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Effects of Anorexia Nervosa and Starvation

Douglas D. Schocken, MD; J. Douglas Holloway, MD; Pauline S. Powers, MD

Arch Intern Med. 1989;149(4):877-881.

Abstract
• Anorexia nervosa is a common psychiatric disorder predominantly affecting young women, associated with significant morbidity and mortality, much involving the cardiovascular system. In contrast, protein-calorie malnutrition, while not strictly analogous to the protein-sparing characteristics often noted in anorexia nervosa, is a problem of global stature. Physiologic consequences of anorexia nervosa include rhythm disturbances, mitral valve prolapse, plus both systolic and diastolic ventricular dysfunction. Diminished exercise capacity occurs in both states, with marked blunting of the heart rate and blood pressure response. Congestive heart failure may appear, especially during refeeding. In addition to the myofibrillar destruction associated with protein-calorie malnutrition, hypophosphatemia, particularly when exacerbated by unrestricted glucose-rich refeedings or hyperalimentation, may be one additional cause of ventricular dysfunction. A high level of suspicion for cardiovascular complications is, therefore, warranted in the evaluation and therapy of weight loss conditions such as starvation and anorexia nervosa.

(Arch Intern Med 1989;149:877-881)

Author Affiliations
From the Division of Cardiology, Department of Internal Medicine (Drs Schocken and Holloway) and Center for Eating Disorders and the Department of Psychiatry and Behavioral Medicine (Dr Powers), University of South Florida College of Medicine, Tampa.

Footnotes
Accepted for publication Nov 11, 1988.

Reprint requests to Department of Internal Medicine, Division of Cardiology, University of South of Florida, College of Medicine, 12901 Bruce B Downs Blvd, Box 19, Tampa, FL 33612 (Dr Schocken).

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