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Nutritional Status and Immunocompetence in Eating Disorders

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Eating Disorders and the Skin

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Abstract

Eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN), are characterized by aberrant eating behaviours with a severe impact on their nutritional status. The undernourished state of AN patients is patent, while BN patients’ malnutrition is more a subclinical state. Overall, the effects on the immune system are characterized by leukopenia with relative lymphocytosis that does not prevent a decrease in the absolute number of T lymphocytes. There is not a general agreement on the magnitude of the alteration of cell-mediated immune function, including activities such as lymphoproliferation, cytokine production, antigen presentation or recall responses, which have shown inconsistent results in different studies. In this regard, it is important to pay attention to individual characteristics such as duration of the disease, ED subtype, compensatory mechanisms, psychiatric comorbidities—including anxiety, depression and stress—and drug prescriptions, which have an influence on the immunological parameters. On the other hand, a surprisingly low incidence of infection has been reported frequently in AN patients; however, this is generally regarded as a perceived lack of infection symptoms due to an impaired capacity to mount an acute-phase response against infectious agents. Changes in the interactions between the endocrine, central nervous and immune systems are considered relevant to understand the adaptive mechanisms triggered in these syndromes. The role of cytokines and several hormones are reviewed for their possible implication in the pathogenesis and maintenance of the disease.

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Abbreviations

ACTH:

Adrenocorticotropic hormone

AN:

Anorexia nervosa

BN:

Bulimia nervosa

CNS:

Central nervous system

DHST:

Delayed hypersensitivity skin test

ED:

Eating disorders

HPAA:

Hypothalamo-pituitary-adrenal axis

IFN:

Interferon

IL:

Interleukin

PBMC:

Peripheral blood mononuclear cells

PEM:

Protein-energy malnutrition

PHA:

Phytohemagglutinin

POMC:

Pro-opiomelanocortin

RIA:

Radioimmunoassay

References

  1. Chandra RK (1991) Nutrition and immunity: lessons from the past and new insights into the future. Am J Clin Nutr 53:1087–1101

    PubMed  CAS  Google Scholar 

  2. Chandra RK (1997) Nutrition and the immune system: an introduction. Am J Clin Nutr 66:460S–463S

    PubMed  CAS  Google Scholar 

  3. Silber TJ, Chan M (1996) Immunologic fluorometric studies in adolescents with anorexia nervosa. Int J Eat Disord 19:415–418

    Article  PubMed  CAS  Google Scholar 

  4. Cason J, Ainley CC, Volstencroft RA, Norton KRW, Thompson RPH (1986) Cell mediated immunity in anorexia nervosa. Clin Exp Immunol 64:370–375

    PubMed  CAS  Google Scholar 

  5. Varela P, Marcos A, Muñoz-Velez A, Santacruz I, Requejo A (1988) Delayed hypersensitivity skin test in anorexia nervosa and bulimia. Med Sci Res 16:1135

    Google Scholar 

  6. Marcos A, Varela P, Santacruz I, Muñoz-Velez A, Morandé G (1993) Nutritional status and immunocompetence in eating disorders. A comparative study. Eur J Clin Nutr 47:787–793

    PubMed  CAS  Google Scholar 

  7. Marcos A, Varela P, Santacruz I, Muñoz-Vélez A (1993) Evaluation of immunocompetence and nutritional status in patients with bulimia nervosa. Am J Clin Nutr 57:65–69

    PubMed  CAS  Google Scholar 

  8. Marcos A, Varela P, Toro O, Nova E, López-Vidriero I, Morandé G (1997) Evaluation of nutritional status by immunological assessment in bulimia nervosa. Influence of BMI and vomiting episodes. Am J Clin Nutr 66S:S491–S497

    Google Scholar 

  9. Van de Berg BC, Malghem J, Devuyst O, Maldague BE, Lambert MJ (1994) Anorexia nervosa: correlation between MR appearance of bone marrow and severity of disease. Radiology 193:859–864

    Google Scholar 

  10. Marcos A (2000) Eating disorders: a situation of malnutrition with peculiar changes in the immune system. Eur J Clin Nutr 54(S1):S61–S64

    Article  PubMed  CAS  Google Scholar 

  11. Brambilla F, Ferrari E, Brunetta M et al (1996) Immunoendocrine aspects of anorexia nervosa. Psychiatry Res 62:97–104

    Article  PubMed  CAS  Google Scholar 

  12. Mustafa A, Ward A, Treasure J, Peakman M (1997) T lymphocyte subpopulations in anorexia nervosa and refeeding. Clin Immunol Immunopathol 82:282–289

