This Article Full Text Full Text (PDF) All Versions of this Article: 200405-651OCv1 170/7/748    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Coxson, H. O. Articles by Birmingham, C. L. Search for Related Content PubMed PubMed Citation Articles by Coxson, H. O. Articles by Birmingham, C. L.

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

This article has been cited by other articles:

				E Ogawa, Y Nakano, T Ohara, S Muro, T Hirai, S Sato, H Sakai, M Tsukino, D Kinose, M Nishioka, et al. Body mass index in male patients with COPD: correlation with low attenuation areas on CT Thorax, January 1, 2009; 64(1): 20 - 25. [Abstract] [Full Text] [PDF]

				H. O. Coxson Chairman's Summary Proceedings of the ATS, December 15, 2008; 5(9): 874 - 877. [Full Text] [PDF]

				H. O. Coxson, P. V. Nasute Fauerbach, C. Storness-Bliss, N. L. Muller, S. Cogswell, D. H. Dillard, C. L. Finger, and S. C. Springmeyer Computed tomography assessment of lung volume changes after bronchial valve treatment Eur. Respir. J., December 1, 2008; 32(6): 1443 - 1450. [Abstract] [Full Text] [PDF]

				J. M. Bishai and W. Mitzner Effect of severe calorie restriction on the lung in two strains of mice Am J Physiol Lung Cell Mol Physiol, August 1, 2008; 295(2): L356 - L362. [Abstract] [Full Text] [PDF]

				J. L. Wright, M. Cosio, and A. Churg Animal models of chronic obstructive pulmonary disease Am J Physiol Lung Cell Mol Physiol, July 1, 2008; 295(1): L1 - L15. [Abstract] [Full Text] [PDF]

				R. Summer, F. F. Little, N. Ouchi, Y. Takemura, T. Aprahamian, D. Dwyer, K. Fitzsimmons, B. Suki, H. Parameswaran, A. Fine, et al. Alveolar macrophage activation and an emphysema-like phenotype in adiponectin-deficient mice Am J Physiol Lung Cell Mol Physiol, June 1, 2008; 294(6): L1035 - L1042. [Abstract] [Full Text] [PDF]

				S. E. Wert Does adiponectin play a role in pulmonary emphysema? Am J Physiol Lung Cell Mol Physiol, June 1, 2008; 294(6): L1032 - L1034. [Full Text] [PDF]

				A. Sharafkhaneh, N. A. Hanania, and V. Kim Pathogenesis of Emphysema: From the Bench to the Bedside Proceedings of the ATS, May 1, 2008; 5(4): 475 - 477. [Abstract] [Full Text] [PDF]

				S. V. Stinchcombe and M. Maden Retinoic Acid Induced Alveolar Regeneration: Critical Differences in Strain Sensitivity Am. J. Respir. Cell Mol. Biol., February 1, 2008; 38(2): 185 - 191. [Abstract] [Full Text] [PDF]

				K. Amjadi, G. G. Alvarez, E. Vanderhelst, B. Velkeniers, M. Lam, and M. Noppen The Prevalence of Blebs or Bullae Among Young Healthy Adults: A Thoracoscopic Investigation Chest, October 1, 2007; 132(4): 1140 - 1145. [Abstract] [Full Text] [PDF]

				J. A. Guenette, B. C. Sporer, M. J. MacNutt, H. O. Coxson, A. W. Sheel, J. R. Mayo, and D. C. McKenzie Lung density is not altered following intense normobaric hypoxic interval training in competitive female cyclists J Appl Physiol, September 1, 2007; 103(3): 875 - 882. [Abstract] [Full Text] [PDF]

				A. W Fogarty, S. Jones, J. R Britton, S. A Lewis, and T. M McKeever Systemic inflammation and decline in lung function in a general population: a prospective study Thorax, June 1, 2007; 62(6): 515 - 520. [Abstract] [Full Text] [PDF]

				D. Massaro, E. Alexander, K. Reiland, E. P. Hoffman, G. D. Massaro, and L. B. Clerch Rapid onset of gene expression in lung, supportive of formation of alveolar septa, induced by refeeding mice after calorie restriction Am J Physiol Lung Cell Mol Physiol, May 1, 2007; 292(5): L1313 - L1326. [Abstract] [Full Text] [PDF]

