From the Guidelines
Yes, eating disorders can cause hyperbilirubinemia, as severe malnutrition and metabolic disturbances associated with these conditions can lead to liver dysfunction and impaired bilirubin processing. When someone severely restricts their food intake, as in anorexia nervosa, or engages in purging behaviors like in bulimia nervosa, the liver can become damaged due to malnutrition and metabolic disturbances. This liver dysfunction may lead to elevated bilirubin levels in the blood, a condition called hyperbilirubinemia. The liver normally processes bilirubin, a yellow compound produced during the breakdown of red blood cells, but when liver function is compromised, bilirubin can accumulate. Starvation can cause increased breakdown of body tissues, including red blood cells, further contributing to bilirubin production. Additionally, severe malnutrition may reduce the liver's ability to conjugate bilirubin, impairing its excretion. Patients with eating disorders who develop hyperbilirubinemia may notice yellowing of the skin and eyes (jaundice).
According to the American Psychiatric Association practice guideline for the treatment of patients with eating disorders 1, the initial evaluation of a patient with a possible eating disorder should include a comprehensive review of systems and laboratory assessment, including a complete blood count and a comprehensive metabolic panel, which can help identify liver dysfunction and hyperbilirubinemia.
Treatment involves addressing the underlying eating disorder through nutritional rehabilitation and psychological therapy, which often leads to normalization of liver function and bilirubin levels as the body recovers. The American Psychiatric Association recommends individualized treatment plans that incorporate medical, psychiatric, psychological, and nutritional expertise 1.
It is essential to note that other conditions, such as Gilbert's syndrome, can also cause hyperbilirubinemia, and a thorough evaluation is necessary to determine the underlying cause 1.
In summary, eating disorders can cause hyperbilirubinemia due to liver dysfunction and impaired bilirubin processing, and treatment involves addressing the underlying eating disorder through nutritional rehabilitation and psychological therapy.
From the Research
Hyperbilirubinemia and Eating Disorders
- Hyperbilirubinemia is a condition characterized by an imbalance between the production and excretion of bilirubin by the liver 2
- Eating disorders, such as anorexia nervosa, can lead to liver dysfunction and potentially cause hyperbilirubinemia 3, 4
- Malnutrition secondary to anorexia nervosa can result in increased serum levels of liver enzymes, including transaminases, and affect liver function 3
- Starvation caused by anorexia nervosa can lead to hepatocyte injury and death, resulting in a rise in aminotransferases and potentially causing hyperbilirubinemia 4
Mechanisms and Associations
- The hepatitis associated with anorexia nervosa can reach severe levels, but supervised increases in caloric intake and a return to a healthy body weight often lead to normalization of elevated aminotransferases caused by starvation 4
- There is no direct evidence to suggest that eating disorders are a primary cause of hyperbilirubinemia, but they can contribute to liver dysfunction and increase the risk of hyperbilirubinemia 3, 4
- Other factors, such as genetic interactions and environmental factors, can also contribute to the development of hyperbilirubinemia in individuals with eating disorders 5
Clinical Implications
- Gastroenterology and hepatology consultations are often requested when patients with anorexia nervosa and signs of hepatitis are hospitalized 4
- Additional laboratory testing, imaging, or liver biopsy may not be necessary for diagnostic purposes, as the hepatitis associated with anorexia nervosa can often be managed with supervised increases in caloric intake and a return to a healthy body weight 4