    Article  PubMed  CAS  Google Scholar 

  13. Allende LM, Corell A, Manzanares J et al (1998) Immunodeficiency associated with anorexia nervosa is secondary and improves after refeeding. Immunology 94:543–551

    Article  PubMed  CAS  Google Scholar 

  14. Fink S, Eckert E, Mitchell J, Crosby R, Pomeroy C (1996) T-lymphocyte subsets in patients with abnormal body weight: longitudinal studies in anorexia nervosa and obesity. Int J Eat Disord 20:295–305

    Article  PubMed  CAS  Google Scholar 

  15. Do Carmo I, Palma-Carlos ML, Melo A (1997) Characterization of leukocytes, lymphocytes and lymphocyte subsets in eating disorders. Allerg Immunol (Paris) 29(9):261–268

    CAS  Google Scholar 

  16. Abe M, Akbar F, Matsuura B, Horiike N, Onji M (2003) Defective antigen-presenting capacity of murine dendritic cells during starvation. Nutrition 19(3):265–269

    Article  PubMed  CAS  Google Scholar 

  17. Nova E, Varela P, Toro O et al (2001) Dietary intake and anthropometry in anorexia nervosa patients undergoing rehabilitation treatment. A one-year follow-up study. Eur J Clin Nutr 55:547–554

    Article  PubMed  CAS  Google Scholar 

  18. Nagata T, Kiriike N, Tobitani W, Kawarada Y, Matsunaga H, Yagamami S (1999) Lymphocyte subset, lymphocyte proliferative response and soluble interleukin-2 receptor in anorexic patients. Biol Psychiatry 45:471–474

    Article  PubMed  CAS  Google Scholar 

  19. Marcos A, Varela P, Toro O (1997) Interactions between nutrition and immunity in anorexia nervosa. A one year follow-up. Am J Clin Nutr 66S:S485–S490

    Google Scholar 

  20. Golla AG, Larson LA, Anderson CF, Lucas AR, Wilson WR, Tomasi TB (1981) Immunological assessment of patients with anorexia nervosa. Am J Clin Nutr 34:2756–2762

    PubMed  CAS  Google Scholar 

  21. Polack E, Nahmod VE, Emeric Sauval E (1993) Low lymphocyte interferon-gamma production and variable proliferative response in anorexia nervosa patients. J Clin Immunol 13:445–451

    Article  PubMed  CAS  Google Scholar 

  22. Freitag KA, Saker KE, Thomas E, Kalnitsky J (2000) Acute starvation and subsequent refeeding affect lymphocyte subsets and proliferation in cats. J Nutr 130(10):2444–2449

    PubMed  CAS  Google Scholar 

  23. Dally P (1969) Anorexia nervosa. William Heinemann Medical Books Ltd, London, pp 30–46

    Google Scholar 

  24. Bowers TK, Eckert E (1978) Leukopenia in anorexia nervosa: lack of risk of increased infection. Arch Intern Med 138:1520–1523

    Article  PubMed  CAS  Google Scholar 

  25. Wade S, Bleiberg F, Mossé A et al (1985) Thymulin (Zn-Facteur Thymique Serique) activity in anorexia nervosa patients. Am J Clin Nutr 42:275–280

    PubMed  CAS  Google Scholar 

  26. Nova E, Samartín S, Gómez S, Morandé G, Marcos A (2002) The adaptive response of the immune system to the particular malnutrition of eating disorders. Eur J Clin Nutr 56(Supl):34S–37S

    Google Scholar 

  27. Hart BL (1990) Behavioral adaptations to pathogens and parasites: five strategies. Neurosci Biobehav Rev 14:273–294

    Article  PubMed  CAS  Google Scholar 

  28. Marcos A (1997) The immune system in eating disorders: an overview. Nutrition 13:853–862

    Article  PubMed  CAS  Google Scholar 

  29. Birmingham CL, Hodgson DM, Fung J et al (2003) Reduced febrile response to bacterial infection in anorexia nervosa patients. Int J Eat Disord 34:269–272

    Article  PubMed  Google Scholar 

  30. Pászthy B, Svec P, Vásárhelyi B, Túry F, Mazzag J, Tulassay T, Treszl A (2007) Investigation of regulatory T cells in anorexia nervosa. Eur J Clin Nutr 61(11):1245–1249

    Article  PubMed  Google Scholar 

  31. Grimble RF (1994) Malnutrition and the immune response. 2. Impact of nutrients on cytokine biology in infection. Trans R Soc Trop Med Hyg 88:615–619

