Anorexia consequences need vigilant monitoring

Because adolescent girls with anorexia frequently develop hormonal, blood and bone density abnormalities, they require intensive clinical monitoring, according to a new report.

"Early recognition, screening for complications, and intervention are mandatory," Dr. Anne Klibanski from Massachusetts General Hospital, Boston, told Reuters Health. "An aggressive multi-disciplinary approach with psychiatric, medical, nutritional, and counseling support is key."

Klibanski and her colleagues investigated medical complications in 60 adolescent girls with anorexia nervosa, along with 58 healthy girls for comparison.

The "bone age" was significantly lower in relation to chronological age in girls with anorexia nervosa than in healthy girls, the authors report in the medical journal Pediatrics. This indicates delayed pubertal maturation, and indeed most girls with anorexia began menstruating at an older age than the average for white girls in the US.

Girls with anorexia had lower heart rates, lower blood pressure, and lower white blood cell counts than did healthy subjects, the team found. Estrogen and other hormones were also lower in girls with anorexia.

A number of girls with anorexia had significant bone loss, mainly in the lumbar spine, the researchers note.

"Patients should be screened at onset and followed for the development of metabolic and other problems," Klibanski said. How often they should be checked "will vary dependent upon severity of illness and development of abnormalities," she added.

"Reversal of disease can prevent most complications, with the exception of bone loss," Klibanski pointed out. Even after recovering from anorexia, many women "may have persistent deficits in bone density."

SOURCE: Pediatrics, December 2004.