Increased lipid and lipoprotein concentrations in anorexia nervosa: A systematic review and meta‐analysis

• Published in: The International journal of eating disorders 2019-06, Vol.52 (6), p.611-629
• Main Authors: Hussain, Alia A., Hübel, Christopher, Hindborg, Mathias, Lindkvist, Emilie, Kastrup, Annie M., Yilmaz, Zeynep, Støving, René K., Bulik, Cynthia M., Sjögren, Jan M.
• Format: Article
• Language: English
• Subjects: Anorexia; cholesterol; eating disorder; Eating disorders; Lipids; Lipoproteins; Medicin och hälsovetenskap; Meta-analysis; re-nutrition; Systematic review; weight restoration
• ISSN: 0276-3478; 1098-108X; 1098-108X
• DOI: 10.1002/eat.23051

Objective Alterations in blood lipid concentrations in anorexia nervosa (AN) have been reported; however, the extent, mechanism, and normalization with weight restoration remain unknown. We conducted a systematic review and a meta‐analysis to evaluate changes in lipid concentrations in acutely‐ill AN patients compared with healthy controls (HC) and to examine the effect of partial weight restoration. Method A systematic literature review and meta‐analysis (PROSPERO: CRD42017078014) were conducted for original peer‐reviewed articles. Results Forty‐eight studies were eligible for review; 33 for meta‐analyses calculating mean differences (MD). Total cholesterol (MD = 22.7 mg/dL, 95% CI = 12.5, 33.0), high‐density lipoprotein (HDL; MD = 3.4 mg/dL, CI = 0.3, 7.0), low‐density lipoprotein (LDL; MD = 12.2 mg/dL, CI = 4.4, 20.1), triglycerides (TG; MD = 8.1 mg/dL, CI = 1.7, 14.5), and apolipoprotein B (Apo B; MD = 11.8 mg/dL, CI = 2.3, 21.2) were significantly higher in acutely‐ill AN than HC. Partially weight‐restored AN patients had higher total cholesterol (MD = 14.8 mg/dL, CI = 2.1, 27.5) and LDL (MD = 16.1 mg/dL, CI = 2.3, 30.0). Pre‐ versus post‐weight restoration differences in lipid concentrations did not differ significantly. Discussion We report aggregate evidence for elevated lipid concentrations in acutely‐ill AN patients compared with HC, some of which persist after partial weight restoration. This could signal an underlying adaptation or dysregulation not fully reversed by weight restoration. Although concentrations differed between AN and HC, most lipid concentrations remained within the reference range and meta‐analyses were limited by the number of available studies. Resumen Objetivo En la anorexia nervosa (AN) han sido reportadas alteraciones en las concentraciones de lípidos sanguíneos; sin embargo, la extensión, mecanismo y normalización con la restauración del peso continúa aún desconocida. Hicimos una revisión sistemática y meta‐análisis para evaluar los cambios en las concentraciones de lípidos en pacientes agudamente enfermas de AN comparados con controles sanos (HC) y para examinar el efecto parcial de la restauración de peso. Método Una revisión sistemática de la literatura y meta‐análisis (PROSPERO: CRD42017078014) fueron llevados a cabo en artículos originales revisados por pares. Resultados Un total de cuarenta y ocho estudios fueron elegibles para revisión; 33 para meta‐análisis calculando las diferencias promedio (MD). Colesterol tot