Hypertransaminasemia in a Woman Diagnosed with Anorexia Nervosa Under Day Hospital Therapeutic Intervention
Adriana Beatriz Di iorio1*, Blanca Cividanes Granda2, Debora Chiquini Busch3, Yordan Martínez Aguila4, Samy J Nolasco5 and Pedro López-Roldan6
1Department of Nutrition, Therapeutic Center Espiral, Alicante, Benidorm, Professor of Master Eating Disorder, Alfonzo X El Sabio University, Madrid Spain
2Direction Clinical, Therapeutic Center Espiral, Elda Spain
3Professor of Master Eating Disorder, Alfonzo X El Sabio University, Madrid Spain
4Institute of Agri-Food Research and Technologies, Tarragona, Spain
5Department of Psychiatry, Therapeutic Cente Espiral, Alicante, Benidorm
6Department of Psychiatry, University Hospital of San Juan de Alicante, Spain
*Corresponding Author: Adriana Beatriz Di Iorio, Department of Nutrition, Therapeutic Cente Espiral, Alicante, Benidorm, Professor of Master eating disorder, Alfonzo X El Sabio University, Madrid Spain.
Received:
April 04, 2025; Published: April 24, 2025
Abstract
Introduction: Eating Disorder (ED) is one of the central chronic pathologies in adolescents, noted for its high morbidity and mortality rates. Within the spectrum of EDs, anorexia nervosa presents a high mortality rate due to medical complications or suicide. This disorder, in addition to its psychological impacts, involves physical complications such as alterations in liver enzymes and non-alcoholic fatty liver disease, often associated with malnutrition.
Materials and Methods: An 18-year-old Caucasian female with a previous history of anorexia nervosa lasting 4 years was referred in January 2021 to the Spiral Therapeutic Center (STC) for a multidisciplinary clinical approach, after being previously hospitalized in the psychiatric unit of the Marina Baixa Regional Hospital during 2020. The therapeutic approach included multidisciplinary treatments spread over two six-month periods, renewable according to the STC protocol, without using enteral or parenteral feeding during her hospital stays.
Results: During her treatment, a gradual improvement in transaminase levels and a reduction in signs of hepatic steatosis were observed. The integration of psychological and nutritional interventions during outpatient treatment allowed for a more effective and sustained recovery, compared to more intensive and less integrated approaches experienced during her previous hospitalizations.
Conclusions: The multidisciplinary management of anorexia nervosa, incorporating medical, psychological, and nutritional aspects, proves to be effective when carried out on an outpatient and continuous basis, rather than through acute or sporadic interventions. This approach not only improves biochemical parameters, such as liver transaminases, but also contributes to a better overall recovery of the patient. Personalization of nutritional and psychological treatment is crucial to effectively address the challenges associCitation
Keywords:Eating Disorders; Fatty Liver; Psychological Treatment; Paroxetine; Biopsy
References
- Fassino Secondo., et al. “Psychological factors affecting eating disorders”. Advances in Psychosomatic Medicine 28 (2007): 141-168.
- First Michael B., et al. “DSM-5-TR: Rationale, Process, and Overview of Changes”. Psychiatric Services (Washington, D.C.)8 (2023): 869-875.
- INE, European Health Survey in Spain (EESE). Year 2020. [Press release]. National Institute of Statistics.
- Fernández-Aranda Fernando., et al. “COVID-19 and implications for eating disorders”. European Eating Disorders Review : The Journal of the Eating Disorders Association3 (2020): 239-245.
- Lewinsohn PM., et al. “Epidemiology and natural course of eating disorders in young women from adolescence to young adulthood”. Journal of the American Academy of Child and Adolescent Psychiatry10 (2000): 1284-1292.
- Johnson Jeffrey G., et al. “Eating disorders during adolescence and the risk for physical and mental disorders during early adulthood”. Archives of General Psychiatry6 (2002): 545-552.
- Tholin Sanna., et al. “Genetic and environmental influences on eating behavior: the Swedish Young Male Twins Study”. The American Journal of Clinical Nutrition3 (2005): 564-569.
- Barsh, G S., et al. “Genetics of body-weight regulation”. Nature6778 (2000): 644-651.
