Anoreksiya Nervoza ve Karaciğer Sağlığı

Öz

Sinirsel iştah kaybı anlamına gelen Anoreksiya Nervoza (AN), düşük vücut ağırlığı, devam eden besin kısıtlaması ve bozuk beden algısı ile karakterize psikiyatrik bir hastalıktır. Her yaş grubunda görülebilen AN, genellikle erken ve orta ergenlik döneminde başlamakta olup, kadınlarda erkeklere göre daha sık görülmektedir. Anoreksiya nervoza tanılı bireyler, enerji alımının kısıtlanması veya alınan enerjinin telafi edilmesi için birtakım davranışlar (kendini kusturma, laksatif-diüretik kullanma, aşırı egzersiz yapma gibi) sergilemektedir. Bunun sonucunda, vücut ağırlığı kaybıyla doğrudan ilişkili olarak tüm organları etkileyebilecek tıbbi komplikasyonlar gelişebilmektedir. Literatürde, AN’ya özgü hepatik komplikasyonların artış gösterdiği belirtilmektedir. Açlıkla uyarılan, hepatosit hasarına ve ölümüne neden olan otofajinin, AN’da karaciğer fonksiyon bozukluğuna neden olan temel mekanizma olduğu ileri sürülmektedir. Aminotransferaz düzeylerinin artması ve karaciğer hasarının ilerlemesi, ciddi bir komplikasyon olan hipoglisemiye neden olmaktadır. Anoreksiya nervoza tedavisinde, psikiyatri, beslenme ve tıbbi uzmanlardan oluşan ekiple ortak bir yaklaşım uygulanmalıdır. Tıbbi beslenme tedavisi, enerji alımını ve ağırlık kazanımını sağlayacak şekilde bireyin ihtiyaçlarına uygun olarak planlanmalıdır. Ayrıca, davranış değişikliği ve düzenli yeme alışkanlığı kazandırmak için bireye beslenme eğitimi verilmesi faydalı olmaktadır. Yapılan çalışmalar, AN tanılı bireylerde karaciğer fonksiyon bozuklukları ve hepatik komplikasyonlarla ilişkili tıbbi durumların iyileştirilebilmesinde tıbbi beslenme tedavisinin etkili olduğunu göstermektedir. Bu derlemede, AN’da yaygın olarak görülen hepatik komplikasyonlar ve tıbbi beslenme tedavisinin karaciğer fonksiyon bozukluğu üzerine etkileri incelenmiştir.

Anahtar Kelimeler

• Anoreksiya Nervoza
• Aminotransferazlar
• Tıbbi Beslenme Tedavisi

Anorexia Nervosa and Liver Health

Öz

Anorexia Nervosa (AN) is, which means loss of nervous appetite, a psychiatric disorder characterized by low body weight, continuous food restriction, and impaired body perception. AN, which can be seen in all age groups, usually begins in early and middle adolescence and is more common in women than men. Individual with anorexia nervosa exhibit certain behaviors (such as self-vomiting, laxative-diuretic use, excessive exercise) to limit energy intake or compensate for the energy received. As a result, medical complications may develop which may affect all organs directly related to body weight loss. In the literature, it is indicated that an increase of AN-specific hepatic complications. It has been suggested that autophagy, which is induced by causes hepatocyte damage and death, is the main mechanism leading to liver dysfunction in AN. Increased aminotransferase levels and progression of liver damage cause hypoglycemia, a serious complication. In the treatment of anorexia nervosa, a joint approach with a team of psychiatry, nutrition, and medical experts should be applied. Medical nutritional therapy should be planned in accordance with the needs of the individuals to ensure to achieve energy intake and weight gain. Besides, it is beneficial to give additional nutritional education to the individuals for improving regular eating habits and behavioral change. Studies have shown that medical nutritional therapy is effective in improving liver function disorders and medical conditions associated with hepatic complications in individuals with AN. In this review, common hepatic complications and the effects of medical nutritional therapy on liver dysfunction have been investigated.

