Abstract
Anorexia nervosa (AN) is a psychiatric disorder associated with a high morbidity and mortality up to5 - 6 %, with an onset especially during midadolescence. It ranks among the eating disorders and it is characterised by a food intake restriction with a goal to lower a bodyweight and by a compulsive fear of gaining weight, associated with a disturbance of viewing of own weight and body shape.
The incidence of AN is estimated to be 0,2 - 0,8 % with the ratio of women/men about 10:1. AN represents a pathophysiological model of simple starvation without systemic inflammation and with clinical, endocrinal, metabolic, hematologic, immunological and nutritional abnormalities.
Clinical changes affect gastrointestinal tract, renal functions, skin, nervous and respiratory system. Cardiovascular changes and electrolyte equilibrium disturbances are among the most serious complications of AN.
Cellular immunity is getting weaker, wound healing is delayed. Anemia, leucopenia, neutropenia, thrombocytopenia or thrombocytosis are common.
In patients with AN we can typically find low level of triiodothyronine (T3) and thyroxine (T4), increased level of reverse T3, hypercortisolism, increased basal secretion of growth hormone with decreased level of IGF-1, decreased level of follicle stimulating hormone, luteinizing hormone and estradiol in women and decreased level of testosterone in men. The level of leptin is decreased; secretion of ghrelin is significantly increased.
Osteopenia and osteoporosis are common. There is common deficiency of potassium, magnesium, phosphorus, calcium, vitamin B1, B2, B6, A and C among nutritional abnormalities of patients with AN.
Serum protein levels are usually normal for a long time, hypoalbuminemia is a serious prognostic factor. The malnutrition leads to changes in serum levels of particular amino acids and their ratios.
We can find dyslipidemia with phenotype HLP IIa in more than 50 % of AN patients. Some studies have proved a deficiency in polyunsaturated fatty acids, elevated levels of plant sterols and unchanged level of lathosterol in patients with AN.
There have been proven increased level of oxidative stress repeatedly in AN patients, the levels of antioxidants are usually lowered. Conclusion: Anorexia nervosa is a complex psychiatric disorder, which can be used as a simple starvation model.
AN is a disorder, accompanied with significant changes in electrolyte equilibrium, endocrinal, metabolic, hematologic, immune and musculoskeletal changes.