Browse > Article
http://dx.doi.org/10.5223/pghn.2022.25.5.432

Cardiac Complications Associated with Eating Disorders in Children: A Multicenter Retrospective Study  

Choi, So Yoon (Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine)
Lee, Kyung Jae (Department of Pediatrics, College of Medicine, Hallym University)
Kim, Soon Chul (Department of Pediatrics, Jeonbuk National University Medical School and Hospital)
Lee, Eun Hye (Department of Pediatrics, Nowon Eulji Medical Center, Eulji University)
Lee, Yoo Min (Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine)
Kim, Yu-Bin (Department of Pediatrics, Ajou University School of Medicine)
Yi, Dae Yong (Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University College of Medicine)
Kim, Ju Young (Department of Pediatrics, Daejeon Eulji Medical Center, Eulji University)
Kang, Ben (Department of Pediatrics, School of Medicine, Kyungpook National University)
Jang, Hyo-Jeong (Department of Pediatrics, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine)
Hong, Suk Jin (Department of Pediatrics, Daegu Catholic University School of Medicine)
Choi, You Jin (Department of Pediatrics, Inje University Ilsan Paik Hospital)
Kim, Hyun Jin (Department of Pediatrics, Chungnam National University Hospital, Chungnam National University College of Medicine)
Publication Information
Pediatric Gastroenterology, Hepatology & Nutrition / v.25, no.5, 2022 , pp. 432-440 More about this Journal
Abstract
Purpose: Eating disorders often result in somatic complications, including cardiac abnormalities. Cardiac abnormalities may involve any part of the heart, including the cardiac conduction system, and can lead to sudden cardiac death. The current study aimed to evaluate the incidence of cardiac complications in pediatric patients with eating disorders and their associated factors. Methods: We retrospectively analyzed patients aged 10-18 years who were diagnosed with DSM-V (Diagnostic and Statistical Manual of Mental Disorder-V) eating disorders and underwent electrocardiography (ECG) and/or echocardiography between January 2015 and May 2020. Results: In total, 127 patients were included, of whom 113 (89.0%) were female. The median body mass index (BMI) was 15.05±3.69 kg/m2. Overall, 74 patients (58.3%) had ECG abnormalities, with sinus bradycardia being the most common abnormality (91.9%). Patients with ECG abnormalities had significantly lower BMI (14.35±2.78 kg/m2 vs. 16.06± 4.55 kg/m2, p<0.001) than patients without ECG abnormalities, as well as lower phosphorus and higher cholesterol levels. Among the 46 patients who underwent echocardiographic evaluation, 23 (50.0%) had echocardiographic abnormalities, with pericardial effusion being the most common (60.9%). The median left ventricular mass (LVM) and ejection fraction were 67.97±21.25 g and 66.91±28.76%, respectively. LVM and BMI showed a positive correlation (r=0.604, p<0.001). After weight gain, the amount of pericardial effusion was reduced in 3 patients, and 30 patients presented with normal ECG findings. Conclusion: Cardiac abnormalities are relatively frequent in patients with eating disorders. Physicians should focus on this somatic complication and careful monitoring is required.
Keywords
Feeding and eating disorders; Cardiovascular diseases; Pericardial effusion; Bradycardia;
Citations & Related Records
Times Cited By KSCI : 1  (Citation Analysis)
연도 인용수 순위
1 Harrington BC, Jimerson M, Haxton C, Jimerson DC. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. Am Fam Physician 2015;91:46-52.
