Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2019 Mar 1;58(5):749-753.
doi: 10.2169/internalmedicine.1663-18. Epub 2018 Oct 17.

Starvation-induced Liver Enzyme Elevation after Initiation of Feeding

Hiroaki Nishioka  1 , Aisa Yoshizaki  1 , Yukihiro Imai  2 , Naoki Higashibeppu  3
Affiliations
Case Reports

Starvation-induced Liver Enzyme Elevation after Initiation of Feeding

Hiroaki Nishioka et al. Intern Med. .

Abstract

Exacerbation of liver enzymes after the initiation of feeding in malnourished patients is caused by refeeding syndrome or persistent starvation. There are no definite clinical markers for distinguishing between the two conditions. We herein report a 63-year-old woman with starvation-induced liver enzyme elevation. Her body weight was inversely associated with the liver enzyme levels after refeeding, which was a different course from refeeding syndrome. Normalization of liver enzymes ensued as the caloric intake increased and weight gain progressed. Daily changes in body weight can be a useful clinical marker for distinguishing between refeeding syndrome and starvation-induced liver enzyme elevation.

Keywords: body weight; liver enzyme; refeeding syndrome; resting energy expenditure; starvation.

PubMed Disclaimer

Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
The clinical course of the patient. ALT: alanine aminotransferase, AST: aspartate aminotransferase
Figure 2.
Figure 2.
Liver histology. (a) Hematoxylin and Eosin staining of the liver revealed ballooning of the hepatocytes and increased brown pigment. (b) Berlin blue and Periodic acid-Schiff staining showed increased hemosiderin (arrows) and lipofuscin in the hepatocytes (arrowheads) (low-power field, ×100).
See this image and copyright information in PMC

References

    1. Solomon SM, Kirby DF. The refeeding syndrome: a review. JPEN J Parenter Enteral Nutr 14: 90-97, 1990. - PubMed
    1. Mehanna HM, Moledina J, Travis J. Refeeding syndrome: what it is, and how to prevent and treat it. BMJ 336: 1495-1498, 2008. - PMC - PubMed
    1. Ozawa Y, Shimizu T, Shishiba Y. Elevation of serum aminotransferase as a sign of multiorgan-disorders in severely emaciated anorexia nervosa. Intern Med 37: 32-39, 1998. - PubMed
    1. Sakurai-Chin C, Ito N, Taguchi M, Miyakawa M, Takeshita A, Takeuchi Y. Hypoglycemic coma in a patient with anorexia nervosa coincident with acute exacerbation of liver injury induced by oral intake of nutrients. Intern Med 49: 1553-1556, 2010. - PubMed
    1. Narayanan V, Gaudiani JL, Harris RH, Mehler PS. Liver function test abnormalities in anorexia nervosa--cause or effect. Int J Eat Disord 43: 378-381, 2010. - PubMed

Publication types