title: Clinical manifestations of liver injury in patients with anorexia nervosa.
abstract: OBJECTIVE
  The number of Japanese patients with anorexia nervosa (AN) is increasing as society changes. Mild liver injury is a complication of AN in around 30% of cases. In some rare instances, patients present with severe liver injury similar to acute liver failure. However, there are numerous uncertainties over the clinical characteristics of this condition. The objective of the present study was to clarify the clinical characteristics of AN complicated by liver injury and to investigate the factors related to hepatic complications.
  
  
  METHODS
  Thirty-seven patients hospitalized at our institution with a diagnosis of AN were enrolled as the study subjects. The study used clinical data obtained at the time of hospitalization. The enrolled patients underwent subgroup analysis and were categorized into three groups: (i) normal alanine aminotransferase (ALT), (ii) moderately elevated ALT, and (iii) highly elevated ALT.
  
  
  RESULTS
  All of the study subjects were female with a median age of 24 years and presenting with marked weight loss (mean body mass index, 13 kg/m(2) ). Thirteen of the subjects had liver injury. We found that patients in the highly elevated ALT group had a significantly high blood urea nitrogen (BUN)/creatinine ratio, and a low blood sugar level.
  
  
  CONCLUSIONS
  Our present findings indicate that AN patients with highly elevated ALT have a severe dehydration. This suggests that dysfunction of hepatic circulation accompanying severe dehydration due to malnutrition may be an important factor in the development of liver injury in AN patients.
authors.affiliation: Department of Gastroenterology, Yamagata University Faculty of Medicine, Yamagata, Japan.
authors.forename: Kyoko
authors.initials: K
authors.lastname: Tomita
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Haga
authors.forename: Genki
authors.initials: G
authors.lastname: Ishii
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Katsumi
authors.forename: Chikako
authors.initials: C
authors.lastname: Sato
authors.forename: Rika
authors.initials: R
authors.lastname: Aso
authors.forename: Kazuo
authors.initials: K
authors.lastname: Okumoto
authors.forename: Yuko
authors.initials: Y
authors.lastname: Nishise
authors.forename: Hisayoshi
authors.initials: H
authors.lastname: Watanabe
authors.forename: Takafumi
authors.initials: T
authors.lastname: Saito
authors.forename: Koichi
authors.initials: K
authors.lastname: Otani
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Ueno
keywords: dehydration; eating disorder; emaciation; hypoxic hepatitis; liver enzyme