Q & A: Anorexia Nervosa and Emphysema-Like Syndromes?

Q: I’ve heard that, among other long-term health problems, patients with anorexia nervosa may be more vulnerable to developing chronic lung diseases such as emphysema-like disorders. Is that true and, if so, how does that come about? (B.L., San Francisco, CA)

A: The idea that patients with anorexia nervosa may be more prone to emphysema-like disorders is currently a matter of some debate. There is clearly evidence that low-weight patients with anorexia nervosa may have decreased values for maximal inspiratory and expiratory pressures, but these seem to be a direct reflection of malnutrition rather than due to anorexia nervosa per se (Pieters T. et al, J Intern Med 2000; 248:137). It also seems evident that any “emphysema-like” syndromes are most likely associated only with very-low-weight patients, and may reflect the effects of concomitant decreases in muscle mass rather than to a specific change in lung structure (Coxson H.O. et al, Am J Respir Crit Care Med 2005; 172:398).

However, measurements of diffusing capacity and computed tomographic lung measurements have also been interpreted in patients with very low body mass indexes (BMIs) as consistent with patterns seen in patients with emphysema (Coxson H.O. et al, Am J Respir Crit Care Med 2004; 170:748). The exact significance of these findings awaits further clarification. Furthermore, these studies do not address whether pulmonary changes that occur in patients with very low weights persist after weight is recovered or whether they confer additional long-term health risks, or whether they resolve. These studies also don’t identify whether those who develop pulmonary findings with severe weight loss carry additional pulmonary vulnerabilities prior to developing anorexia nervosa.

— J.Y.