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International audience; Objectives: Anorexia nervosa is a complex psychiatric disorder that can lead to specific somatic complications. Malnutrition is frequent and can involve a decrease of mobility, up to functional impotence, in individuals with extremely severe cases. The aim of this pilot study was to examine muscle strength and peak expiratory flow (PEF) in severely undernourished patients with anorexia nervosa at admission and after 5 wk of renutrition by tube feeding, and to find the clinical and biological correlates of muscle-strength impairment. Methods: A prospective observational study was conducted over 6 mo. Manual muscle testing, measures of PEF, and clinical and biologic assessments were performed at baseline and after 5 wk of renutrition. Results: Twenty-three extremely malnourished female participants (mean body mass index: 11.4 ± 1.3 kg/m2) were included. All participants had global impairment in muscle strength (manual muscle testing: 37.7 ± 7.7) and PEF (253.3 ± 60 mL/min) at admission. Muscle weakness was higher in axial than peripheral muscle groups (P < 0.01), with no significant difference between proximal and distal muscles (P > 0.05). Muscle strength at admission was significantly associated with severity of undernourishment (body mass index and albumin) and transaminitis (P < 0.05). At follow-up, musculoskeletal strength and PEF were significantly improved after partial weight recovery (P < 0.01). Conclusions: Extremely undernourished people with anorexia nervosa present a decrease of PEF and musculoskeletal strength predominant on axial muscles. Both are associated with severity of malnutrition and liver damage. Partial recovery was observed after 5 wk of enteral nutrition.

Background Anorexia Nervosa (AN) is a complex psychiatric disorder that can lead to specific somatic complications. Heart abnormalities are frequently reported, while their frequency and associated factors in severely malnourished AN patients remain poorly defined. Objectives This study aimed to characterize echocardiographic abnormalities in severely malnourished AN patients and to assess associated clinical, biological and related body composition features. Methods Between January 2013 and January 2015, all severely malnourished adult patients with AN (Mental Disorders, 4th Edn.-DSM IVr) were included in a monocentric study performed in in a highly specialized AN inpatient unit. Electrocardiogram (ECG) and echocardiography were used to assess both heart rhythm and function. All inpatients underwent a Doppler echocardiography procedure after undergoing combined blood volume adjustment, micronutrients deficiencies supplementation and electrolyte disorders correction. Right Ventricular (RV) and Left Ventricular (LV) systolic and diastolic functions were collected and compared to 29 healthy normal subjects in a control group. Results One hundred and 24 patients (119 (96%) women, 5 (4%) men) with a mean age of 30.1 ± 11 years old and an average Body Mass Index (BMI) of 12 kg/m2 were included. Ninety patients (73%) had been diagnosed with AN Restrictive type (AN-R), 34 (27%) an AN Binge eating/Purging type (AN-BP). Eighteen patients (15%) disclosed an abnormal Left Ventricular Ejection Fraction (LVEF) (p p p p p p p p p p p = 0.056). Thirty-four patients (27%) had a pericardial effusion and were significantly associated with a decreased all body FFMI (p Conclusion Heart abnormalities are frequent in malnourished patients with AN, particularly in AN-BP type. Both liver enzymes and body composition abnormalities tended to be associated with heart dysfunction (non-significant association). Prospective studies are needed to better characterize and describe the evolution of cardiac abnormalities during the refeeding period and subsequent weight restoration.

OBJECTIVE Anorexia nervosa (AN) is a mental disorder potentially leading to severe malnutrition and life-threatening complications, with high mortality rates and dropouts from treatment. In the most severe cases, treatment refusal associated with acute nutritional disorders may require compulsory admission in specialised units. The aim of this study was to investigate clinical and nutritional parameters associated with the use of compulsory treatment for severely ill AN patients requiring intensive nutritional care. METHODS This retrospective, single-centre study performed in a unit of specialised nutritional care compared severely undernourished inpatients, compulsorily admitted for AN, with a population of sex- and age-matched voluntarily admitted patients. Socio-demographic and clinical variables were collected for univariate comparison and logistic regression. RESULTS Compulsory treatment in AN was mainly associated with lower socio-economic status (p < 0.01), history of lower weight (p < 0.05), more frequently prescribed psychotropic medication (p = 0.02), more previous admissions for AN, longer hospitalisations (p < 0.01) and binge eating/purging subtype (p = 0.02). Binge eating/purging subtype and the number of past admissions showed the strongest odds of compulsory treatment in multivariate analysis. CONCLUSION The knowledge of factors associated with compulsory treatment may help practitioners of all fields to better evaluate its pertinence and indications in AN.

