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Anorexia patients show emphysema-like changes.

CHICAGO -- Patients with anorexia nervosa have emphysema-like changes in the lungs that are similar to those seen in elderly smokers, Harvey O. Coxson, Ph.D., reported at the annual meeting of the Radiological Society of North America.

In anorexic patients, but not in age-matched controls, a lower body mass index (BMI) was significantly correlated with increased lung inflation, as measured by using a computer analysis of CT scans, said Dr. Coxson of Vancouver (B.C.) General Hospital.

The study compared 18 female patients with anorexia nervosa with 16 age- and sex-matched controls. The average age of the anorexic patients was 37 years. As expected, the two groups differed significantly in mean BMI, which was 18.9 kg/[m.sup.2] in the anorexics and 26.6 kg/[m.sup.2] in controls. The groups also differed in their smoking histories, with anorexic patients averaging 4 pack-years and controls averaging 27 pack-years.

The investigators acquired three CT images of each patient; the scans were taken at the levels of the aortic arch, the carina, and the posterior position of the eighth rib. They used a computer analysis of the images to derive measures of lung inflation (mL of gas per gram of tissue) and tissue density (grams per mL).

In the control patients, 70% of the lung volume was judged to have normal amounts of inflation and 10% was judged to be highly hyperinflated, a characteristic of emphysema. In anorexic patients, just 20% of lung volume was normal and 30% was highly hyperinflated, with the remainder being moderately hyperinflated; this constituted a significant difference. The lungs of the anorexic patients also had a decreased ability to exchange gas, as measured by tissue density.

The two groups did not differ significantly in the amount of hemoglobin in the blood or measures of lung function such as forced expiratory volume in 1 second, total lung capacity, or diffusion capacity for carbon dioxide.

Dr. Coxson cautioned that the anorexic patients did not fit the clinical definition of emphysema. And he stopped short of recommending CT scans to measure lung function in patients with anorexia. The changes found on CT were subtle and were seen only with custom computer analysis; individual radiologists are unlikely to note such changes on typical CT scans. Also, most patients with anorexia nervosa are young women, and radiation exposure may be particularly problematic for them.

But the findings could be used to help convince patients with anorexia to improve their nutrition. "Any information we can give to anorexia patients that will help them keep their nutrition up is valuable," he said. "If in fact malnutrition is causing emphysema in the lungs and causing the lungs to be destroyed, it is another reason to work with anorexic patients and another reason that they need to pay more attention to their nutritional needs."


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Title Annotation:Psychosomatic Medicine
Author:Finn, Robert
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Mar 1, 2004
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