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Published ahead of print on July 15, 2004, doi:10.1164/rccm.200405-651OC

Am. J. Respir. Crit. Care Med., Volume 170, Number 7, October 2004, 748-752

A more recent version of this article appeared on October 1, 2004
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Submitted on May 20, 2004
Accepted on July 12, 2004

Early Emphysema in Patients with Anorexia Nervosa

Harvey O Coxson1*, Ida H.T. Chan1, John R Mayo1, Julia Hlynsky2, Yasutaka Nakano3, and C. Laird Birmingham2

1 Department of Radiology and James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, Vancouver Coastal Health Research Institute, Vancouver General Hospital, Vancouver, BC, Canada, 2 Eating Disorders Program, St. Paul's Hospital, Vancouver, BC, Canada, 3 Department of Radiology and James Hogg iCAPTURE Centre for Cardiovascular and Pulmonary Research, Vancouver Coastal Health Research Institute, Vancouver General Hospital, Vancouver, BC, Canada; Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Shiga, Japan

* To whom correspondence should be addressed. E-mail: hcoxson{at}vanhosp.bc.ca.

Post-mortem studies of patients who died in the Warsaw Ghetto during World War II suggested that death from starvation was associated with pulmonary emphysema. The present study re-examines this hypothesis in patients who are chronically malnourished due to 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 scans were obtained from three regions of the lung (at the level of the aortic arch, the carina and the posterior position of the 8th rib) using a multi-slice scanner. The computed tomographic measurements of lung density, emphysema, and surface area-to-volume ratio were obtained using the X-ray attenuation values. Computed tomographic measurements of emphysema were greater in the anorexic group than historical controls (p<0.001). Furthermore, there were significant correlations between body mass index and the computed tomographic measures of emphysema for all the patients, and between diffusing capacity and the CT measurements in the anorexic patients. 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 that are chronically malnourished.
Key words: anorexia nervosa, emphysema, CT, COPD, malnutrition




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