2 Giovinazzo S, Sukkar SG, Rosa GM, Zappi A, Bezante GP, Balbi M, et al. Anorexia nervosa and heart disease: a systematic review. Eat Weight Disord 2019;24:199-207.   DOI
3 Anderson E, Gunn J. Extreme bradycardia as presentation of an eating disorder. BMJ Case Rep 2021;14:e238224.
4 Spaulding-Barclay MA, Stern J, Mehler PS. Cardiac changes in anorexia nervosa. Cardiol Young 2016;26:623-8.   DOI
5 Marin B V, Rybertt V, Briceno AM, Abufhele M, Donoso P, Cruz M, et al. [Female adolescents with eating disordes: cardiac abnormalities]. Rev Med Chil 2019;147:47-52. Spanish.   DOI
6 Kollai M, Bonyhay I, Jokkel G, Szonyi L. Cardiac vagal hyperactivity in adolescent anorexia nervosa. Eur Heart J 1994;15:1113-8.   DOI
7 Cooke RA, Chambers JB, Singh R, Todd GJ, Smeeton NC, Treasure J, et al. QT interval in anorexia nervosa. Br Heart J 1994;72:69-73.   DOI
8 Panagiotopoulos C, McCrindle BW, Hick K, Katzman DK. Electrocardiographic findings in adolescents with eating disorders. Pediatrics 2000;105:1100-5.   DOI
9 Uvelin A, Pejakovic J, Mijatovic V. Acquired prolongation of QT interval as a risk factor for torsade de pointes ventricular tachycardia: a narrative review for the anesthesiologist and intensivist. J Anesth 2017;31:413-23.   DOI
10 Bazoukis G, Yeung C, Wui Hang Ho R, Varrias D, Papadatos S, Lee S, et al. Association of QT dispersion with mortality and arrhythmic events-a meta-analysis of observational studies. J Arrhythm 2019;36:105-15.
11 DiVasta AD, Walls CE, Feldman HA, Quach AE, Woods ER, Gordon CM, et al. Malnutrition and hemodynamic status in adolescents hospitalized for anorexia nervosa. Arch Pediatr Adolesc Med 2010;164:706-13.
12 Forman SF, McKenzie N, Hehn R, Monge MC, Kapphahn CJ, Mammel KA, et al. Predictors of outcome at 1 year in adolescents with DSM-5 restrictive eating disorders: report of the national eating disorders quality improvement collaborative. J Adolesc Health 2014;55:750-6.   DOI
13 Cass K, McGuire C, Bjork I, Sobotka N, Walsh K, Mehler PS. Medical complications of anorexia nervosa. Psychosomatics 2020;61:625-31.   DOI
14 Swenne I, Larsson PT. Heart risk associated with weight loss in anorexia nervosa and eating disorders: risk factors for QTc interval prolongation and dispersion. Acta Paediatr 1999;88:304-9.   DOI
15 Treasure J, Duarte TA, Schmidt U. Eating disorders. Lancet 2020;395:899-911.   DOI
16 Westmoreland P, Krantz MJ, Mehler PS. Medical complications of anorexia nervosa and bulimia. Am J Med 2016;129:30-7.   DOI
17 Dai S, Harrist RB, Rosenthal GL, Labarthe DR. Effects of body size and body fatness on left ventricular mass in children and adolescents: Project HeartBeat! Am J Prev Med 2009;37(1 Suppl):S97-104.   DOI
18 Mont L, Castro J, Herreros B, Pare C, Azqueta M, Magrina J, et al. Reversibility of cardiac abnormalities in adolescents with anorexia nervosa after weight recovery. J Am Acad Child Adolesc Psychiatry 2003;42:808-13.   DOI
19 Fleming S, Thompson M, Stevens R, Heneghan C, Pluddemann A, Maconochie I, et al. Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. Lancet 2011;377:1011-8.   DOI
20 Haque IU, Zaritsky AL. Analysis of the evidence for the lower limit of systolic and mean arterial pressure in children. Pediatr Crit Care Med 2007;8:138-44.   DOI