Anahtar Kelimeler

• Anorexia nervosa
• Aminotransferases
• Medical nutritional therapy

Kaynakça

1. Moskowitz, L, Weiselberg, E, Anorexia Nervosa/Atypical Anorexia Nervosa, Current Problems in Pediatric and Adolescent Health Care, 2017, 47(4), 70-84.
2. Schorr, M, Miller, K.K, The endocrine manifestations of anorexia nervosa: mechanisms and management. Nature Reviews Endocrinology, 2017, 13(3), 174-186.
3. Silverman, J.A, Sir William Gull (1819-1890). Limner of anorexia nervosa and myxoedema. An historical essay and encomium, Eating and Weight Disorders, 1997, 2(3), 111-116.
4. Yücel, B, Estetik bir kaygıdan hastalığa uzanan yol: Yeme bozuklukları, İlk Söz, 2009, 22(4), 39-45.
5. Mustelin, L, Silén, Y, Raevuori, A, Hoek, H.W, Kaprio, J, Keski-Rahkonen, A, The DSM-5 diagnostic criteria for anorexia nervosa may change its population prevalence and prognostic value, Journal of Psychiatric Research, 2016, 77, 85-91.
6. Zipfel, S, Giel, K.E, Bulik, C.M, Hay, P, Schmidt, U, Anorexia nervosa: aetiology, assessment, and treatment, Lancet Psychiatry, 2015, 2(12), 1099-1111.
7. Winston, A.P, The clinical biochemistry of anorexia nervosa, Annals of Clinical Biochemistry, 2012, 49(Pt 2), 132-143.
8. Smink, F.R.E, van Hoeken, D, Hoek, H.W, Epidemiology, course, and outcome of eating disorders, Current Opinion in Psychiatry, 2013, 26(6), 543-548.

