
The study excluded patients under 16 years old as well as AN patients who had pre-existing heart conditions or any other concern that might be associated with heart disease (e.g., diabetes and chronic inflammatory disease) . The study’s goal was not only to identify echocardiographic abnormalities in severely malnourished AN patients but also to uncover and assess the possible causes of heart concerns in individuals with AN.
Testing the patient’s heart function and rhythm with ECG and echocardiography, the researchers discovered the following heart concerns in Anorexia Nervosa patients:
- One hundred percent of severely undernourished AN patients presented sub-clinical myocardial impairments.
- Fifteen percent displayed abnormal left ventricular systolic function (< 52%). In some cases, this can lead to sudden cardiac arrest.
- Twenty-seven percent (33 patients) had mild to moderate pericardial effusion (a build-up of excess fluid in the structure around the heart that, if left untreated, can lead to heart failure or even death).
- Tricuspid annular plane systolic excursion (TAPSE) was significantly decreased in AN patients compared to controls. Reduced TAPSE suggests right ventricular (RV) dysfunction and is associated with lower cardiac index and adverse survival rates.
- LV mass and LVEDD was decreased in AN patients.
The researchers further found that liver enzyme levels are directly associated with heart dysfunction. It is important to note here that adults with severe AN commonly have elevated liver enzyme levels since low BMI is directly linked to irregular liver enzyme levels.
The study also confirmed a connection between severe malnourishment and heart abnormalities. Finally, while both the restrictive (AN-R) and binge-purge (AN-BP) subtypes of AN patients presented heart concerns, the researchers found more frequent heart abnormalities among the AN-BP type.
They conclude that there may be a specific association between laxative misuse and purge vomiting that leads to metabolic alkalosis, hypokalemia, and hypomagnesemia.
The results of this study on heart concerns in Anorexia Nervosa confirm the relationship between extreme undernutrition and heart complications and suggest that AN patients (especially those with elevated liver enzyme levels) should always be assessed for cardiac abnormalities prior to refeeding or early on in their refeeding/treatment.
As the research indicates, early assessment and detection of heart abnormalities in AN patients may prevent future complications like heart failure.
Resources: Hanachi, M., Pleple, A., Barry, C. et al. Echocardiographic abnormalities in 124 severely malnourished adult anorexia nervosa patients: frequency and relationship with body composition and biological features. J Eat Disord 8, 66 (2020). https://doi.org/10.1186/s40337-020-00343-y  ibid.  ibid.
About the Author:
Sarah Musick is a freelance writer who specializes in eating disorder awareness and education. After battling with a 4-years long eating disorder, she made it her mission to help others find hope and healing in recovery.
Her work has been featured on numerous eating disorder blogs and websites. When she’s not writing, Sarah is off traveling the world with her husband.
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Published December 10, 2020, on EatingDisorderHope.com
Reviewed & Approved on December 10, 2020, by Jacquelyn Ekern MS, LPC