Iron overload may be critical for liver dysfunction in anorexia nervosa, and the role of haematocrit-adjusted albumin in assessing nutritional status: a case report

• Published in: BMC pediatrics Vol. 23; no. 1; pp. 1 - 547
• Main Authors: Yoshida, Tomohiko, Namiki, Toshiki, Yamaga, Masaya, Onishi, Shunichiro, Takemoto, Minoru
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 31.10.2023; BioMed Central; BMC
• Subjects: Anorexia; Anorexia Nervosa; Blood tests; Body mass index; Care and treatment; Case Report; Case reports; Creatinine; Diagnosis; Electrolytes; Enzymes; Health aspects; Hematocrit-adjusted albumin; Hospitalization; Iron in the body; iron overload; Liver; Liver diseases; Liver dysfunction; Malnutrition; Menstruation; Metabolism; Nutritional marker; Nutritional status; Patients; Pediatrics; Phosphorus; Proteins; Risk factors; Systematic review; Japan
• ISSN: 1471-2431; 1471-2431
• DOI: 10.1186/s12887-023-04367-6

Background Anorexia nervosa (AN) is frequently associated with liver dysfunction, but the precise mechanism remains undefined. Since the nutritional marker albumin has a low correlation with changes in body weight in AN, and patients with AN often have dehydration as a complication, we also examined whether haematocrit (HCT)-adjusted serum albumin could be a better nutritional marker in AN. Case presentation We describe a 15-year-old girl with severe weight loss and liver damage whose liver enzymes normalized after 1.5 months of hospitalization and weight gain. We found a significant correlation between body weight (BW) and HCT-adjusted serum albumin (Spearman's rank correlation coefficient (r.sub.s) = 0.66, P = 5.28 x 10.sup.-3) and between BW and alanine aminotransferase (ALT) (r.sub.s = -0.825, P = 8.45 x 10.sup.-5). After division by HCT, correlations between serum albumin and ALT (r.sub.s = -0.835, P = 5.24 x 10.sup.-5) and between the iron-storage protein ferritin and the liver enzyme gamma-glutamyl transferase (r.sub.s = 1.0, P = 0.017) were also statistically significant. Conclusion These results suggest that improvement of the nutritional status in AN could relieve liver dysfunction and facilitate iron transport. Since a decrease in the iron-transport protein transferrin presumably increases labile non-transferrin-bound iron, resulting in excess reactive oxygen species production, a defect in iron transport due to malnutrition could be one of the causes of liver injury in AN. In addition, HCT-adjusted albumin could be a better marker than its raw data to assess changes in nutritional status in AN. Keywords: Anorexia Nervosa, Liver dysfunction, iron overload, Hematocrit-adjusted albumin, Nutritional marker