PDF(Pubmed)
Abstract：
BACKGROUND: Secondary carnitine deficiency in patients with anorexia nervosa has been rarely reported. This study aimed to investigate the occurrence of carnitine deficiency in severely malnourished patients with eating disorders during refeeding and assess its potential adverse effects on treatment outcomes.
METHODS: In a cohort study of 56 female inpatients with eating disorders at a single hospital from March 2010 to December 2020, we measured plasma free carnitine (FC) levels and compared to those of a healthy control group (n = 35). The patients were categorized into three groups based on FC levels: FC deficiency (FC< 20 µmol/L), FC pre-deficiency (20 µmol/L ≤ FC< 36 µmol/L), and FC normal (36 µmol/L ≤ FC).
RESULTS: Upon admission, the patients had a median age of 26 years (interquartile range [IQR]: 21-35) and a median body mass index (BMI) of 13.8 kg/m2 (IQR: 12.8-14.8). Carnitine deficiency or pre-deficiency was identified in 57% of the patients. Hypocarnitinemia was associated with a decline in hemoglobin levels during refeeding (odds ratio [OR]: 0.445; 95% confidence interval [CI]: 0.214-0.926, p = 0.03), BMI at admission (OR: 0.478; 95% CI: 0.217-0.874, p = 0.014), and moderate or greater hepatic impairment at admission (OR: 6.385; 95% CI: 1.170-40.833, p = 0.032).
CONCLUSIONS: Hypocarnitinemia, particularly in cases of severe undernutrition (BMI< 13 kg/m2 at admission) was observed in severely malnourished patients with eating disorders during refeeding, a critical metabolic transition phase. Moderate or severe hepatic impairment at admission was considered a potential indicator of hypocarnitinemia. Although hypocarnitinemia was not associated with any apparent adverse events other than anemia during refeeding, the possibility that carnitine deficiency may be a risk factor for more serious complications during sudden increases in energy requirements associated with changes in physical status cannot be denied. Further research on the clinical significance of hypocarnitinemia in severely malnourished patients with eating disorders is warranted.
Carnitine is an amino acid derivative that plays an important role in the promotion and regulation of fatty acid metabolism, and carnitine deficiency is assumed in patients with anorexia nervosa associated with chronic starvation, but there are few reports on this issue. This study represents the inaugural documentation of hypocarnitinemia in severely malnourished patients with eating disorders, including anorexia nervosa. Hypocarnitinemia, particularly in cases of severe undernutrition (BMI < 13 kg/m2) was observed during refeeding, a critical metabolic transition phase. Moderate or severe hepatic impairment was considered a potential indicator of hypocarnitinemia. Although no apparent association with adverse events other than anemia during refeeding was identified, clinical manifestations of hypocarnitinemia may occur when a sudden increase in energy demand is added to a change in the physical condition of the patient group. Further investigation is required to determine the clinical significance of hypocarnitinemia.
METHODS: In a cohort study of 56 female inpatients with eating disorders at a single hospital from March 2010 to December 2020, we measured plasma free carnitine (FC) levels and compared to those of a healthy control group (n = 35). The patients were categorized into three groups based on FC levels: FC deficiency (FC< 20 µmol/L), FC pre-deficiency (20 µmol/L ≤ FC< 36 µmol/L), and FC normal (36 µmol/L ≤ FC).
RESULTS: Upon admission, the patients had a median age of 26 years (interquartile range [IQR]: 21-35) and a median body mass index (BMI) of 13.8 kg/m2 (IQR: 12.8-14.8). Carnitine deficiency or pre-deficiency was identified in 57% of the patients. Hypocarnitinemia was associated with a decline in hemoglobin levels during refeeding (odds ratio [OR]: 0.445; 95% confidence interval [CI]: 0.214-0.926, p = 0.03), BMI at admission (OR: 0.478; 95% CI: 0.217-0.874, p = 0.014), and moderate or greater hepatic impairment at admission (OR: 6.385; 95% CI: 1.170-40.833, p = 0.032).
CONCLUSIONS: Hypocarnitinemia, particularly in cases of severe undernutrition (BMI< 13 kg/m2 at admission) was observed in severely malnourished patients with eating disorders during refeeding, a critical metabolic transition phase. Moderate or severe hepatic impairment at admission was considered a potential indicator of hypocarnitinemia. Although hypocarnitinemia was not associated with any apparent adverse events other than anemia during refeeding, the possibility that carnitine deficiency may be a risk factor for more serious complications during sudden increases in energy requirements associated with changes in physical status cannot be denied. Further research on the clinical significance of hypocarnitinemia in severely malnourished patients with eating disorders is warranted.
Carnitine is an amino acid derivative that plays an important role in the promotion and regulation of fatty acid metabolism, and carnitine deficiency is assumed in patients with anorexia nervosa associated with chronic starvation, but there are few reports on this issue. This study represents the inaugural documentation of hypocarnitinemia in severely malnourished patients with eating disorders, including anorexia nervosa. Hypocarnitinemia, particularly in cases of severe undernutrition (BMI < 13 kg/m2) was observed during refeeding, a critical metabolic transition phase. Moderate or severe hepatic impairment was considered a potential indicator of hypocarnitinemia. Although no apparent association with adverse events other than anemia during refeeding was identified, clinical manifestations of hypocarnitinemia may occur when a sudden increase in energy demand is added to a change in the physical condition of the patient group. Further investigation is required to determine the clinical significance of hypocarnitinemia.
