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Meta-Analysis
. 2019 Jun;52(6):611-629.
doi: 10.1002/eat.23051. Epub 2019 Mar 28.

Increased lipid and lipoprotein concentrations in anorexia nervosa: A systematic review and meta-analysis

Alia A Hussain  1   2 , Christopher Hübel  3   4 , Mathias Hindborg  1   2 , Emilie Lindkvist  1   2 , Annie M Kastrup  1   2 , Zeynep Yilmaz  5   6 , René K Støving  7 , Cynthia M Bulik  3   5   8 , Jan M Sjögren  1   2
Affiliations
Meta-Analysis

Increased lipid and lipoprotein concentrations in anorexia nervosa: A systematic review and meta-analysis

Alia A Hussain et al. Int J Eat Disord. 2019 Jun.

Abstract
in English, French

Objective: Alterations in blood lipid concentrations in anorexia nervosa (AN) have been reported; however, the extent, mechanism, and normalization with weight restoration remain unknown. We conducted a systematic review and a meta-analysis to evaluate changes in lipid concentrations in acutely-ill AN patients compared with healthy controls (HC) and to examine the effect of partial weight restoration.

Method: A systematic literature review and meta-analysis (PROSPERO: CRD42017078014) were conducted for original peer-reviewed articles.

Results: Forty-eight studies were eligible for review; 33 for meta-analyses calculating mean differences (MD). Total cholesterol (MD = 22.7 mg/dL, 95% CI = 12.5, 33.0), high-density lipoprotein (HDL; MD = 3.4 mg/dL, CI = 0.3, 7.0), low-density lipoprotein (LDL; MD = 12.2 mg/dL, CI = 4.4, 20.1), triglycerides (TG; MD = 8.1 mg/dL, CI = 1.7, 14.5), and apolipoprotein B (Apo B; MD = 11.8 mg/dL, CI = 2.3, 21.2) were significantly higher in acutely-ill AN than HC. Partially weight-restored AN patients had higher total cholesterol (MD = 14.8 mg/dL, CI = 2.1, 27.5) and LDL (MD = 16.1 mg/dL, CI = 2.3, 30.0). Pre- versus post-weight restoration differences in lipid concentrations did not differ significantly.

Discussion: We report aggregate evidence for elevated lipid concentrations in acutely-ill AN patients compared with HC, some of which persist after partial weight restoration. This could signal an underlying adaptation or dysregulation not fully reversed by weight restoration. Although concentrations differed between AN and HC, most lipid concentrations remained within the reference range and meta-analyses were limited by the number of available studies.

Objetivo: En la anorexia nervosa (AN) han sido reportadas alteraciones en las concentraciones de lípidos sanguíneos; sin embargo, la extensión, mecanismo y normalización con la restauración del peso continúa aún desconocida. Hicimos una revisión sistemática y meta-análisis para evaluar los cambios en las concentraciones de lípidos en pacientes agudamente enfermas de AN comparados con controles sanos (HC) y para examinar el efecto parcial de la restauración de peso. MÉTODO: Una revisión sistemática de la literatura y meta-análisis (PROSPERO: CRD42017078014) fueron llevados a cabo en artículos originales revisados por pares.

Resultados: Un total de cuarenta y ocho estudios fueron elegibles para revisión; 33 para meta-análisis calculando las diferencias promedio (MD). Colesterol total (MD = 22.7 mg/dL, 95% CI = 12.5, 33.0), lipoproteína de alta densidad (HDL; MD = 3.4 mg/dL, CI = 0.3, 7.0), lipoproteína de baja densidad (LDL; MD = 12.2 mg/dL, CI = 4.4, 20.1), triglicéridos (TG; MD = 8.1 mg/dL, CI = 1.7, 14.5), y apolipoproteína B (Apo B; MD = 11.6 mg/dL, CI = 2.3, 21.2) fueron significativamente elevados en los pacientes agudamente enfermos de AN en comparación con los controles sanos (HC). Los pacientes con AN parcialmente recuperados de peso tuvieron niveles más elevados de colesterol total (MD = 14.8 mg/dL, CI = 2.1, 27.5) y de LDL (MD = 16.1 mg/dL, CI = 2.3, 30.0). Las diferencias pre- versus post- restauración de peso en las concentraciones de lípidos no difirieron significativamente. DISCUSIÓN: Reportamos evidencia agregada de concentraciones elevadas de lípidos en pacientes agudamente enfermos de AN comparados con controles sanos (HC), algunos de los cuales persisten después de la restauración parcial de peso. Esto podría señalar una adaptación subyacente o desregulación no completamente revertida por la restauración del peso. Aunque las concentraciones difirieron entre AN y HC, la mayoría de las concentraciones de lípidos permanecieron dentro del rango de referencia y los meta-análisis fueron limitados por el número de estudios disponibles.

Keywords: cholesterol; eating disorder; lipids; re-nutrition; weight restoration.

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Figures

Figure 1.
Figure 1.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram of study selection process. PICO: population, intervention, comparator and outcomes. BMI: body mass index.
Figure 2.
Figure 2.
Percent of studies exhibiting degrees of bias. Included studies were assessed for risk of bias using the Cochrane Collaboration’s risk of bias tool focused on four domains. Each item was rated with ‘high’, ‘low’ or ‘unclear’ risk of bias.
Figure 3.
Figure 3.
Forest plot for total cholesterol concentrations in acutely-ill individuals with anorexia nervosa (AN) compared with healthy control participants. SD: standard deviation. MD: mean difference. CI: confidence interval.
Figure 4.
Figure 4.
Bubble plot. Meta-regression examining the association of the moderator BMI with the mean differences in high-density lipoprotein (HDL) cholesterol between acutely-ill individuals with anorexia nervosa and healthy control participants. Bubble size is inversely proportional to the variance of the estimated mean difference. This means bubbles are sized according to the precision of each estimate with larger bubble for more precise estimates.
See this image and copyright information in PMC

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