Hypercholesterolaemia in anorexia nervosa: frequency and changes during refeeding.

UNLABELLED

High total cholesterol (TC) is common in patients with anorexia nervosa (AN), but its mechanisms remain unclear.

PATIENTS AND METHODS

We prospectively studied plasma lipoprotein (LP), haptoglobin, free (f) T3, fT4, TSH, transthyretin and albumin in 120 malnourished adult AN patients (BMI: 13.5+/-1.5 kg/m(2)), 116 non-AN malnourished patients and 119 healthy subjects, matched for age and gender.

RESULTS

In 18% of our AN patients, TC was higher than 270 mg/100mL (in non-AN: 5%; P<0.01). TC, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and HDL2 levels were higher in AN patients than in non-AN patients (P<0.001). Low TC (<150 mg/100mL) and LP levels were observed in 8% of AN patients, but only when BMI was less than 13 kg/m(2). Cholesterol ester transfer protein (CETP) activity was higher in AN patients than in healthy subjects. LP was positively correlated with BMI, albumin, fT3 and haptoglobin levels. In AN patients, there was a biphasic LP profile (low values when BMI was very low, normal values in an intermediate state, and high values when BMI was highest and where bulimia was also present).

CONCLUSION

In AN, both high and low cholesterol-rich LP levels were observed. Low T3 and low catabolism allow LP to be maintained, while CETP activity increases cholesterol turnover as an adaptation to its low intake. In severely malnourished AN patients, this fails and LP drops. On the other hand, LP values were higher in the bingeing-purging type of AN than in the restrictive type. Recovery from AN results in the normalization of the LP profile.