title: Oxidative stress and antioxidant levels in patients with anorexia nervosa: A systematic review and exploratory meta-analysis.
abstract: OBJECTIVE
  To systematically review and meta-analyze oxidative stress and antioxidant markers in anorexia nervosa (AN).
  
  
  METHODS
  Electronic PubMed search from database inception until 12/31/2013. Out of 1062 hits, 29 studies comparing oxidative stress/antioxidant markers between patients with AN and healthy controls (HCs) with a total of 1,729 participants (AN = 895, HCs = 834) were eligible. Data about oxidative stress and antioxidant markers, independent of their source, were extracted. We calculated random effects standardized mean differences (SMDs) as effect size measures for outcomes reported in ≥5 studies; others were summarized descriptively.
  
  
  RESULTS
  Compared to HCs, AN patients showed significantly higher apolipoprotein B (ApoB) levels (studies = 7; n = 551; SMD = 0.75; p = .0003, I(2)  = 74%), with higher age being associated with higher ApoB (Coefficient: 0.61 ± 0.15, p < .0001), whereas BMI (p = .15) and measurement method (p = .70) did not moderate the results. Serum albumin levels were similar between AN and HCs (studies = 13; n = 509; SMD =-0.19; 95%CI: -0.62 to 0.24; p = .38; I(2)  = 81%), with neither age (p = .84) nor BMI (p = .52) being significant moderators. Lower superoxide dismutase levels were reported in 2 studies, while findings for vitamin A and its metabolites were inconclusive. In single studies, patients with AN had significantly higher catalase and nitric oxide (NO) parameter levels (platelet NO, exhaled NO and nitrites), such as lower glutathione and free cysteine levels, compared to HCs.
  
  
  CONCLUSIONS
  AN appears to be associated with some markers of increased oxidative stress. Additional research is needed to discern whether oxidative stress is a potential cause or effect of AN, and whether treatments improving oxidative stress could be useful in AN.
authors: Department of Neurosciences, University of Padova, via Giustiniani, Padova, Italy.
authors: Marco
authors: M
authors: Solmi
authors: Department of Medicine- DIMED, University of Padova, Geriatrics Section, via Giustiniani, Padova, Italy.
authors: Nicola
authors: N
authors: Veronese
authors: Department of Medicine- DIMED, University of Padova, Geriatrics Section, via Giustiniani, Padova, Italy.
authors: Enzo
authors: E
authors: Manzato
authors: Department of Medicine- DIMED, University of Padova, Geriatrics Section, via Giustiniani, Padova, Italy.
authors: Giuseppe
authors: G
authors: Sergi
authors: Department of Neurosciences, University of Padova, via Giustiniani, Padova, Italy.
authors: Angela
authors: A
authors: Favaro
authors: Department of Neurosciences, University of Padova, via Giustiniani, Padova, Italy.
authors: Paolo
authors: P
authors: Santonastaso
authors: Department of Psychiatry, the Zucker Hillside Hospital, Glen Oaks, New York.|Hofstra North Shore LIJ School of Medicine, Hempstead, New York.|The Feinstein Institute for Medical Research, Manhasset, New York.|Albert Einstein College of Medicine, Bronx, New York.
authors: Christoph U
authors: CU
authors: Correll
mesh_terms: D000856:Anorexia Nervosa / Q000378:metabolism*; D000975:Antioxidants; D015415:Biomarkers / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D018384:Oxidative Stress; D055815:Young Adult
chemical_list: D000975:Antioxidants; D015415:Biomarkers
keywords: anorexia nervosa; antioxidant; healthy controls; oxidative stress