Liver alterations in anorexia nervosa are not caused by insulin resistance

  • Alice FaninEmail author
  • Lucia Miele
  • Emanuela Bertolini
  • Alessia Giorgini
  • Antonio Ettore Pontiroli
  • Alberto Benetti
CE-Research Letter to the Editor



Liver dysfunction has been widely reported in connection with anorexia nervosa (AN) but the pathogenesis of these alterations has never been fully understood despite reported theories about the presence of insulin resistance (IR) and non-alcoholic fatty liver disease (NAFLD). The aim of this study is to investigate if hypertransaminasemia in AN is linked to IR and NAFLD.


Anthropometric data and laboratory exams of 34 patients and 34 controls were analyzed, including alanine-aminotransferase, aspartate-aminotransferase and homeostatic model assessment of insulin resistance (HOMA-IR) index. All subjects also underwent magnetic resonance imaging (MRI), ultrasonography (US), and transient elastography (TE).


Evidence of increased alanine aminotransferase in AN patients was confirmed in our sample together with a lower HOMA-IR index compared to controls. Positive results in US appeared in 16 patients vs none in controls (p = 0.0007); patients with liver parenchyma abnormalities in US were not different than normal-US patients in any of the studied variables. Only one patient showed non-alcoholic fatty liver disease in MRI while abnormal TE was found in four patients and never in controls.


Liver damage suggested by increased serum liver enzymes cannot be due to liver steatosis but potentially to a different liver disease (not identified by MRI) or to an early liver fibrosis not associated with an insulin-resistant status.


Anorexia nervosa Non-alcoholic fatty liver disease Liver fibrosis Insulin resistance 



The authors wish to thank Sara Bertelli, M.D., Martina Carbone, M.D., and Matteo Marcatili, M.D., for the contribution in selecting patients; Simona Anselmetti, psychologist, who performed psychological and diagnostic tests; Maddalena L. Zighetti, M.D., for recruiting blood donors; Carlo Pozzato, M.D., for performing magnetic resonance.


This study was funded by Università degli Studi di Milano and by Ospedale San Paolo.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The present study was approved by the ethics committee of Ospedale San Paolo (Milan, Italy). All procedures were performed in accordance with the ethical standards of the institutional research and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  1. 1.Dipartimento di Scienze della Salute, Ospedale San PaoloUniversità degli Studi di MilanoMilanItaly

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