    Article  PubMed  CAS  Google Scholar 

  32. Holden RJ, Pakula IS (1996) The role of tumour necrosis factor-α in the pathogenesis of anorexia and bulimia nervosa, cancer cachexia and obesity. Med Hypotheses 47:423–438

    Article  PubMed  CAS  Google Scholar 

  33. Holden RJ, Pakula IS (1999) Tumor necrosis factor-alpha: is there a continuum of liability between stress, anxiety states and anorexia nervosa? Med Hypotheses 52:155–162

    Article  PubMed  CAS  Google Scholar 

  34. Emeric-Sauval E, Polack E, Bello M et al (1989) Anorexia nervosa y bulimia-un modelo para el estudio de las interaciones immunoneuroendocrinas en respecto al CRH humano. Rev Argent Endocrinol Metab 26:72–73

    Google Scholar 

  35. Mitchell JE, Eckert E, Pomeroy C (1994) The role of cytokines in anorexia nervosa. Neuropsychopharma­cology 10:206S (Abstract)

    Google Scholar 

  36. Pomeroy C, Eckert E, Shuxian H et al (1994) Role of interleukine-6 and transforming growth factor-α in anorexia nervosa. Soc Biol Psychiatry 36:836–839

    Article  CAS  Google Scholar 

  37. Nakai Y, Hamagaki S, Tagaki R, Taniguchi A, Kurimoto F (1999) Plasma concentrations of tumor necrosis factor α (TNF-α) and soluble TNF receptors in patients with anorexia nervosa. J Clin Endocrinol Metab 84:1226–1228

    Article  PubMed  CAS  Google Scholar 

  38. Vaisman N, Barak Y, Hahn T, Karov Y, Malach L, Barak V(1996) Defective in vitro granulopoiesis in patients with anorexia nervosa. Pediatr Res 40:108–111

    Article  PubMed  CAS  Google Scholar 

  39. Brambilla F, Bellodi L, Brunetta M, Perna G (1998) Plasma concentrations of interleukin-1 beta, interleukin-6 and tumor necrosis factor-alpha in anorexia and bulimia nervosa. Psychoneuroendocrinology 23:439–447

    Article  PubMed  CAS  Google Scholar 

  40. Brambilla F, Monti D, Franceschi C (2001) Plasma concentrations of interleukin-1-beta, interleukin 6 and tumor necrosis factor-alpha, and of their soluble receptors and receptor antagonist in anorexia nervosa. Psychiatry Res 103:107–114

    Article  PubMed  CAS  Google Scholar 

  41. Monteleone P, Maes M, Fabrazzo M et al (1999) Immunoendocrine findings in patients with eating disorders. Neuropsychobiology 40:115–120

    Article  PubMed  CAS  Google Scholar 

  42. Nagata T, Tobitani W, Kiriike N, Iketani T, Yamagami S (1999) Capacity to produce cytokines during weight restoration in patients with anorexia nervosa. Psychosom Med 61:371–377

    PubMed  CAS  Google Scholar 

  43. Corcos M, Guilbaud O, Chaouat G et al (2001) Cytokines and anorexia nervosa. Psychosom Med 63:502–504

    PubMed  CAS  Google Scholar 

  44. Schattner A, Tepper R, Steinbock M, Vaisman N, Hahn T, Schonfeld A (1990) TNF, interferon-γ, and cell-mediated cytotoxicity in anorexia nervosa; effect of refeeding. J Clin Lab Immunol 32:183–184

    PubMed  CAS  Google Scholar 

  45. Limone P, Biglino A, Bottino F et al (2000) Evidence for a positive correlation between serum cortisol levels and IL-1beta production by peripheral mononuclear cells in anorexia nervosa. J Endocrinol Invest 23:422–427

    PubMed  CAS  Google Scholar 

  46. Marcos A, Nova E, Lopez-Varela S (2008) The immune system in eating disorders. In: Fuller R, Perdigon G (eds) Gut flora, nutrition, immunity and health. Blackwell Publishing, Oxford, pp 137–154

    Chapter  Google Scholar 

  47. Nova E, Gómez-Martínez S, Morandé G, Marcos A (2002) Cytokine production by blood mononuclear cells from in-patients with anorexia nervosa. Br J Nutr 88:183–188

    Article  PubMed  CAS  Google Scholar 

  48. Yirmiya R, Chiappelli F, Tio DL, Tritt SH, Taylor AN (1998) Effects of prenatal alcohol and pair feeding on lipopolysaccharide-induced secretion of TNF-alpha and corticosterone. Alcohol 15:327–335