Introduction et but de l’etude L’anorexie mentale (AM) est la pathologie psychiatrique avec le plus haut taux de mortalite, notamment a cause de la denutrition. L’immunodepression cellulaire induite par cette denutrition severe pourrait etre a l’origine de l’apparition d’infections pulmonaires chroniques opportunistes (IPCO). Seuls quelques cas d’IPCO dans l’AM ont ete rapportes dans la litterature. Le but de cette etude etait d’identifier les facteurs associes aux IPCO dans une population de patients denutris atteints d’AM. Materiel et methodes Une etude observationnelle a ete realisee dans un service soins tertiaires dedie aux patients atteints d’AM et severement denutris. Le diagnostic d’IPCO a ete fait sur la presence de lesions suggestives au scanner thoracique, associe ou non a une identification microbiologique. Chaque patient avec un diagnostic d’IPCO a ete apparie sur l’âge et le sexe a deux patients non malades, hospitalises au cours de la meme periode. Les variables suivantes ont ete recueillies : poids, IMC, CRP, albuminemie, transthyretine, neutrophiles, lymphocytes, et identification des germes a la culture des expectorations le cas echeant. Le test t de Student et la regression logistique ont ete effectues pour determiner les parametres associes aux IPCO. Une analyse discriminante et des courbes de ROC ont ete realisees pour les variables significatives en univariee. Resultats et analyse statistique Entre 2004 et 2020, 1441 patients ont ete hospitalises et 31 avaient un diagnostic d’IPCO (2,2 %). Les patients atteints d’IPCO avaient un IMC inferieur (11,5 vs 13,0 ; p = 0,02), un taux de lymphocytes sanguins plus bas (763 vs 1637/mm3 ; p Conclusion L’IPCO est une des complications somatiques observees chez les patients avec AM. Cette etude observationnelle a identifie le taux de lymphocytes comme etant le principal facteur predictif d’IPCO. Des etudes prospectives sont necessaires pour confirmer ce seuil en prospectif et juger de l’utilite de realiser un scanner thoracique systematique pour ces patients.

Introduction et but de l’etude Les patients extremement denutris avec AM sont a haut risque de developper une maladie renale chronique (MRC). Aucune methode n’est validee pour evaluer la fonction renale chez ces patients, la creatininemie etant egalement un reflet de la masse musculaire. L’objectif de l’etude etait de comparer les differentes methodes de calcul validees utilisees en pratique courante. L’objectif secondaire etait d’evaluer l’evolution de la creatininemie et des parametres biologiques associes au cours de l’hospitalisation. Materiel et methodes Une etude retrospective a ete menee chez 176 patients adultes souffrant d’AM hospitalisees pour denutrition extreme. L’ensemble des donnees clinicobiologiques ont ete recueillies au cours de l’hospitalisation. Les formules de Cockcroft (CG), MDRD et MAYO ont ete utilisees pour estimer le debit de filtration glomerulaire (DFG). La methode de Bland et Altman a ete utilisee pour evaluer la concordance des formules. L’evolution de la creatinine et des parametres biologiques associees a ete evaluee au cours de l’hospitalisation chez 46 patients. Une comparaison des valeurs a ete realisee par test de t Student. Resultats et analyse statistique Cent soixante-seize patients ont ete inclus (âge : 29,83 ± 12,44 ans, IMC : 12,45 ± 1,86, poids : 33,70 ± 6,32 kg, duree d’evolution de la maladie : 9,44 ± 1,86 ans ; 50 (28 %) presentait une forme purgative). La creatininemie moyenne etait de 58,6 ± 18,8 μmol/L. Le DGF moyen estime par Cockcroft etait de 72,3 (± 27,9) μmol/L, 131,9(± 65,8) μmol/L par MDRD et 116,5(± 14,2) μmol/L par MAYO. La prevalence de MRC ≥ stade 2 etait de 95 % d’apres CG, 28 % d’apres Mayo et 55 % patients d’apres MDRD. Aucune concordance n’a ete retrouvee entre les differentes formules. La creatininemie etait a 53,67 (± 19,2) μmol/L a l’entree, 49,39 (± 17,3) μmol/L au 7e jour d’hospitalisation et 49,96 (± 15,1) μmol/L a la sortie. On observe une diminution significative de la creatininemie apres rehydratation et renutrition partielle. Conclusion L’atteinte renale est une complication decrie et potentiellement grave observee chez l’AM extremement denutrie. La prevalence de MRC est tres variable selon la methode d’estimation consideree. Les equations disponibles ne permettent pas une estimation fiable de la fonction. Des etudes prospectives utilisant une methode isotopique comme comparateur sont necessaires pour valider une methode fiable. L’evolution de la creatininemie suppose une part fonctionnelle initiale de l’insuffisance renale.