REVIEW PAPER
Immune disorders in anorexia
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Submission date: 2017-03-29
Acceptance date: 2017-04-07
Publication date: 2017-10-30
Cent Eur J Immunol 2017;42(3):294-300
KEYWORDS
ABSTRACT
Anorexia nervosa is a disease involving eating disorders. It mainly affects young people, especially teenage women. The disease is often latent and occurs in many sub-clinical and partial forms. Approximately from 0.3% to 1% of the population suffers from anorexia. It has been shown that patients with anorexia develop neurotransmitter-related disorders, leading to uncontrolled changes in the immune and endocrine systems. Interactions between cytokines, neuropeptides, and neurotransmitters play an important role in disease development. Significant malnutrition induces disorders and alterations in T-cell populations. The cellular response in patients with anorexia nervosa has been shown to be normal, although opinions on this issue are controversial. Laboratory studies on neutrophils in anorexia patients showed decreased adhesion and reduced bactericidal and cell activities. Despite such unfavourable results, patients with anorexia are resistant to infections, which are very rare in this group. Glutamine improves the performance of the human immune system. The administration of glutamine to anorexia patients, as a supplement to parenteral nutrition, has resulted in significant improvements in immune system parameters. The results of previous studies on the causes and risk factors in the development of anorexia nervosa are still ambiguous. One can hope that the differences and similarities between patients with anorexia nervosa and those with other forms of protein-calorie malnutrition may be helpful in determining the relationship between nutritional status and body defences and susceptibility to infection, and can help to broaden the knowledge about the aetiopathogenesis of anorexia nervosa.
REFERENCES (63)
1.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Text Revision. Washington, DC: American Psychiatric Association; 1994.
2.
World Health Organization. The ICD-10 classification of mental and behavioral disorders. Clinical description and diagnostic guidelines. Geneva: World Health Organization 1992.
3.
Pritts S, Susman J (2003): Diagnosis of eating disorders in primary care. American Family Physician (Pro Quest Medical Library) 67: 297-308.
4.
Fairburn CG, Harrison PJ (2003): Eating disorders. Lancet 361: 407-416.
5.
Pull ChB (2004): Binge eating disorder. Curr Opin Psychiatry. Lippincott Williams & Wilkins.
6.
Hoek HW, Van Hoeken D (2003): Review of the prevalence and incidence of eating disorders. Int J Eat Disord 34: 383-396.
7.
Grimble RF (1998): Modification of inflammatory aspects of immune function by nutrients. Nutr Res 18: 1297-1317.
8.
Pomposelli JJ, Flores EA, Bistrian BR (1988): Role of Biochemical Mediators in Clinical Nutrition and Surgical Metabolism. J Parenter Enteral Nutr 1988, 12: 212-18.
9.
Chandra RK (2002): Effect of Post-natal Protein Malnutrition and Intrauterine Growth Retardation on Immunity and Risk of Infection pp 41-56. Nutrition and Immune Function. Edited by Calder PC, Field CJ, Gill HS. CAB International.
10.
Brambilla F, Ferrari E, Brunetta M, et al. (1996): Immunoendocrine aspects of anorexia nervosa. Psychitry Res 62: 97-104.
11.
Holden RJ, Pakula IS (1996): The role of tumor necrosis factor-alpha in the pathogenesis of anorexia and bulimia nervosa, cancer cachexia and obesity. Med Hypotheses 47: 423-438.
12.
Corcos M, Guilbaud O, Chaouat G, et al. (2001): Cytokines and anorexia nervosa. Psychosom Med 63: 502-504.
13.
Nagata T, Tobitani W, Kiriike N, et al. (1999): Capacity to produce cytokines during weight restoration in patients with anorexia nervosa. Psychosom Med 61: 371-377.
14.
Agnello E, Malfi G, Costantino AM, et al. (2012): Tumor necrosis factor alpha and oxidative stress as maintaining factors in the evolution of anorexia nervosa. Eat Weight Disord 17: 194-199.
15.
Saito H, Nomura K, Hotta M, Takano K (2007): Malnutrition induces dissociated changes in lymphocyte count and subset proportion in patients with anorexia nervosa. Int J Eat Disord 40: 575-579.
16.
Schaible UE, Kaufmann SHE (2007): Malnutrition and Infection: Complex Mechanisms and Global Impacts. PLoS Medicine 4: 806-812.
17.
