Early Emphysema in Patients with Anorexia Nervosa

• Published in: American journal of respiratory and critical care medicine Vol. 170; no. 7; pp. 748 - 752
• Main Authors: Coxson, Harvey O, Chan, Ida H. T, Mayo, John R, Hlynsky, Julia, Nakano, Yasutaka, Birmingham, C. Laird
• Format: Journal Article
• Language: English
• Published: New York, NY Am Thoracic Soc 01.10.2004; American Lung Association; American Thoracic Society
• Subjects: Adult; Algorithms; alpha 1-Antitrypsin - metabolism; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anorexia; Anorexia Nervosa - complications; Anorexia Nervosa - metabolism; Biological and medical sciences; Body Mass Index; Case-Control Studies; Chronic Disease; Emphysema; Female; Forced Expiratory Volume; Functional Residual Capacity; Hemoglobin; Hemoglobins - metabolism; Humans; Hypotheses; Intensive care medicine; Linear Models; Malnutrition; Maximal Voluntary Ventilation; Medical imaging; Medical sciences; Middle Aged; Organ Size; Oxygen Consumption; Patients; Predictive Value of Tests; Pulmonary Diffusing Capacity; Pulmonary Emphysema - diagnosis; Pulmonary Emphysema - etiology; Pulmonary Emphysema - metabolism; Regression analysis; Residual Volume; Risk Factors; Smoking; Spirometry; Starvation; Statistics, Nonparametric; Tomography; Tomography, X-Ray Computed - methods; Total Lung Capacity; Vital Capacity; World War II; Human; computed tomography; Lung disease; Intensive care; Radiodiagnosis; Respiratory disease; Nutrition disorder; Anorexia nervosa; Eating disorder; Chronic; Bronchus disease; Medical imagery; Computerized axial tomography; Obstructive pulmonary disease; Malnutrition; Emphysema; Resuscitation; chronic obstructive pulmonary disease
• ISSN: 1073-449X; 1535-4970
• DOI: 10.1164/rccm.200405-651OC

Postmortem studies of patients who died in the Warsaw Ghetto during World War II suggested that death from starvation was associated with pulmonary emphysema. This study re-examines this hypothesis in patients who are chronically malnourished because of anorexia nervosa. Age, smoking history, body mass index, and pulmonary function were measured in 21 subjects with anorexia nervosa and 16 control subjects. Computed tomography (CT) scans were obtained from three regions of the lung (at the level of the aortic arch, the carina, and the posterior position of the eighth rib) using a multislice scanner. The CT measurements of lung density, emphysema, and surface area-to-volume ratio were obtained using the X-ray attenuation values. CT measurements of emphysema were greater in the group that was anorexic than in historical control subjects (p < 0.001). Furthermore, there were significant correlations between the body mass index and the CT measures of emphysema for all the patients and between diffusing capacity and the CT measurements in the patients who were anorexic. A multiple linear regression analysis showed the diffusing capacity was predicted best by the percentage of lung voxels within the large emphysematous changes category. These data demonstrate that emphysema-like changes are present in the lungs of patients who are chronically malnourished.