From the Guidelines
Elevated cholesterol and albumin levels in anorexia nervosa require careful monitoring but typically don't need specific medication treatment, as they often normalize with weight restoration and nutritional rehabilitation. For anorexia treatment, a comprehensive approach is essential, including medical monitoring, nutritional rehabilitation with a target weight gain of 0.5-1 kg per week for inpatients (0.2-0.5 kg for outpatients), psychotherapy (particularly cognitive behavioral therapy, family-based therapy for adolescents), and possibly psychiatric medications for comorbid conditions, as recommended by the American Psychiatric Association 1.
Key Components of Treatment
- Medical monitoring: Regular assessment of vital signs, electrolytes, and cardiac function to prevent complications like refeeding syndrome.
- Nutritional rehabilitation: Targeted weight gain and restoration of normal eating patterns.
- Psychotherapy: Cognitive behavioral therapy, family-based therapy for adolescents, and other forms of eating disorder-focused psychotherapy to address psychological aspects of the disorder.
- Psychiatric medications: For comorbid conditions such as depression, anxiety, or other psychiatric illnesses.
Importance of Multidisciplinary Care
The treatment team should include a physician, dietitian, and mental health professional working collaboratively to address both physical and psychological aspects of this complex disorder, as emphasized in the guidelines 1. This approach ensures comprehensive care that prioritizes morbidity, mortality, and quality of life outcomes.
Monitoring and Prevention of Complications
Regular monitoring of laboratory values, including cholesterol and albumin levels, is crucial, but these abnormalities often serve as markers of illness severity rather than requiring direct treatment. The focus should be on overall nutritional rehabilitation and weight restoration, with careful monitoring to prevent complications like refeeding syndrome, as recommended in the guidelines 1.
From the Research
Elevated Cholesterol and Albumin in Anorexia
- Elevated cholesterol levels are common in patients with anorexia nervosa, with 18% of patients having total cholesterol levels higher than 270 mg/100mL 2.
- Low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and HDL2 levels are also higher in anorexia nervosa patients compared to non-anorexia nervosa patients 2.
- Albumin levels, on the other hand, may not correlate with weight status in severe anorexia nervosa, and can be normal even in patients with severe disease 3, 4.
- The presence of hypoalbuminemia in anorexia nervosa patients should prompt investigation for other potentially life-threatening conditions, such as occult infection 3.
- Refeeding and recovery from anorexia nervosa can result in the normalization of lipid profiles and albumin levels 2.
Mechanisms and Associations
- The mechanisms behind elevated cholesterol levels in anorexia nervosa are unclear, but may be related to increased cholesterol ester transfer protein (CETP) activity and adaptations to low caloric intake 2.
- Lipid profiles in anorexia nervosa patients can be biphasic, with low values at very low body mass index (BMI) levels, normal values at intermediate BMI levels, and high values at higher BMI levels and in the presence of bulimia 2.
- Albumin levels are positively correlated with BMI, free T3, and haptoglobin levels in anorexia nervosa patients 2.