Hypercarotenemia in Anorexia Nervosa Patients May Influence Weight Balance: Results of a Clinical Cross-Sectional Cohort Study

Sonja Lackner; Nathalie Meier-Allard; Sabrina Mörkl; Wolfram Müller; Alfred Fürhapter-Rieger; Harald Mangge; Sieglinde Zelzer; Sandra Holasek

doi:10.3389/fpsyt.2021.758300

Hypercarotenemia in Anorexia Nervosa Patients May Influence Weight Balance: Results of a Clinical Cross-Sectional Cohort Study

Front Psychiatry. 2021 Dec 20:12:758300. doi: 10.3389/fpsyt.2021.758300. eCollection 2021.

Authors

Sonja Lackner¹, Nathalie Meier-Allard¹, Sabrina Mörkl², Wolfram Müller³, Alfred Fürhapter-Rieger³, Harald Mangge⁴, Sieglinde Zelzer⁴, Sandra Holasek¹

Affiliations

¹ Division of Immunology and Pathophysiology, Otto Loewi Research Center, Medical University of Graz, Graz, Austria.
² Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Graz, Austria.
³ Division of Biophysics, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria.
⁴ Clinical Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Graz, Austria.

Abstract

Introduction: Anorexia nervosa (AN) can co-occur with hypercarotenemia, a clinical condition characterized by elevated β-carotene in plasma and skin tissue. Carotenoids have known anti-obesogenic effects in adipocyte biology. Thus, carotenoids may potentially play a retarding role in weight gain during the recovery of AN patients. This study evaluated the plasma carotenoid profile and subcutaneous adipose tissue (SAT) in a cohort of AN patients and normal weight (NW) controls. Methods: Plasma concentrations of α-carotene, β-carotene, β-cryptoxanthin, and lycopene were determined by HPLC analysis. SAT thicknesses were measured by a highly accurate and reliable ultrasound technique. Information on dietary intakes were collected by repeated 24-h recalls. Results: Sixty-two females (AN: n = 18, NW: n = 44) were included. The concentrations of β-cryptoxanthin (p = 0.045) and lycopene (p = 0.004) were significantly lower in AN patients. β-carotene levels were higher in AN patients (n.s.) and α-carotene did not differ significantly. SAT thickness was significantly lower in AN patients compared to controls (p < 0.001). β-carotene was significantly negative (r _s = -0.471) and lycopene significantly positive (r _s = 0.366) correlated with SAT. The correlation of β-carotene and SAT was even higher in the AN group alone (r _s = -0.742). Also, β- cryptoxanthin and the sum of provitamin A carotenoids were correlated to SAT (r _s = -0.647 and r _s = -0.746, respectively) in AN patients. Fruits and vegetable intake did not differ significantly between AN and NW but adjusted for SAT, AN patients consumed relatively higher amounts (p = 0.006). Conclusion: Higher plasma β-carotene concentrations were associated with reduced SAT levels, most probably due to a reduced ability of the remaining adipose tissue to store carotenoids. Thus, the antiobesity effects of carotenoids might impact the treatment success of undernutrition and AN. A systemic carotenoid overload may contribute to changes in adipogenesis and metabolic capacities for energy storage. Therefore, high plasma β-carotene may be a marker of delay in weight recovery in AN patients. Interventional studies should consider including carotenoid-status in AN treatment.

Keywords: adipocyte biology; anorexia nervosa; beta-carotene; body fat; carotenoids; hypercarotenaemia; treatment success; weight gain.