The biochemistry of anorexia nervosa

We have reviewed studies reporting biochemical abnormalities consequent upon anorexia nervosa (AN). Hitherto, these reports have lacked any coherent synthesis in the account of how such abnormalities arise. The paper firstly addresses electrolyte imbalances, changes in underlying physiology, and the clinical consequences if such abnormalities are not recognized. Mechanisms contributing to changes in renal function are discussed. The use of alternative energy sources for the Krebs' cycle is considered in the context of catabolic processes occurring in the AN subject. Liver function, and protein and fat metabolism are considered in this context. Comparisons with the catabolism of starvation and the processes found in dietary-deficient forms of malnutrition are made. The AN subject has many features in common with the state of marasmus. The implications of chronic dietary abnormalities in activating rarely exploited metabolic pathways are considered and well recognized findings, for example hypercarotinemia, are explained through such processes. Evidence for specific trace element and vitamin deficiencies are also reviewed. © 1992 John Wiley & Sons, Inc.