				A. Shifren, A. G. Durmowicz, R. H. Knutsen, E. Hirano, and R. P. Mecham Elastin protein levels are a vital modifier affecting normal lung development and susceptibility to emphysema Am J Physiol Lung Cell Mol Physiol, March 1, 2007; 292(3): L778 - L787. [Abstract] [Full Text] [PDF]

				K. Bry, J. A. Whitsett, and U. Lappalainen IL-1beta Disrupts Postnatal Lung Morphogenesis in the Mouse Am. J. Respir. Cell Mol. Biol., January 1, 2007; 36(1): 32 - 42. [Abstract] [Full Text] [PDF]

				S. I. Rennard, S. Togo, and O. Holz Cigarette Smoke Inhibits Alveolar Repair: A Mechanism for the Development of Emphysema Proceedings of the ATS, November 1, 2006; 3(8): 703 - 708. [Abstract] [Full Text] [PDF]

				D. Massaro and G. D. Massaro Toward Therapeutic Pulmonary Alveolar Regeneration in Humans Proceedings of the ATS, November 1, 2006; 3(8): 709 - 712. [Abstract] [Full Text] [PDF]

				H. Chen, M. J. Hansen, J. E. Jones, R. Vlahos, S. Bozinovski, G. P. Anderson, and M. J. Morris Cigarette Smoke Exposure Reprograms the Hypothalamic Neuropeptide Y Axis to Promote Weight Loss Am. J. Respir. Crit. Care Med., June 1, 2006; 173(11): 1248 - 1254. [Abstract] [Full Text] [PDF]

				T. M. Martinez, C. J. Llapur, T. H. Williams, C. Coates, R. Gunderman, M. D. Cohen, M. S. Howenstine, O. Saba, H. O. Coxson, and R. S. Tepper High-Resolution Computed Tomography Imaging of Airway Disease in Infants with Cystic Fibrosis Am. J. Respir. Crit. Care Med., November 1, 2005; 172(9): 1133 - 1138. [Abstract] [Full Text] [PDF]

				A. Perez IV, H. O. Coxson, J. C. Hogg, K. Gibson, P. F. Thompson, and R. M. Rogers Use of CT Morphometry To Detect Changes in Lung Weight and Gas Volume Chest, October 1, 2005; 128(4): 2471 - 2477. [Abstract] [Full Text] [PDF]

				D. Stanescu and T. Pieters Anorexia Nervosa and Emphysema Am. J. Respir. Crit. Care Med., August 1, 2005; 172(3): 398 - 398. [Full Text] [PDF]

				A. M. Schols, R. Broekhuizen, C. A Weling-Scheepers, and E. F Wouters Body composition and mortality in chronic obstructive pulmonary disease Am. J. Clinical Nutrition, July 1, 2005; 82(1): 53 - 59. [Abstract] [Full Text] [PDF]

				M. A. Birrell, S. Wong, D. J. Hele, K. McCluskie, E. Hardaker, and M. G. Belvisi Steroid-resistant Inflammation in a Rat Model of Chronic Obstructive Pulmonary Disease Is Associated with a Lack of Nuclear Factor-{kappa}B Pathway Activation Am. J. Respir. Crit. Care Med., July 1, 2005; 172(1): 74 - 84. [Abstract] [Full Text] [PDF]

				H. Wada, H. Goto, E. Saitoh, R. Ieki, T. Okamura, T. Ota, S.-i. Hagiwara, T. Kodaka, and Y. Yamamoto Reduction in Plasma Free Fatty Acid in Patients with Chronic Obstructive Pulmonary Disease Am. J. Respir. Crit. Care Med., June 15, 2005; 171(12): 1465 - 1465. [Full Text] [PDF]

				L. Fabbri, S. P. Peters, I. Pavord, S. E. Wenzel, S. C. Lazarus, W. MacNee, F. Lemaire, and E. Abraham Allergic Rhinitis, Asthma, Airway Biology, and Chronic Obstructive Pulmonary Disease in AJRCCM in 2004 Am. J. Respir. Crit. Care Med., April 1, 2005; 171(7): 686 - 698. [Full Text] [PDF]

				D. Massaro and G. D. Massaro Hunger Disease and Pulmonary Alveoli Am. J. Respir. Crit. Care Med., October 1, 2004; 170(7): 723 - 724. [Full Text] [PDF]