9. Larrañaga, A, Docet, M.F, García-Mayor, R.V, High prevalence of eating disorders not otherwise specified in northwestern Spain: population-based study, Social Psychiatry and Psychiatric Epidemiology, 2012, 47(10), 1669-1673.
10. Rosen, E, Bakshi, N, Watters, A, Rosen, H.R, Mehler, P.S, Hepatic Complications of Anorexia Nervosa, Digestive Diseases and Sciences, 2017, 62(11), 2977-2981.
11. Westmoreland, P, Krantz, M.J, Mehler, P.S, Medical Complications of Anorexia Nervosa and Bulimia, The American Journal of Medicine, 2016, 129(1), 30-37.
12. Harris, R.H, Sasson, G, Mehler, P.S, Elevation of liver function tests in severe anorexia nervosa, International Journal of Eating Disorders, 2013, 46(4), 369-374.
13. Narayanan, V, Gaudiani, J.L, Harris, R.H, Mehler, P.S, Liver function test abnormalities in anorexia nervosa--cause or effect, International Journal of Eating Disorders, 2010, 43(4), 378-381.
14. Vootla, V.R, Daniel, M, Abnormal Liver Function Tests in an Anorexia Nervosa Patient and an Atypical Manifestation of Refeeding Syndrome, Case Reports in Gastroenterology, 2015, 9(2), 261-265.
15. Rosen, E, Sabel, A.L, Brinton, J.T, Catanach, B, Gaudiani, J.L, Mehler, P.S. Liver dysfunction in patients with severe anorexia nervosa, International Journal of Eating Disorders, 2016, 49(2), 151-158.
16. Tomita, K, Haga, H, Ishii, G, Katsumi, T, Sato, C, Aso, R, Okumoto, K, Nishise, Y, Watanabe, H, Saito, T, Otani, K, Ueno, Y, Clinical manifestations of liver injury in patients with anorexia nervosa, Hepatology Research, 2014, 44(10), E26-E31.
17. Gaudiani, J.L, Sabel, A.L, Mascolo, M, Mehler, P.S, Severe anorexia nervosa: outcomes from a medical stabilization unit, International Journal of Eating Disorders, 2012, 45(1), 85-92.
18. Demir, M, Lang, S, Steffen, H.M, Nonalcoholic fatty liver disease - current status and future directions, Journal of Digestive Diseases, 2015, 16(10), 541-557.
19. [Imaeda, M, Tanaka, S, Fujishiro, H, Kato, S, Ishigami, M, Kawano, N, Katayama, H, Kohmura, K, Ando, M, Nishioka, K, Ozaki, N, Risk factors for elevated liver enzymes during refeeding of severely malnourished patients with eating disorders: a retrospective cohort study, Journal of Eating Disorders, 2016, 4, 37.
20. Nagata, J.M, Park, K.T, Colditz, K, Golden, N.H, Associations of elevated liver enzymes among hospitalized adolescents with anorexia nervosa, The Journal of Pediatrics, 2015, 166(2), 439-43, e1.
21. Kheloufi, M, Boulanger, C.M, Durand, F, Rautou, P.E, Liver autophagy in anorexia nervosa and acute liver injury, BioMed Research International, 2014, 2014, 701064.
22. Risi, R, Tuccinardi, D, Mariani, S, Lubrano, C, Manfrini, S, Donini, L.M, Watanabe, M, Liver disease in obesity and underweight: the two sides of the coin. A narrative review, Eating and Weight Disorders, 2021, 26(7), 2097-2107.
23. Rautou, P.E, Cazals-Hatem, D, Moreau, R, Francoz, C, Feldmann, G, Lebrec, D, Ogier-Denis, E, Bedossa, P, Valla, D, Durand, F, Acute liver cell damage in patients with anorexia nervosa: a possible role of starvation-induced hepatocyte autophagy, Gastroenterology, 2008, 135(3), 840-848, e1-3.
24. Bern, E.M, Woods, E.R, Rodriguez, L, Gastrointestinal Manifestations of Eating Disorders, Journal of Pediatric Gastroenterology and Nutrition, 2016, 63(5), e77-e85.
25. Arslan, D.Ö, Korkmaz, G, Gözüaçık, D, Otofaji: Bir hücresel stres yanıtı ve ölüm mekanizması, Acıbadem Üniversitesi Sağlık Bilimleri Dergisi, 2011, (4), 184-194.
26. Ohsumi, Y, Molecular dissection of autophagy: two ubiquitin-like systems, Nature Reviews Molecular Cell Biology, 2001, 2(3), 211-216.
27. Shintani, T, Klionsky, D.J, Autophagy in health and disease: a double-edged sword, Science, 2004, 306(5698), 990-995.
28. Dowman, J, Arulraj, R, Chesner, I, Recurrent acute hepatic dysfunction in severe anorexia nervosa, International Journal of Eating Disorders, 2010, 43(8), 770-772.
29. De Caprio, C, Alfano, A, Senatore, I, Zarrella, L, Pasanisi, F, Contaldo, F, Severe acute liver damage in anorexia nervosa: two case reports, Nutrition, 2006, 22(5), 572-575.
30. Lelli, L, Castellini, G, Gabbani, T, Godini, L, Rotella, F, Ricca, V, Associations between liver enzymes, psychopathological and clinical features in eating disorders, European Eating Disorders Review, 2014, 22(6), 443-447.
31. Practice guideline for the treatment of patients with eating disorders (revision). American Psychiatric Association Work Group on Eating Disorders, American Journal of Psychiatry, 2000, 157(1 Suppl), 1-39.
32. Gibson, D, Watters, A, Cost, J, Mascolo, M, Mehler, P.S, Extreme anorexia nervosa: medical findings, outcomes, and inferences from a retrospective cohort, Journal of Eating Disorders, 2020, 8, 25.
33. Ozier, A.D, Position of the American Dietetic Association: nutrition intervention in the treatment of eating disorders, Journal of the American Dietetic Association, 2011, 111(8), 1236-1241.
34. Rosen, D.S, Identification and management of eating disorders in children and adolescents, Pediatrics, 2010, 126(6), 1240-1253.
35. Treatment of patients with eating disorders, third edition. American Psychiatric Association, American Journal of Psychiatry, 2006, 163(7 Suppl), 4-54.
36. Garber, A.K, Sawyer, S.M, Golden, N.H, Guarda, A.S, Katzman, D.K, Kohn, M.R, Grange, D.L, Madden, S, Whitelaw, M, Redgrave, G.W, A systematic review of approaches to refeeding in patients with anorexia nervosa, International Journal of Eating Disorders, 2016, 49(3), 293-310.
37. Bridet, L, Martin, J.J, Nuno J.L, Acute liver damage and anorexia nervosa: a case report, Turkish Journal of Gastroenterology, 2014, 25(2), 205-208.
38. Hunt, D.P, Becker, A.E, Guimaraes, A.R, Stemmer-Rachamimov, A, Misdraji, J. Case 21-2012: A 27-Year-Old Man with Fatigue, Weakness, Weight Loss, and Decreased Libido, New England Journal of Medicine, 2012, 367(2), 157-169.
39. Ramsoekh, D, Taimr, P, Vanwolleghem, T, Reversible severe hepatitis in anorexia nervosa: a case report and overview, European Journal of Gastroenterology & Hepatology, 2014, 26(4), 473-477.
40. Restellini, S, Spahr, L, Rubbia Brandt, L, Severe starvation-induced hepatocyte autophagy as a cause of acute liver injury in anorexia nervosa: a case report, Case Reports in Hepatology, 2013, 2013, 749169.
41. Smith, R.W, Korenblum, C, Thacker, K, Bonifacio, H.J, Gonska, T, Katzman, D.K, Severely elevated transaminases in an adolescent male with anorexia nervosa, International Journal of Eating Disorders, 2013, 46(7), 751-754.
42. Yoshida, S, Shimada, M, Kornek, M, Kim, S.J, Shimada, K, Schuppan, D, Elevated transaminases as a predictor of coma in a patient with anorexia nervosa: a case report and review of the literature, Journal of Medical Case Reports, 2010, 4, 307.