Hepatic Complications of Anorexia Nervosa

Dig Dis Sci. 2017 Nov;62(11):2977-2981. doi: 10.1007/s10620-017-4766-9. Epub 2017 Sep 20.


Anorexia nervosa (AN) has the highest mortality rate of all psychiatric illnesses due to the widespread organ dysfunction caused by the underlying severe malnutrition. Starvation causes hepatocyte injury and death leading to a rise in aminotransferases. Malnutrition-induced hepatitis is common among individuals with AN especially as body mass index decreases. Acute liver failure associated with coagulopathy and encephalopathy can rarely occur. Liver enzymes may also less commonly increase as part of the refeeding process due to hepatic steatosis and can be distinguished from starvation hepatitis by the finding of a fatty liver on ultrasonography. Individuals with AN and starvation-induced hepatitis are at increased risk of hypoglycemia due to depleted glycogen stores and impaired gluconeogenesis. Gastroenterology and hepatology consultations are often requested when patients with AN and signs of hepatitis are hospitalized. It should be noted that additional laboratory testing, imaging, or liver biopsy all have low diagnostic yield, are costly, and potentially invasive, therefore, not generally recommended for diagnostic purposes. While the hepatitis of AN can reach severe levels, a supervised increase in caloric intake and a return to a healthy body weight often quickly lead to normalization of elevated aminotransferases caused by starvation.

Keywords: Aminotransferases; Anorexia nervosa; Eating disorder; Liver; Starvation.

Publication types

  • Review

MeSH terms

  • Anorexia Nervosa / diagnosis
  • Anorexia Nervosa / diet therapy
  • Anorexia Nervosa / epidemiology*
  • Anorexia Nervosa / physiopathology
  • Energy Intake
  • Humans
  • Liver / metabolism
  • Liver / pathology
  • Liver / physiopathology*
  • Liver Diseases / diagnosis
  • Liver Diseases / diet therapy
  • Liver Diseases / epidemiology*
  • Liver Diseases / physiopathology
  • Liver Function Tests
  • Nutrition Assessment
  • Nutritional Status*
  • Predictive Value of Tests
  • Prevalence
  • Recovery of Function
  • Risk Factors
  • Treatment Outcome