- Birch LL and KK Davison. “Family environmental factors influencing the developing behavioral controls of food intake and childhood overweight”. Pediatric Clinics of North America4 (2001): 893-907.
- Rautou Pierre-Emmanuel., et al. “Acute liver cell damage in patients with anorexia nervosa: a possible role of starvation-induced hepatocyte autophagy”. Gastroenterology 135,3 (2008): 840-8, 848.e1-3.
- Rosen Elissa., et al. “Hepatic Complications of Anorexia Nervosa”. Digestive Diseases and Sciences 11 (2017): 2977-2981.
- Powell EE., et al. “The natural history of nonalcoholic steatohepatitis: a follow-up study of forty-two patients for up to 21 years”. Hepatology (Baltimore, Md.)1 (1990): 74-80.
- Sollberger Daniel. “The inversion of the fall: on identity construction in anorexia nervosa”. Psychopathology4 (2014): 244-251.
- Jones Emily J., et al. “An examination of the transdiagnostic cognitive-behavioural model of eating disorders in adolescents”. Eating Behaviors 39 (2020): 101445.
- Simpson KJ. “Anorexia nervosa and culture”. Journal of Psychiatric and Mental Health Nursing1 (2002): 65-71.
- Pinto Sofia., et al. “Eating Patterns and Dietary Interventions in ADHD: A Narrative Review”. Nutrients 20 (2022): 4332.
- National Heart, Lung and Blood Institute. Managing Overweight and Obesity in Adults: Systematic Evidence Review from the Obesity Expert Panel (2013).
- American Heart Association”. Blood (2016).
- Bardone-Cone Anna M., et al. “Perfectionism and eating disorders: current status and future directions”. Clinical Psychology Review3 (2007): 384-405.
- Fairburn Christopher G., et al. “Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment”. Behaviour Research and Therapy5 (2003): 509-528.
- Turner Hannah., et al. “CBT for eating disorders: The impact of early changes in eating pathology on later changes in personality pathology, anxiety and depression”. Behaviour Research and Therapy 77 (2016): 1-6.
- Stice Eric. “Risk and maintenance factors for eating pathology: a meta-analytic review”. Psychological bulletin 128,5 (2002): 825-8748
- Cash TF and EA Deagle 3rd. “The nature and extent of body-image disturbances in anorexia nervosa and bulimia nervosa: a meta-analysis”. The International Journal of Eating Disorders2 (1997): 107-125.
- Wildes Jennifer E., et al. “Emotion avoidance in patients with anorexia nervosa: initial test of a functional model”. The International Journal of Eating Disorders5 (2010): 398-404.
- Curzio O., et al. “Transdiagnostic vs. disorder-focused perspective in children and adolescents with eating disorders: Findings from a large multisite exploratory study”. European Psychiatry : The Journal of the Association of European Psychiatrists 49 (2018): 81-93.
- Bruce Kenneth R., et al. “Reduced platelet [3H] paroxetine binding in anorexia nervosa: relationship to eating symptoms and personality pathology”. Psychiatry Research 2-3 (2006): 225-232.
- Yamamiya Yuko and Eric Stice. “Risk Factors That Predict Future Onset of Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder, and Purging Disorder in Adolescent Girls”. Behavior Therapy4 (2024): 712-723.
- Dani C., et al. “A transdiagnostic and diagnostic-specific approach on inflammatory biomarkers in eating disorders: A meta-analysis and systematic review” . Psychiatry Research 340 (2024): 116115.
- Bruce Kenneth R., et al. “Reduced platelet [3H]paroxetine binding in anorexia nervosa: relationship to eating symptoms and personality pathology”. Psychiatry Research2-3 (2006): 225-232.
- Delorme Richard., et al. “Platelet serotonergic markers as endophenotypes for obsessive-compulsive disorder”. Neuropsychopharmacology : Official Publication of the American College of Neuropsychopharmacology8 (2005): 1539-1547.
- Bissada Hany., et al. “Olanzapine in the treatment of low body weight and obsessive thinking in women with anorexia nervosa: a randomized, double-blind, placebo-controlled trial”. The American Journal of Psychiatry10 (2008): 1281-1288.