摘要：
背景：神经性厌食症患者继发性肉碱缺乏的报道很少。这项研究旨在调查严重营养不良的饮食失调患者在重新喂养期间肉碱缺乏的发生情况，并评估其对治疗结果的潜在不利影响。
方法：在2010年3月至2020年12月在一家医院进行的56名饮食失调女性住院患者的队列研究中，我们测量了血浆游离肉碱（FC）水平，并与健康对照组（n=35）进行了比较。根据FC水平将患者分为三组：FC缺乏症（FC<20µmol/L），FC预缺乏（20µmol/L≤FC<36µmol/L），和FC正常（36μmol/L≤FC）。
结果：入院时，患者的中位年龄为26岁(四分位间距[IQR]:21~35),中位体重指数(BMI)为13.8kg/m2(IQR:12.8~14.8).在57％的患者中发现了肉碱缺乏或预缺乏。低肉碱血症与再喂养期间血红蛋白水平下降相关(比值比[OR]:0.445;95%置信区间[CI]:0.214-0.926,p=0.03),入院时的BMI（OR：0.478；95％CI：0.217-0.874，p=0.014），入院时中度或更严重的肝功能损害（OR：6.385；95％CI：1.170-40.833，p=0.032）。
结论：低肉碱血症，特别是在严重营养不良的情况下（入院时BMI<13kg/m2），在严重营养不良的患者中观察到，关键的代谢过渡阶段.入院时中度或重度肝功能损害被认为是低肉碱血症的潜在指标。尽管低肉碱血症与除再喂养期间贫血以外的任何明显不良事件无关，不能否认,在身体状态变化相关的能量需求突然增加时,肉碱缺乏可能是导致更严重并发症的危险因素.有必要进一步研究严重营养不良的饮食失调患者的低肉碱血症的临床意义。
肉碱是一种氨基酸衍生物，在促进和调节脂肪酸代谢中起重要作用，和肉碱缺乏假设与慢性饥饿相关的神经性厌食症患者，但是关于这个问题的报道很少。这项研究代表了严重营养不良的饮食失调患者的低肉碱血症的初步文献，包括神经性厌食症.低肉碱血症,特别是在严重营养不良（BMI<13kg/m2）的情况下，关键的代谢过渡阶段.中度或重度肝功能损害被认为是低肉碱血症的潜在指标。尽管没有发现与再喂养期间贫血以外的不良事件的明显关联，当能量需求的突然增加加上患者组身体状况的变化时，可能会出现低肉碱血症的临床表现。需要进一步研究以确定低肉碱血症的临床意义。
方法：在2010年3月至2020年12月在一家医院进行的56名饮食失调女性住院患者的队列研究中，我们测量了血浆游离肉碱（FC）水平，并与健康对照组（n=35）进行了比较。根据FC水平将患者分为三组：FC缺乏症（FC<20µmol/L），FC预缺乏（20µmol/L≤FC<36µmol/L），和FC正常（36μmol/L≤FC）。
结果：入院时，患者的中位年龄为26岁(四分位间距[IQR]:21~35),中位体重指数(BMI)为13.8kg/m2(IQR:12.8~14.8).在57％的患者中发现了肉碱缺乏或预缺乏。低肉碱血症与再喂养期间血红蛋白水平下降相关(比值比[OR]:0.445;95%置信区间[CI]:0.214-0.926,p=0.03),入院时的BMI（OR：0.478；95％CI：0.217-0.874，p=0.014），入院时中度或更严重的肝功能损害（OR：6.385；95％CI：1.170-40.833，p=0.032）。
结论：低肉碱血症，特别是在严重营养不良的情况下（入院时BMI<13kg/m2），在严重营养不良的患者中观察到，关键的代谢过渡阶段.入院时中度或重度肝功能损害被认为是低肉碱血症的潜在指标。尽管低肉碱血症与除再喂养期间贫血以外的任何明显不良事件无关，不能否认,在身体状态变化相关的能量需求突然增加时,肉碱缺乏可能是导致更严重并发症的危险因素.有必要进一步研究严重营养不良的饮食失调患者的低肉碱血症的临床意义。
肉碱是一种氨基酸衍生物，在促进和调节脂肪酸代谢中起重要作用，和肉碱缺乏假设与慢性饥饿相关的神经性厌食症患者，但是关于这个问题的报道很少。这项研究代表了严重营养不良的饮食失调患者的低肉碱血症的初步文献，包括神经性厌食症.低肉碱血症,特别是在严重营养不良（BMI<13kg/m2）的情况下，关键的代谢过渡阶段.中度或重度肝功能损害被认为是低肉碱血症的潜在指标。尽管没有发现与再喂养期间贫血以外的不良事件的明显关联，当能量需求的突然增加加上患者组身体状况的变化时，可能会出现低肉碱血症的临床表现。需要进一步研究以确定低肉碱血症的临床意义。
