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Early Emphysema in Patients with Anorexia Nervosa

Department of Radiology and James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, Vancouver Coastal Health Research Institute-Vancouver General Hospital, Vancouver; Eating Disorders Program, St. Paul's Hospital, Vancouver, British Columbia, Canada; and Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan

Correspondence and requests for reprints should be addressed to Harvey O. Coxson, Ph.D., Department of Radiology, Vancouver General Hospital, 855 West 12th Avenue, Jim Pattison Pavilion North, Room 3350, Vancouver, BC, V5Z 1M9 Canada. E-mail: hcoxson{at}vanhosp.bc.ca

Postmortem studies of patients who died in the Warsaw Ghetto during World War II suggested that death from starvation was associated with pulmonary emphysema. This study re-examines this hypothesis in patients who are chronically malnourished because of anorexia nervosa. Age, smoking history, body mass index, and pulmonary function were measured in 21 subjects with anorexia nervosa and 16 control subjects. Computed tomography (CT) scans were obtained from three regions of the lung (at the level of the aortic arch, the carina, and the posterior position of the eighth rib) using a multislice scanner. The CT measurements of lung density, emphysema, and surface area-to-volume ratio were obtained using the X-ray attenuation values. CT measurements of emphysema were greater in the group that was anorexic than in historical control subjects (p < 0.001). Furthermore, there were significant correlations between the body mass index and the CT measures of emphysema for all the patients and between diffusing capacity and the CT measurements in the patients who were anorexic. A multiple linear regression analysis showed the diffusing capacity was predicted best by the percentage of lung voxels within the large emphysematous changes category. These data demonstrate that emphysema-like changes are present in the lungs of patients who are chronically malnourished.

Key Words: anorexia nervosa • chronic obstructive pulmonary disease • computed tomography • emphysema • malnutrition

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