    Article  PubMed  CAS  Google Scholar 

  49. Corcos M, Guilbaud O, Paterniti S et al (2003) Involvement of cytokines in eating disorders: a critical review of the human literature. Psychoneuroen­docrinology 28:229–249

    Article  PubMed  CAS  Google Scholar 

  50. Bessler H, Karp L, Notti I et al (1993) Cytokine production in anorexia nervosa. Clin Neuropharmacol 16:237–243

    Article  PubMed  CAS  Google Scholar 

  51. Licinio J, Litsvak S, Altemus ME et al (1990) Serum and CSF interleukin-1 in bulimia nervosa. Biol Psychiatry 27(Suppl 9A):147A (Abstract)

    Google Scholar 

  52. Pászthy B, Svec P, Túry F, Kovács L, Vásárhelyi B, Tulassay T, Treszl A (2007) Impact of anorexia nervosa on activation characteristics of lymphocytes. Neuro Endocrinol Lett 28(4):422–426

    PubMed  Google Scholar 

  53. Licinio J, Altemus ME, Wong M, Gold PW (1991) Circulating levels of interleukin-2 in patients with anorexia nervosa. Biol Psychiatry 29(Suppl 9A):56A (Abstract)

    Google Scholar 

  54. Savendhal L, Underwood LE (1997) Decreased interleukin-2 production from cultured peripheral blood mononuclear cells in human acute starvation. J Clin Endocrinol Metab 82:1177–1180

    Article  Google Scholar 

  55. Shintani F, Kanba S, Nakaki T et al (1993) Interleukin-1 beta augments release of norepinephrine, dopamine, and serotonin in the rat anterior hypothalamus. J Neurosci 13:3574–3581

    PubMed  CAS  Google Scholar 

  56. Smagin GN, Swiergiel AH, Dunn AJ (1996) Peripheral administration of interleukin-1 increases extracellular concentrations of norepinephrine in rat hypothalamus: comparison with plasma corticosterone. Psychoneuro­endocrinology 21:83–93

    Article  PubMed  CAS  Google Scholar 

  57. McCarthy HD, Dryden S, Williams G (1995) Interleukin-1 beta induced anorexia and pyrexia in rats: relationship to hypothalamic neuropeptide Y. Am J Physiol 269:E852–E857

    PubMed  CAS  Google Scholar 

  58. Reyes TM, Sawchenko PE (2000) Is the arcuate nucleus involved in cytokine-induced anorexia? Soc Neurosci Abstr 26:4413

    Google Scholar 

  59. Konsman JP, Dantzer R (2001) How the immune and nervous systems interact during disease-associated anorexia. Nutrition 17:664–668

    Article  PubMed  CAS  Google Scholar 

  60. Kahl KG, Kruse N, Rieekmann P, Schmidt MH (2004) Cytokine mRNA expression patterns in the disease course of female adolescents with anorexia nervosa. Psychoneuroendocrinology 29:13–20

    Article  PubMed  CAS  Google Scholar 

  61. Schattner A, Steinbock M, Tepper R, Schonfeld A, Vaisman N, Hahn T (1990) Tumour necrosis factor production and cell-mediated immunity in anorexia nervosa. Clin Exp Immunol 79:62–66

    Article  PubMed  CAS  Google Scholar 

  62. Vaisman N, Hahn T (1991) Tumor necrosis factor-α and anorexia-cause or effect? Metabolism 40:720–723

    Article  PubMed  CAS  Google Scholar 

  63. Dostálová I, Kaválková P, Papezová H, Domluvilová D, Zikán V, Haluzík M (2010) Association of macrophage inhibitory cytokine-1 with nutritional status, body composition and bone mineral density in patients with anorexia nervosa: the influence of partial realimentation. Nutr Metab (Lond) 23:7–34

    Google Scholar 

  64. Monteleone P, Di Lieto A, Tortorella A, Longobardi N, Maj M (2000) Circulating leptin in patients with anorexia nervosa, bulimia nervosa or binge eating disorder: relationship to body weight, eating patterns, psychopathology and endocrine changes. Psychiatry Res 94:121–129

    Article  PubMed  CAS  Google Scholar 

  65. Matarese G (2000) Leptin and the immune system: how nutritional status influences the immune response. Eur Cytokine Netw 11:7–13

