title: Malnutrition and hemodynamic status in adolescents hospitalized for anorexia nervosa.
abstract: OBJECTIVE
  To determine the effects of malnutrition on hemodynamic status of adolescents hospitalized for anorexia nervosa.
  
  
  METHODS
  Longitudinal observational study.
  
  
  METHODS
  Tertiary care pediatric hospital. Patients Thirty-eight adolescents with anorexia nervosa, aged 13 to 21 years, with a mean (SD) body mass index (calculated as weight in kilograms divided by height in meters squared) of 15.9 (1.8). Intervention Subjects received standard care, including bed rest and graded nutritional therapy. A subsample of subjects (n=19) returned 11 to 57 weeks following hospitalization for a second cardiac evaluation.
  
  
  METHODS
  Results from a 15-lead electrocardiogram, echocardiogram, treadmill stress test, and spinal bone mineral density measurement.
  
  
  RESULTS
  On admission, 26 subjects (68%) had sinus bradycardia. Bradycardia was less common in participants with a longer duration of illness (P=.04). Left ventricle mass was lower than predicted for age (Z score<-1.0) in 11 subjects (31%). Exercise tolerance was normal by all measures. Both heart rate and QT interval were predictors of spinal bone mineral density. In those who returned for follow-up, absolute measures of left ventricle mass did not change (P=.27). However, the corresponding Z scores declined over time (mean [SD] change, -0.9 [1.3]; P=.02).
  
  
  CONCLUSIONS
  In acutely malnourished adolescents with anorexia nervosa, few truly pathologic cardiac findings were identified. Sinus bradycardia was observed in most cases. Mild reductions in left ventricle mass and left ventricle function were seen both at baseline and at follow-up, suggesting early sparing of cardiac muscle in the face of moderate malnutrition as well as a relative delay of cardiac muscle restoration. The association of hemodynamic status with altered spinal bone mineral density emphasizes the range of systems affected by malnutrition in anorexia nervosa.
authors.affiliation: Department of Cardiology, Children's Hospital Boston, 333 Longwood Ave, Boston, MA 02115, USA. amy.divasta@childrens.harvard.edu
authors.forename: Amy D
authors.initials: AD
authors.lastname: DiVasta
authors.forename: Courtney E
authors.initials: CE
authors.lastname: Walls
authors.forename: Henry A
authors.initials: HA
authors.lastname: Feldman
authors.forename: Ashley E
authors.initials: AE
authors.lastname: Quach
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Woods
authors.forename: Catherine M
authors.initials: CM
authors.lastname: Gordon
authors.forename: Mark E
authors.initials: ME
authors.lastname: Alexander
mesh_terms: D000293:Adolescent; D000856:Anorexia Nervosa / Q000150:complications / Q000503:physiopathology*; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006334:Heart Function Tests; D006439:Hemodynamics; D006760:Hospitalization; D006801:Humans; D044342:Malnutrition / Q000209:etiology / Q000503:physiopathology*; D011446:Prospective Studies; D055815:Young Adult