Tomkins A (2002): Nutrition, Infection and Immunity: Public Health Implications. Pp 375-412. Nutrition and Immune Function. Calder PC, Field CJ, Gill HS (eds.). CAB International.
18.
Pali AA, Paszthy B (2008): Changes of the immune function in patients with eating disorders. Ideggyogy Sz 61: 381-384.
19.
Paszthy B, Svec P, Tury F, et al. (2007): Impact of anorexia nervosa on activation characteristics of lymphocytes. Neuro Endocrinol Lett 28: 422-426.
20.
Paszthy B, Svec P, Vasarhelyi B, et al. (2007): Investigation of regulatory T cells in anorexia nervosa. Eur J Clin Nutr 61: 1245-1249.
21.
Komorowska-Pietrzykowska R, Rajewski A, Wiktorowicz K, Służewska A (1996): Immunological system activity in anorexia nervosa. Psychiatr Pol 30: 801-810.
22.
Maltoni M, Fabbri L, Nanni O, et al. (1997): Serum levels of tumor necrosis factor alpha and other cytokines do not correlate with weight loss and anorexia in cancer patients. Support Care Cancer 5: 130-135.
23.
Golla JA, Larson LA, Anderson CF, et al. (1981): An immunological assessment of patients with anorexia nervosa. Am.
24.
J Clin Nutr 34: 2756-2762.
25.
Fink S, Eckert E, Mitchell J, et al. (1996): T-lymphocytes subsets in patients with abnormal body weight: longitudinal studies in anorexia nervosa and obesity. Int J Eat Disord 20: 295-305.
26.
Nagata T, Kiriike N, Tobitani W, et al. (1999): Lymphocyte subset, lymphocyte proliferative response, and soluble interleukin-2 receptor in anorexic patients. Biol Psychiatry 45: 471-474.
27.
Bessler H, Karp L, Notti I, et al. (1993): Cytokine production in anorexia nervosa. Clin Neuropharmacol 16: 237-243.
28.
Brambilla F, Monti D, Franceschi C (2001): Plasma concentrations of interleukin-1 beta, interleukin-6 and tumor necrosis factor-alpha, and of their soluble receptors and receptor antagonist in anorexia nervosa. Psychitry Res 103: 107-114.
29.
Solmi M, Veronese N, Favaro A, et al. (2015): Inflammatory cytokines and anorexia nervosa: a metaanalysis of crossectional and longitudinal studies. Psychoneuroendocrinology 51: 237-252.
30.
Pisetsky DS, Trace SE, Brownley KA, et al. (2014): The expression of cytokines and chemokines in the blood of patients with severe weight loss from anorexia nervosa: an exploratory study. Cytokine 69: 110-115.
31.
Kahl KG, Kruse N, Rieckmann P, Schmidt MH (2004): Cytokine mRNA expression patterns in the disease course of female adolescents with anorexia nervosa. Psychoneuroendocrinology 29: 13-20.
32.
do Carmo I, Palma-Carlos ML, Melo A, et al. (1997): Characterization of leucocytes, lymphocytes and lymphocytes subsets in eating disorders. Allerg Immunol 29: 261-268.
33.
Cason J, Ainley CC, Wolstencroft RA, et al. (1986): Cell-mediated immunity in anorexia nervosa. Clin Exp Immunol 64: 370-375.
34.
Schattner A, Steinbock M, Tepper R, et al. (1990): Tumor necrosis factor production and cell-mediated immunity in anorexia nervosa. Clin Exp Immunol 79: 62-66.
35.
Mustafa A, Ward A, Treasure J, Peakman M (1997): T lymphocyte subpopulations in anorexia nervosa and refeeding. Clin Immunol Immunopathol 82: 282-289.
36.
Schattner A, Tepper R, Steinbock M, et al. (1990): TNF, interferon-gamma and cell-mediated cytotoxicity in anorexia nervosa. J Clin Lab Immunol 32: 183-184.
37.
Schattner A, Tepper R, Steinbock M, et al. (1992): Cytokines in anorexia nervosa – nutritional or neuroimmunal changes. Harefuah 123: 245-247.
38.
Allende M, Corell J, Manzanares J, et al. (1998): Immunodeficiency associated with anorexia nervosa is secondary and improves after refeeding. Immunology 94: 543-551).
39.
Nova E, Gomez-Martinez S, Morande G, Marcos A (2002): Cytokine production by mononuclear cells from in-patients with anorexia nervosa. Br J Nutr 88: 183-188.