    PubMed  CAS  Google Scholar 

  66. Matarese G, Moschos S, Mantzoros CS (2005) Leptin in immunology. J Immunol 174(6):3137–3142

    PubMed  CAS  Google Scholar 

  67. Loffreda S, Yang SQ, Lin HZ et al (1998) Leptin regulates proinflammatory immune responses. FASEB J 12:57–65

    PubMed  CAS  Google Scholar 

  68. Fantuzzi G (2005) Adipose tissue, adipokines and inflammation. J Allergy Clin Immunol 115(5):911–919

    Article  PubMed  CAS  Google Scholar 

  69. Herpertz S, Norbert A, Richard W et al (2000) Longitudinal changes of circadian leptin, insulin and cortisol plasma levels and their correlation during refeeding in patients with anorexia nervosa. Eur J Endocrinol 142:373–379

    Article  PubMed  CAS  Google Scholar 

  70. Diez JJ, Iglesias P (2003) The role of the novel adipocyte-derived hormone adiponectin in human disease. Eur J Endocrinol 148:293–300

    Article  PubMed  CAS  Google Scholar 

  71. Yokota T, Oritani K, Takahashi I et al (2000) Adiponectin, a new member of the family of soluble defense collagens, negatively regulates the growth of myelomonocytic progenitors and the functions of macrophages. Blood 96:1723–1732

    PubMed  CAS  Google Scholar 

  72. Brichard SM, Delporte ML, Lambert M (2003) Adipocytokines in anorexia nervosa: a review focusing on leptin and adiponectin. Horm Metab Res 35(6):337–342

    Article  PubMed  CAS  Google Scholar 

  73. Pannacciulli N, Vettor R, Milan G et al (2003) Anorexia nervosa is characterized by increased adiponectin plasma levels and reduced nonoxidative glucose metabolism. J Clin Endocrinol Metab 88:1748–1752

    Article  PubMed  CAS  Google Scholar 

  74. Iwahashi H, Funahashi T, Kurokawa N, Sayama K, Fukuda E, Okita K et al (2003) Plasma adiponectin levels in women with anorexia nervosa. Horm Metab Res 35:537–540

    Article  PubMed  CAS  Google Scholar 

  75. Tagami T, Satoh N, Usui T, Yamada K, Shimatsu A, Kuzuya H (2004) Adiponectin in anorexia nervosa and bulimia nervosa. J Clin Endocrinol Metab 89:1833–1837

    Article  PubMed  CAS  Google Scholar 

  76. Nogueira JP, Maraninchi M, Lorec AM, Corroller AB, Nicolay A, Gaudart J, Portugal H, Barone R, Vialettes B, Valéro R (2010) Specific adipocytokines profiles in patients with hyperactive and/or binge/purge form of anorexia nervosa. Eur J Clin Nutr 64(8):840–844

    Article  PubMed  Google Scholar 

  77. Patel L, Buckels AC, Kinghorn IJ et al (2003) Resistin is expressed in human macrophages and directly regulated by PPAR gamma activators. Biochem Biophys Res Commun 300(2):472–476

    Article  PubMed  CAS  Google Scholar 

  78. Dolezalova R, Lacinova Z, Dolinkova M, Kleiblova P, Haluzikova D, Housa D, Papezova H, Haluzik M (2007) Changes of endocrine function of adipose tissue in anorexia nervosa: comparison of circulating levels versus subcutaneous mRNA expression. Clin Endocrinol (Oxf) 67(5):674–678

    Article  CAS  Google Scholar 

  79. Kim Y, Michael AF (1975) Hypocomplementemia in anorexia nervosa. J Pediatr 87(4):582–585

    Article  PubMed  CAS  Google Scholar 

  80. Pomeroy C, Mitchell J, Eckert E, Raymond N, Crosby R,Dalmasso AP (1997) Effect of body weight and caloric restriction on serum complement proteins, including Factor D/adipsin: studies in anorexia nervosa and obesity. Clin Exp Immunol 108:507–515

    Article  PubMed  CAS  Google Scholar 

  81. Nova E, Lopez-Vidriero I, Varela P, Toro O, Casas J, Marcos A (2004) Indicators of nutritional status in restricting-type anorexia nervosa patients. A one-year follow-up study. Clin Nutr 23:1353–1359

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Immunonutrition Group, Department of Metabolism and Nutrition, Institute of Food Science, Technology and Nutrition (ICTAN-CSIC), C/Jose Antonio Novais, 10, 28040, Madrid, Spain

    Esther Nova Ph.D. & Ascensión Marcos Ph.D.

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  1. Esther Nova Ph.D.
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  2. Ascensión Marcos Ph.D.
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Correspondence to Ascensión Marcos Ph.D. .

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  1. Viale Cavour, Ferrara, 44121, Italy

    Renata Strumia

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Nova, E., Marcos, A. (2013). Nutritional Status and Immunocompetence in Eating Disorders. In: Strumia, R. (eds) Eating Disorders and the Skin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-29136-4_5

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