21 Devereux RB, Alonso DR, Lutas EM, Gottlieb GJ, Campo E, Sachs I, et al. Echocardiographic assessment of left ventricular hypertrophy: comparison to necropsy findings. Am J Cardiol 1986;57:450-8.   DOI
22 Sharp CW, Freeman CP. The medical complications of anorexia nervosa. Br J Psychiatry 1993;162:452-62.   DOI
23 Silverman NH, Ports TA, Snider AR, Schiller NB, Carlsson E, Heilbron DC. Determination of left ventricular volume in children: echocardiographic and angiographic comparisons. Circulation 1980;62:548-57.   DOI
24 Casiero D, Frishman WH. Cardiovascular complications of eating disorders. Cardiol Rev 2006;14:227-31.   DOI
25 Sullivan PF. Mortality in anorexia nervosa. Am J Psychiatry 1995;152:1073-4.   DOI
26 Neumarker KJ. Mortality and sudden death in anorexia nervosa. Int J Eat Disord 1997;21:205-12.   DOI
27 Yahalom M, Spitz M, Sandler L, Heno N, Roguin N, Turgeman Y. The significance of bradycardia in anorexia nervosa. Int J Angiol 2013;22:83-94.   DOI
28 Escudero CA, Potts JE, Lam PY, De Souza AM, Mugford GJ, Sandor GG. An echocardiographic study of left ventricular size and cardiac function in adolescent females with anorexia nervosa. Eur Eat Disord Rev 2016;24:26-33.   DOI
29 Inagaki T, Yamamoto M, Tsubouchi K, Miyaoka T, Uegaki J, Maeda T, et al. Echocardiographic investigation of pericardial effusion in a case of anorexia nervosa. Int J Eat Disord 2003;33:364-6.   DOI
30 Guleri N, Rana S, Chauhan RS, Negi PC, Diwan Y, Diwan D. Study of left ventricular mass and its determinants on echocardiography. J Clin Diagn Res 2017;11:OC13-6.
31 Gosseaume C, Dicembre M, Bemer P, Melchior JC, Hanachi M. Somatic complications and nutritional management of anorexia nervosa. Clin Nutr Exp 2019;28:2-10.   DOI
32 Mehler PS, Brown C. Anorexia nervosa - medical complications. J Eat Disord 2015;3:11.
33 Sardar MR, Greway A, DeAngelis M, Tysko EO, Lehmann S, Wohlstetter M, et al. Cardiovascular impact of eating disorders in adults: a single center experience and literature review. Heart Views 2015;16:88-92.   DOI
34 Isner JM, Roberts WC, Heymsfield SB, Yager J. Anorexia nervosa and sudden death. Ann Intern Med 1985;102:49-52.   DOI
35 Kastner S, Salbach-Andrae H, Renneberg B, Pfeiffer E, Lehmkuhl U, Schmitz L. Echocardiographic findings in adolescents with anorexia nervosa at beginning of treatment and after weight recovery. Eur Child Adolesc Psychiatry 2012;21:15-21.   DOI
36 Bazett HC. An analysis of the time-relations of electrocardiograms. Ann Noninvasive Electrocardiol 1997;2:177-94.   DOI
37 Kalla A, Krishnamoorthy P, Gopalakrishnan A, Garg J, Patel NC, Figueredo VM. Gender and age differences in cardiovascular complications in anorexia nervosa patients. Int J Cardiol 2017;227:55-7.   DOI
38 Vedel-Larsen E, Iepsen EW, Lundgren J, Graff C, Struijk JJ, Hansen T, et al. Major rapid weight loss induces changes in cardiac repolarization. J Electrocardiol 2016;49:467-72.   DOI
39 Zhu W, Wan R, Liu F, Hu J, Huang L, Li J, et al. Relation of body mass index with adverse outcomes among patients with atrial fibrillation: a meta-analysis and systematic review. J Am Heart Assoc 2016;5:e004006.
40 Rigaud D, Tallonneau I, Verges B. Hypercholesterolaemia in anorexia nervosa: frequency and changes during refeeding. Diabetes Metab 2009;35:57-63.   DOI