Clinical

Nutritional status from anorexia nervosa can cause acute liver cell damage

Last Updated: 2008-10-13 16:30:54 -0400 (Reuters Health)

NEW YORK (Reuters Health) - The results of a study published in the September issue of Gastroenterology suggest that an extremely poor nutritional status from anorexia nervosa can result in acute and profound alterations in liver function.

"Acute liver insufficiency is a rare complication of anorexia nervosa," Dr. Francois Durand, of Hopital Beaujon, Clichy, and his colleagues in France write. "The mechanisms of liver injury during anorexia nervosa remain unclear," they note.

Dr. Durand's group performed a detailed pathologic examination under electron microscopy of liver specimens from 12 anorexia nervosa patients. The patients were a median of 24 years old, had a median body mass index of 11.3, and were mostly female. Their prothrombin index was less than 50% and the International Normalized Ratio greater than 1.7. Anorexia nervosa was the only cause for acute liver injury in these subjects.

The authors observed signs of "profound alteration of liver function."

A marked depletion in liver cell glycogen was a constant finding. There was also a rapid increase in serum aspartate aminotransferase and serum alanine aminotransferase (67 and 56 times normal, on average).

On electron microscopy, the hepatocytes of four patients showed numerous autophagosomes, a hallmark of autophagy. However, the authors note that the mitochondria, endoplasmic reticulum, and nuclei were normal in most cells. There was an absence of significant hepatocyte necrosis on histology. Clinical and morphological evidence of chronic liver disease were absent.

All of the patients had a favorable outcome, with a rapid return of normal liver function. Of the 12 patients, 10 were still alive after a mean follow-up of 46 months. One patient was lost to follow-up and the other died for unknown reasons.

"In conclusion, anorexia nervosa with severe undernutrition should be added to the list of conditions causing acute liver insufficiency," Dr. Durand and colleagues comment. "Our findings strongly suggest that in these severely undernourished patients, autophagy was the leading pathway, resulting in significant alteration in liver cell function," they note. "Further studies are needed on the role of autophagy during other conditions in humans."

Gastroenterology 2008;135:840-848.