Sunday, 1 December 2013

Eating Disorders: Anorexia nervosa - The Consequences

Anorexia nervosa
Anorexia nervosa is a type of eating disorder usually develop in the teen years and effect over 90% of female, because of excessive food restriction and irrational fear to become fat due the wrongly influenced media as attractiveness is equated to thinness.
The Consequences
In anorexia nervosa because of malnutrition as a result of self starvation, it can cause abnormal function of the body of that can lead to serious medical consequences:
1. Cardiovascular diseases
In the stidy of 181 women: 140 women with anorexia nervosa (AN) [85 not receiving oral contraceptive pills (OCPs) (AN-E) and 55 receiving oral contraceptive pills (OCPs)(AN+E)] and 41 healthy controls [28 not receiving OCPs (HC-E) and 13 receiving OCPs (HC+E)]. Dr. Lawson EA, and the research team at Harvard Medical School, showed that although hsCRP levels are lower in AN than healthy controls, OCP use puts such women at a greater than 20% chance of having high-sensitivity C-reactive protein (hsCRP), in the high-Cardiovascular (CV)-risk (>3 mg/liter) category. The elevated mean IL-6 in women with AN and high-risk hsCRP levels suggests that increased systemic inflammation may underlie the hsCRP elevation in these patients. Although OCP use in AN was associated with slightly lower mean LDL and higher mean HDL, means were within the normal range, and few patients in any group had high-risk LDL or HDL levels. IGF-I levels appear to be important determinants of hsCRP in healthy young women(24).
Other researchers suggested that anorexia nervosa can slow heart rate and low blood pressure, because of badly underweight.

2. Osteoporosis
Badly underweight can increase the risk of  Osteoporosis, researchers at the  Uniwersytet Medyczny suggested that the consequences of low energy fractures are the main causes of death in women with AN. Hormonal disturbances (e.g. hypoestrogenism, increased levels of ghrelin and Y peptide, changes in leptin and endocannabinoid levels), as well as the mechanisms involved in bone resorption (RANK/RANKL/OPG system), are considered to be of great importance for anorectic bone quality(25).

3. Muscle dysfunction
Protein-energy malnutrition in anorexia nervosa is an under-recognised cause of muscle dysfunction and weakness. In the study to characterise the skeletal myopathy that occurs in patients with severe anorexia nervosa, muscle function and structure. All of the patients showed impaired muscle function on strength and exercise measurement(26).

4. Severe dehydration
In the study to investigate the medical history, dental examination, and saliva tests of 39 patients aged 14 to 42 years, having suffered from AN for periods of 1 to 20 years, showed dental caries, due to excessive carbohydrate consumption, in all subjects, often in a rampant form. In patients with a history of intense vomiting (27 cases) severe lingual-occlusal erosion (perimylolysis) was nearly always present. Buccal erosion, mainly due to high consumption of acid fruits and drinks to relieve thirst caused by dehydration, was more frequent in vomiting than in non-vomiting patients(27). 
5. Fainting, fatigue, and overall weakness
Fainting, fatigue, and overall weakness are expected as patients  body required to conserve energy as protect the body organs due to malnutrition.

6. Lanugo
Lanugo is the growth of fine, downy hair on the face and body of anorexics. It's a sign that the body's natural defenses are at work. Hypertrichosis refers to the amount or length of extra hair that is grown -- to the point of excessive.
At a certain point during the starvation process, some anorexics may start to notice some fine, white hair on their body. People may even call it "fur".
It's usually visible on the face first, but it can appear anywhere on the body, including the back. Extra thick hair is normally found on the legs.
In women and girls with anorexia, the hair tends appear in areas where there is typically very little hair growth, such as the face, chest and back areas(28).

7. Psychiatric health problems
In a register study based on based on socio-economic and health data was conducted for a national cohort of female residents in Sweden born between 1968 and 1977, including 748 in-patients with anorexia nervosa. At follow-up 9-14 years after hospital admission, 8.7% of patients with anorexia nervosa had persistent psychiatric health problems demanding hospital care and 21.4% were dependent on society for their main income; the stratified relative risks were 5.8 (95% CI 4.7-7.6) and 2.6 (2.3-3.0) respectively, compared with the general female population(29).

8.   Psychoactive substance use and suicide
Anorexia nervosa is a mental disorder with high mortality. Dr. Papadopoulos FC, and the research team at the University Hospital, Uppsala, showed that the overall SMR for anorexia nervosa was 6.2 (95% CI 5.5-7.0). Anorexia nervosa, psychoactive substance use and suicide had the highest SMR. The SMR was significantly increased for almost all natural and unnatural causes of death. The SMR 20 years or more after the first hospitalisation remained significantly high. Lower mortality was found during the last two decades. Younger age and longer hospital stay at first hospitalisation was associated with better outcome, and psychiatric and somatic comorbidity worsened the outcome(30).
9. Reproductive issues  
The physical and psychological demands of pregnancy and motherhood can represent an immense challenge for women already struggling with the medical and psychological stress of an eating disorder. This article summarizes key issues related to reproduction in women with anorexia nervosa, highlighting the importance of preconception counseling, adequate gestational weight gain, and sufficient pre- and post-natal nutrition. Postpartum issues including eating disorder symptom relapse, weight loss, breastfeeding, and risk of perinatal depression and anxiety(31)
I would like summarize this section with research from Dt. Miller KK at Massachusetts General Hospital and Harvard Medical School, Boston "Despite significant progress in the field, further research is needed to elucidate the mechanisms underlying the development of anorexia nervosa and its endocrine complications. Such investigations promise to yield important advances in the therapeutic approach to this disease as well as to the understanding of the regulation of endocrine function, skeletal biology, and appetite regulation" (32).Chinese Secrets To Fatty Liver And Obesity Reversal
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