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Micronutrients Deficiencies in 374 Severely Malnourished Anorexia Nervosa Inpatients

1
Nutrition Unit, Raymond Poincaré University Hospital (Assistance Publique–Hôpitaux de Paris), 92380 Garches, France
2
Versailles Saint Quentin-en-Yvelines University, 78180 Montigny-le-Bretonneux, France
3
Nutrition Unit, Georges Pompidou University Hospital (Assistance Publique–Hôpitaux de Paris), 75015 Paris, France
4
Paris Descartes University, 75006 Paris, France
5
Clinical Research Unit, Pitié-Salpêtrière University Hospital, (Assistance Publique–Hôpitaux de Paris, 75013 Paris, France
6
Laboratory of Biological Toxicology, Saint Louis–Lariboisiere, University Hospital Paris France, 75010 Paris, France
7
Laboratory of Biochemistry, Beaujon University Hospital (Assistance Publique–Hôpitaux de Paris), 92110 Clichy, France
*
Author to whom correspondence should be addressed.
Nutrients 2019, 11(4), 792; https://doi.org/10.3390/nu11040792
Received: 31 January 2019 / Revised: 27 March 2019 / Accepted: 1 April 2019 / Published: 5 April 2019
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Abstract

Introduction: Anorexia nervosa (AN) is a complex psychiatric disorder, which can lead to specific somatic complications. Undernutrition is a major diagnostic criteria of AN which can be associated with several micronutrients deficiencies. Objectives: This study aimed to determinate the prevalence of micronutrients deficiencies and to compare the differences between the two subtypes of AN (restricting type (AN-R) and binge-eating/purging type (AN-BP)). Methods: We report a large retrospective, monocentric study of patients hospitalized in a highly specialized nutrition unit between January 2011 and August 2017 for severe malnutrition treatment in the context of anorexia nervosa. Results: Three hundred and seventy-four patients (360 (96%) women, 14 (4%) men), age: 31.3 ± 12.9 years, Body Mass Index (BMI) 12.5 ± 1.7 kg/m2 were included; 253 (68%) patients had AN-R subtype while, 121 (32%) had AN-BP. Zinc had the highest deficiency prevalence 64.3%, followed by vitamin D (54.2%), copper (37.1%), selenium (20.5%), vitamin B1 (15%), vitamin B12 (4.7%), and vitamin B9 (8.9%). Patients with AN-BP type had longer disease duration, were older, and had a lower left ventricular ejection fraction (LVEF) (p < 0.001, p = 0.029, p = 0.009), when compared with AN-R type, patients who instead, had significantly higher Alanine Aminotransferase (ALT) and Brain Natriuretic Peptide (BNP) levels (p < 0.001, p < 0.021). In the AN-BP subgroup, as compared to AN-R, lower selenium (p < 0.001) and vitamin B12 plasma concentration (p < 0.036) were observed, whereas lower copper plasma concentration was observed in patients with AN-R type (p < 0.022). No significant differences were observed for zinc, vitamin B9, vitamin D, and vitamin B1 concentrations between the two types of AN patients. Conclusion: Severely malnourished AN patients have many micronutrient deficiencies. Differences between AN subtypes are identified. Micronutrients status of AN patients should be monitored and supplemented to prevent deficiencies related complications and to improve nutritional status. Prospective studies are needed to explore the symptoms and consequences of each deficiency, which can aggravate the prognosis during recovery. View Full-Text
Keywords: anorexia nervosa; malnutrition; micronutrients; zinc; copper; selenium; vitamin B1; vitamin B12; vitamin D; vitamin B9 anorexia nervosa; malnutrition; micronutrients; zinc; copper; selenium; vitamin B1; vitamin B12; vitamin D; vitamin B9
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Hanachi, M.; Dicembre, M.; Rives-Lange, C.; Ropers, J.; Bemer, P.; Zazzo, J.-F.; Poupon, J.; Dauvergne, A.; Melchior, J.-C. Micronutrients Deficiencies in 374 Severely Malnourished Anorexia Nervosa Inpatients. Nutrients 2019, 11, 792.

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