- Feng Xiongcai., et al. “Treatment of obesity and metabolic-associated fatty liver disease with a diet or orlistat: A randomized controlled trial”. The American Journal of Clinical Nutrition4 (2023): 691-700.
- Attia E., et al. “Olanzapine versus placebo for out-patients with anorexia nervosa”. Psychological Medicine10 (2011): 2177-2182.
- Jiang Ting., et al. “Up-regulation of hepatic fatty acid transporters and inhibition/down-regulation of hepatic OCTN2 contribute to olanzapine-induced liver steatosis”. Toxicology Letters 316 (2019): 183-193.
- Liu Xuemei., et al. “Acute effects of oral olanzapine treatment on the expression of fatty acid and cholesterol metabolism-related gene in rats”. Life Sciences 128 (2015): 72-78.
- Longo Nicola., et al. “Carnitine transport and fatty acid oxidation”. Biochimica et Biophysica Acta 10 (2016): 2422-2435.
- Frank Guido KW. “Neuroimaging and eating disorders”. Current Opinion in Psychiatry6 (2019): 478-483.
- Tommasi Marco., et al. “Association of COMT, BDNF and 5-HTT functional polymorphisms with personality characteristics”. Frontiers in Bioscience (Landmark Edition) 11 (2021): 1064-1074.
- Elovainio Marko., et al. “Temperament and depressive symptoms: a population-based longitudinal study on Cloninger's psychobiological temperament model”. Journal of Affective Disorders2-3 (2004): 227-232.
- Abou Al Hassan Sirine., et al. “The impact of COMT, BDNF and 5-HTT brain-genes on the development of anorexia nervosa: a systematic review”. Eating and Weight Disorders: EWD5 (2021): 1323-1344.
- Cloninger C Robert., et al. “Can personality assessment predict future depression? A twelve-month follow-up of 631 subjects”. Journal of Affective Disorders1 (2006): 35-44.
- Bourin M., et al. “Paroxetine: a review”. CNS Drug Reviews1 (2001): 25-47.
- Schlösser R., et al. “Effects of subchronic paroxetine administration on night-time endocrinological profiles in healthy male volunteers”. Psychoneuroendocrinology 4 (2000): 377-388.v
- Yoshida Tomohiko., et al. “Iron overload may be critical for liver dysfunction in anorexia nervosa, and the role of haematocrit-adjusted albumin in assessing nutritional status: a case report”. BMC Pediatrics1 (2023): 547.
- De Sanctis Vincenzo., et al. “Impact of oral nutritional supplements (ONS) on growth outcomes and IGF-1 level in underweight older children and young adolescents (5-14 years) with short stature and no systemic disease: High versus normal calories density formula”. Acta Bio-Medica: Atenei Parmensis4 (2021): e2021320.
- Kersten Sander. “The impact of fasting on adipose tissue metabolism”. Biochimica et biophysica acta”. Molecular and Cell Biology of Lipids3 (2023): 159262.
- Matsuzawa-Ishimoto Yu., et al. “Autophagy and Inflammation”. Annual Review of Immunology 36 (2018): 73-101.
- Verebi Camille., et al. “Potential New Expression Biomarkers for Anorexia Nervosa”. American Journal of Medical Genetics. Part B, Neuropsychiatric Genetics : The Official Publication of the International Society of Psychiatric Genetics (2024): e33018.
- Bridet Lionel., et al. “Acute liver damage and anorexia nervosa: a case report”. The Turkish Journal of Gastroenterology : The Official Journal of Turkish Society of Gastroenterology 25,2 (2014): 205-208.
- Kheloufi Marouane., et al. “Liver autophagy in anorexia nervosa and acute liver injury”. BioMed Research International 2014 (2014): 701064.
- Giorgio Valentina., et al. “Elevated Hemoglobin Level Is Associated With Advanced Fibrosis in Pediatric Nonalcoholic Fatty Liver Disease”. Journal of Pediatric Gastroenterology and Nutrition 2 (2017): 150-155.
- Kishi Taro., et al. “Antidepressants for the treatment of adults with major depressive disorder in the maintenance phase: a systematic review and network meta-analysis”. Molecular Psychiatry 1 (2023): 402-409.
Citation
Copyright