Jason M Nagata1, K T Park2, Kelley Colditz3, Neville H Golden4. 1. Department of Pediatrics, Stanford University, Stanford, CA; Division of Adolescent Medicine, Stanford University, Stanford, CA. Electronic address: jasonmnagata@gmail.com. 2. Department of Pediatrics, Stanford University, Stanford, CA; Division of Pediatric Gastroenterology, Stanford University, Stanford, CA. 3. Division of Adolescent Medicine, Stanford University, Stanford, CA; Department of Clinical Nutrition, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA. 4. Department of Pediatrics, Stanford University, Stanford, CA; Division of Adolescent Medicine, Stanford University, Stanford, CA.
Abstract
OBJECTIVES: To analyze the prevalence, predictors, and evolution of increased liver enzymes in a large sample of adolescents hospitalized with anorexia nervosa (AN). STUDY DESIGN: Electronic medical records of all subjects 10-22 years of age with AN, first admitted to a tertiary children's hospital from January 2007 to December 2012, were reviewed retrospectively. Demographic factors, anthropometric factors, initial prescribed calories, and alanine aminotransferase levels were recorded. Multivariate analysis was performed to assess the effect of sex, degree of malnutrition, and initial calories prescribed on having alanine aminotransferase ≥40 IU/L. RESULTS: A total of 356 subjects met eligibility criteria (age 16.1 ± 2.4; 89.0% female; admission body mass index [BMI] 15.9 ± 1.9; admission percentage median BMI 78.2 ± 8.5), with elevated liver enzymes present in 37.0% on admission and in 41.1% at any point during the hospitalization. Lower percentage median BMI (aOR 0.96; 95% CI 0.93-0.98) and male sex (aOR 0.45; 95% CI 0.22-0.94) were significantly associated with odds of elevated liver enzymes on admission. Higher initial prescribed calories were associated with odds of elevated liver enzymes after admission (aOR 1.81; 95% CI 1.04-3.18). CONCLUSIONS: In this study of AN and elevated liver enzymes, the degree of malnutrition and male sex predicted elevated liver enzymes on admission but initial prescribed calories also may be associated with elevated liver enzymes after admission in a small proportion of patients. Future research should better characterize the evolution of elevated liver enzymes in patients hospitalized with AN undergoing refeeding.
OBJECTIVES: To analyze the prevalence, predictors, and evolution of increased liver enzymes in a large sample of adolescents hospitalized with anorexia nervosa (AN). STUDY DESIGN: Electronic medical records of all subjects 10-22 years of age with AN, first admitted to a tertiary children's hospital from January 2007 to December 2012, were reviewed retrospectively. Demographic factors, anthropometric factors, initial prescribed calories, and alanine aminotransferase levels were recorded. Multivariate analysis was performed to assess the effect of sex, degree of malnutrition, and initial calories prescribed on having alanine aminotransferase ≥40 IU/L. RESULTS: A total of 356 subjects met eligibility criteria (age 16.1 ± 2.4; 89.0% female; admission body mass index [BMI] 15.9 ± 1.9; admission percentage median BMI 78.2 ± 8.5), with elevated liver enzymes present in 37.0% on admission and in 41.1% at any point during the hospitalization. Lower percentage median BMI (aOR 0.96; 95% CI 0.93-0.98) and male sex (aOR 0.45; 95% CI 0.22-0.94) were significantly associated with odds of elevated liver enzymes on admission. Higher initial prescribed calories were associated with odds of elevated liver enzymes after admission (aOR 1.81; 95% CI 1.04-3.18). CONCLUSIONS: In this study of AN and elevated liver enzymes, the degree of malnutrition and male sex predicted elevated liver enzymes on admission but initial prescribed calories also may be associated with elevated liver enzymes after admission in a small proportion of patients. Future research should better characterize the evolution of elevated liver enzymes in patients hospitalized with AN undergoing refeeding.
Authors: Andrea K Garber; Jing Cheng; Erin C Accurso; Sally H Adams; Sara M Buckelew; Cynthia J Kapphahn; Anna Kreiter; Daniel Le Grange; Vanessa I Machen; Anna-Barbara Moscicki; Kristina Saffran; Allyson F Sy; Leslie Wilson; Neville H Golden Journal: Pediatrics Date: 2019-11-06 Impact factor: 7.124