Reprinted from Eating Disorders Review
January/February 2004 Volume 15, Number 1
©2004 Gürze Books
In a study that has implications for patients with anorexia nervosa, researchers recently went back as far as the Second World War to evaluate the long-term effects of starvation during periods of growth. They discovered that starvation with chronic stress, especially just before or during puberty, has long-term adverse consequences, especially upon the heart (BMJ 2004; 328: 11).
From September 8, 1941 to January 27, 1944, citizens in Leningrad (now St. Petersburg), Russia faced starvation as German troops blocked supplies during the Siege of Leningrad. The population of Leningrad at that time was 2.9 million, including a half million children. The average daily ration for citizens was 460 kcal per day.
During the siege, 630,000 people died from hunger-related causes, most during the winter of 1941-42. Dr. Pär Sparén, at the Karolinska Institute, Stockholm, and co-workers studied 5000 men born 1916 to 1935 who lived in Leningrad; 3905 of the men had lived in Leningrad during the siege.
Three to six decades after the siege, men who had been in the siege around the age of puberty had blood pressures a mean of 3.3 mmHg higher than normal. This group also had a higher rate of death from ischemic heart disease and stroke, including hemorrhagic stroke. Lifestyle and socioeconomic factors did not confound the association between death from cardiovascular disease and siege exposure.
Starvation at puberty increased risk
Starvation around the time of puberty (ages 9-15) was more strongly associated with high systolic blood pressure and strokes in adult life than was starvation at other ages. According to the authors, this casts new light on the long-term effects of severe malnutrition in early life. The researcher chose the age limit of 9 years on the basis of Marshall and Tanner’s work, where the “fat spurt” was considered to be the earlier sign of or trigger of puberty that is visible before age 10.
Heart abnormalities in anorexic patients
Studies of patients with anorexia nervosa report several cardiovascular abnormalities, especially reduction of ventricular mass, valve dysfunctions, and EKG abnormalities. Damage to the myocardial fibers has been documented in obese patients on very-low-calorie diets. In addition, endocrine changes accompany self-starvation occurring around the time of puberty (Marshall and Tanner, Human Growth, a comprehensive treatise, Plenum Press, 1986, pp. 171-209).
The authors concluded that starvation around the time of puberty might increase the risk of future cardiovascular disease.