Long-term cardiovascular consequences of adolescent anorexia nervosa

Pediatric Research · 9 authors, 11 centres

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TL;DR

This cohort study assessed cardiovascular function in young adults who recovered from adolescent anorexia nervosa and found persistent adaptations like increased carotid artery stiffness, endothelial dysfunction, reduced aortic stiffness, and altered autonomic regulation.

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Compared to healthy controls, former AN patients showed significantly lower pulse wave velocity (aortic stiffness), lower carotid distensibility and compliance, higher carotid elastic modulus, and greater parasympathetic tone. Endothelial dysfunction, measured by reactive hyperemia index, was evident in 46% of former patients. The study used multiple non-invasive techniques including blood pressure monitoring, ultrasound, electrocardiography, and the EndoPat system. Limitations include a small sample size, potential confounding by exercise and menstrual cycle, inability to confirm complete recovery without detailed psychological assessment, and the cohort representing a moderately rather than severely ill population. The findings suggest persistent cardiovascular adaptations years after AN recovery, highlighting a potential need for long-term cardiovascular monitoring in this population.

STUDY TYPE

cohort

SPECIALTY

cardiology

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ORIGINAL PAPER

PMC10589084

Long-term cardiovascular consequences of adolescent anorexia nervosa

Pediatric Research

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ABSTRACT

Abstract Background Anorexia nervosa (AN) is associated with maladaptive cardiovascular changes. This study investigated whether individuals who recovered from AN during adolescence experience long-term cardiovascular risk in early adulthood. Methods Former AN patients discharged from the Royal Children’s and Monash Children’s Hospital Eating Disorder Services in Melbourne, Australia underwent cardiovascular testing. Measurements were performed using an oscillometric device for blood pressure and pulse wave velocity, ultrasound for carotid wall structure/function, resting electrocardiogram for heart-rate variability, and the EndoPat 2000 (Itamar) system for endothelial function. Patient measures were compared to healthy controls and/or normal thresholds. Results Ninety-one percent of the former AN patients ( N = 22) and controls ( N = 66) were female, aged approximately 25 years, with a healthy body mass index. The mean time interval from AN recovery to participation was 7.4 years. Pulse wave velocity was lower in the former AN patients than controls. Carotid intima–media thickness was not different; however, carotid distensibility and compliance were lower, and the elastic modulus higher in the former AN patients. Greater vagal tone was observed and endothelial dysfunction was evident in 46% of the former patients. Conclusions Young adults who recovered from adolescent AN exhibit persistent cardiovascular adaptations. Routine cardiovascular monitoring could manage potential disease risk. Impact Cardiovascular complications are common in patients with anorexia nervosa (AN) and population studies have revealed that developmental adaptations in response to undernutrition have long-term consequences for cardiovascular health. In this study of young adults treated for AN during adolescence, there was evidence of increased carotid artery stiffness, reduced aortic stiffness, vagal hyperactivity, and endothelial dysfunction in early adulthood when compared to healthy controls. It is important to consider the cardiovascular health of patients with AN beyond achieving medical stability. Interventions that monitor cardiovascular health could minimise the burden of future cardiovascular disease.

CITATION EXPORT

Gabriella A C Springall, Michelle Caughey, Diana Zannino et al.. Long-term cardiovascular consequences of adolescent anorexia nervosa. Pediatric Research. (2023). https://doi.org/10.1038/s41390-023-02521-5

AUTHORS

9 · 11 CENTRES

Gabriella A C Springall, Michelle Caughey, Diana Zannino, Kypros Kyprianou, Jonathan P Mynard, Subashini Rudolph, Jeanie Cheong, Michele Yeo, Michael M H Cheung

1Department of Paediatrics, University of Melbourne, Parkville, VIC Australia
2Murdoch Children’s Research Institute, Parkville, VIC Australia
3Department of Adolescent Medicine, Monash Children’s Hospital, Clayton, VIC Australia
4Clinical Epidemiology and Biostatistics Unit, Murdoch Children’s Research Institute, Parkville, VIC Australia
5Monash University, Clayton, VIC Australia
6Department of Biomedical Engineering, University of Melbourne, Parkville, VIC Australia
7Department of Paediatric Medicine, Austin Health, Heidelberg, VIC Australia
8Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, VIC Australia
9Neonatal Services, Royal Women’s Hospital, Parkville, VIC Australia
10Department of Adolescent Medicine, Royal Children’s Hospital, Parkville, VIC Australia
11Department of Cardiology, Royal Children’s Hospital, Parkville, VIC Australia