40.
Nova E, Samartin S, Gomez, et al. (2002): The adaptive response of the immune system to the particular malnutrition of eating disorders. Eur J Clin Nutr 56 suppl 3: S34-37.
41.
Nova E, Toro O, Varela P, et al. (2006): Effects of a nutritional intervention with yogurt on lymphocyte subsets and cytokine production capacity in anorexia nervosa patients. Eur J Nutr 45: 225-233).
42.
Mondello S, Italiano D, Giacobbe MS, et al. (2010): Glutamine-supplemented total parenteral nutrition improves immunological status in anorectic patients. Nutrition 26: 677-681.
43.
Narayanan V, Gaudiani JL, Mehler PS (2009): Serum albumin levels may not correlate with weight status in severe anorexia nervosa. Eat Disord 17: 322-326.
44.
Raymond NC, Dysken M, Bettin K, et al. (2000): Cytokine production in patients with anorexia nervosa, bulimia nervosa, and obesity. Int J Eat Disord 28: 293-302.
45.
Flierl MA, Gaudiani JL, Sabel AL, et al. (2011): Complement C3 serum levels in anorexia nervosa: a potential biomarker for the severity of disease. Ann Gen Psychiatry doi: 10.1186/1744-859X-10-16.
46.
Fetissov SO, Sinno MH, Coeffier M, et al. (2008): Autoantibodies against appetite-regulating peptide hormones and neuropeptides: Putative modulation by gut microflora. Nutrition 24: 348-359.
47.
Terashi M, Asakawa A, Harada T, et al. (2011): Ghrelin reactive autoantibodies in restrictive anorexia nervosa. Nutrition 27: 407-413.
48.
Solmi M, Veronese N, Sergi G, et al. (2016): The association between smoking prevalence and eating disorders: a systemic review and meta-analysis. Addiction doi: 10.1111/add.13457.
49.
Alberti L, Gilardini L, Girola A, et al. (2007): Adiponectin receptors gene expression in lymphocytes of obese and anorectic patients. Diabetes Obes Metab 9: 344-349.
50.
Omodei D, Pucino V, Labruna G, et al. (2015): Immune-metabolic profiling of anorexia patients reveals an antioxidant and anti-inflammatory phenotype. Metabolism 64: 396-405.
51.
Kay J, Stricker RB (1983): Hematologic and immunologic abnormalities in anorexia nervosa. South Med J 76: 1008-1010.
52.
Gotch FM, Spry CJF, Mowat AG, et al. (1975): Reversible granulocyte killing defect in anorexia nervosa. Clin Exp Immunol 21: 244-249.
53.
Palmblad J, Fohlin L, Lundsrtom M (1977): Anorexia nervosa and polymorphonuclear (PMN) granulocyte reactions. Scand J Haematol 19: 334-342.
54.
Sabel AL, Gaudiani JL, Statland B, Mehler PS (2013): Hematological abnormalities in severe anorexia nervosa. Ann Hematol 92: 605-613.
55.
Bowers TK, Eckert E (1978): Leukopenia in anorexia nervosa: lack of increased risk of infection. Arch Intern Med 138: 1520-1523.
56.
Chandra RK, Newberne PM (1977): Nutrition, immunity, and infection: mechanisms of interactions. New York: Plenum Press.
57.
Lucas AR (1977): On the meaning of laboratory values in anorexia nervosa. Mayo Clin Proc 52: 748-750.
58.
Marcos A (2000): Eating disorders: a situation of malnutrition with peculiar changes in the immune system. Eur J Clin Nutr 54 Suppl 1: S61-4.
59.
Berthold-Losleben M, Heitmann S, Himmerich H (2009): Anti-inflammatory drugs in psychiatry. Inflamm Allergy Drug Targets 8: 266-276.
60.
Suskind RM (1977): Malnutrition and the immune response. New York: Raven Press.
61.
Chandra RK (1974): Rosette-forming T lymphocytes and cell-mediated immunity in malnutrition. Br Med J 3: 608-609.
62.
Chandra RK (1976): Nutrition as a critical determinant in susceptibility to infection. World Rev Nutr Diet 25: 166-188.
63.
Sobotka L (2013): Postawy dŻywienia Klinicznego. Ed. 4 Krakowskie Wydawnictwo Scientifica Sp. z oo.