Young people with anorexia nervosa (AN) or other restrictive eating disorders (EDs) can be at risk of medical instability regardless of whether they are underweight, according to results from a systematic review and meta-analysis published in the Journal of Eating Disorders.
“The findings of this review support the hypothesis that medical instability can occur across a range of weights in adolescent eating disorders, with rapid weight loss being an important indicator of increasing medical risk,” researchers noted. “Rapid weight loss should be considered as an important indicator of medical instability in adolescents presenting with both typical and atypical anorexia nervosa.”
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Researchers used medical databases including PubMed and EMBASE to identify relevant studies. The final study included 1 randomized controlled trial, 5 cohort studies, and 3 chart reviews, with a total of 2331 participants diagnosed with anorexia nervosa or atypical anorexia nervosa (AAN)—a subtype where patients meet criteria for anorexia nervosa but are not clinically underweight.
Findings revealed that between 29% and 42% of participants exhibited medical instability that required hospitalization, even if they weren’t underweight. Adolescents that were considered clinically underweight were significantly more likely to have lower blood pressure (p < 0.0001), and bradycardia was significantly associated with greater weight loss (p < 0.05). However, no statistically significant associations were found between the degree of underweight and heart rate, temperature, or rate of weight loss. Adolescents with a body mass index (BMI) less than 70% of the median were significantly more likely to have hypophosphatemia (p < 0.05).
“Future work should focus on studies that can be compared to current evidence to allow a more thorough analysis of data relating to weight parameters and their significance in typical and atypical adolescent anorexia nervosa,” authors concluded. “Further research is essential in this area, particularly in non-underweight adolescents with AAN to help clinicians understand medical risks arising in the absence of underweight.”
Authors noted that results may be limited due to the small number of existing studies that contain data for statistical analysis.
Reference
Brennan C, Illingworth S, Cini E, et al. Medical instability in typical and atypical adolescent anorexia nervosa: a systematic review and meta-analysis. J Eat Disord. 2023;11. doi.org/10.1186/s40337-023-00779-y
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