Abstract
Eating disorders (ED), such as anorexia nervosa (AN) and bulimia nervosa (BN), are characterized by aberrant eating behaviours with a severe impact on their nutritional status. The undernourished state of AN patients is patent, while BN patients’ malnutrition is more a subclinical state. Overall, the effects on the immune system are characterized by leukopenia with relative lymphocytosis that does not prevent a decrease in the absolute number of T lymphocytes. There is not a general agreement on the magnitude of the alteration of cell-mediated immune function, including activities such as lymphoproliferation, cytokine production, antigen presentation or recall responses, which have shown inconsistent results in different studies. In this regard, it is important to pay attention to individual characteristics such as duration of the disease, ED subtype, compensatory mechanisms, psychiatric comorbidities—including anxiety, depression and stress—and drug prescriptions, which have an influence on the immunological parameters. On the other hand, a surprisingly low incidence of infection has been reported frequently in AN patients; however, this is generally regarded as a perceived lack of infection symptoms due to an impaired capacity to mount an acute-phase response against infectious agents. Changes in the interactions between the endocrine, central nervous and immune systems are considered relevant to understand the adaptive mechanisms triggered in these syndromes. The role of cytokines and several hormones are reviewed for their possible implication in the pathogenesis and maintenance of the disease.
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- ACTH:
-
Adrenocorticotropic hormone
- AN:
-
Anorexia nervosa
- BN:
-
Bulimia nervosa
- CNS:
-
Central nervous system
- DHST:
-
Delayed hypersensitivity skin test
- ED:
-
Eating disorders
- HPAA:
-
Hypothalamo-pituitary-adrenal axis
- IFN:
-
Interferon
- IL:
-
Interleukin
- PBMC:
-
Peripheral blood mononuclear cells
- PEM:
-
Protein-energy malnutrition
- PHA:
-
Phytohemagglutinin
- POMC:
-
Pro-opiomelanocortin
- RIA:
-
Radioimmunoassay
References
Chandra RK (1991) Nutrition and immunity: lessons from the past and new insights into the future. Am J Clin Nutr 53:1087–1101
Chandra RK (1997) Nutrition and the immune system: an introduction. Am J Clin Nutr 66:460S–463S
Silber TJ, Chan M (1996) Immunologic fluorometric studies in adolescents with anorexia nervosa. Int J Eat Disord 19:415–418
Cason J, Ainley CC, Volstencroft RA, Norton KRW, Thompson RPH (1986) Cell mediated immunity in anorexia nervosa. Clin Exp Immunol 64:370–375
Varela P, Marcos A, Muñoz-Velez A, Santacruz I, Requejo A (1988) Delayed hypersensitivity skin test in anorexia nervosa and bulimia. Med Sci Res 16:1135
Marcos A, Varela P, Santacruz I, Muñoz-Velez A, Morandé G (1993) Nutritional status and immunocompetence in eating disorders. A comparative study. Eur J Clin Nutr 47:787–793
Marcos A, Varela P, Santacruz I, Muñoz-Vélez A (1993) Evaluation of immunocompetence and nutritional status in patients with bulimia nervosa. Am J Clin Nutr 57:65–69
Marcos A, Varela P, Toro O, Nova E, López-Vidriero I, Morandé G (1997) Evaluation of nutritional status by immunological assessment in bulimia nervosa. Influence of BMI and vomiting episodes. Am J Clin Nutr 66S:S491–S497
Van de Berg BC, Malghem J, Devuyst O, Maldague BE, Lambert MJ (1994) Anorexia nervosa: correlation between MR appearance of bone marrow and severity of disease. Radiology 193:859–864
Marcos A (2000) Eating disorders: a situation of malnutrition with peculiar changes in the immune system. Eur J Clin Nutr 54(S1):S61–S64
Brambilla F, Ferrari E, Brunetta M et al (1996) Immunoendocrine aspects of anorexia nervosa. Psychiatry Res 62:97–104
Mustafa A, Ward A, Treasure J, Peakman M (1997) T lymphocyte subpopulations in anorexia nervosa and refeeding. Clin Immunol Immunopathol 82:282–289
Allende LM, Corell A, Manzanares J et al (1998) Immunodeficiency associated with anorexia nervosa is secondary and improves after refeeding. Immunology 94:543–551
Fink S, Eckert E, Mitchell J, Crosby R, Pomeroy C (1996) T-lymphocyte subsets in patients with abnormal body weight: longitudinal studies in anorexia nervosa and obesity. Int J Eat Disord 20:295–305
Do Carmo I, Palma-Carlos ML, Melo A (1997) Characterization of leukocytes, lymphocytes and lymphocyte subsets in eating disorders. Allerg Immunol (Paris) 29(9):261–268
Abe M, Akbar F, Matsuura B, Horiike N, Onji M (2003) Defective antigen-presenting capacity of murine dendritic cells during starvation. Nutrition 19(3):265–269
Nova E, Varela P, Toro O et al (2001) Dietary intake and anthropometry in anorexia nervosa patients undergoing rehabilitation treatment. A one-year follow-up study. Eur J Clin Nutr 55:547–554
Nagata T, Kiriike N, Tobitani W, Kawarada Y, Matsunaga H, Yagamami S (1999) Lymphocyte subset, lymphocyte proliferative response and soluble interleukin-2 receptor in anorexic patients. Biol Psychiatry 45:471–474
Marcos A, Varela P, Toro O (1997) Interactions between nutrition and immunity in anorexia nervosa. A one year follow-up. Am J Clin Nutr 66S:S485–S490
Golla AG, Larson LA, Anderson CF, Lucas AR, Wilson WR, Tomasi TB (1981) Immunological assessment of patients with anorexia nervosa. Am J Clin Nutr 34:2756–2762
Polack E, Nahmod VE, Emeric Sauval E (1993) Low lymphocyte interferon-gamma production and variable proliferative response in anorexia nervosa patients. J Clin Immunol 13:445–451
Freitag KA, Saker KE, Thomas E, Kalnitsky J (2000) Acute starvation and subsequent refeeding affect lymphocyte subsets and proliferation in cats. J Nutr 130(10):2444–2449
Dally P (1969) Anorexia nervosa. William Heinemann Medical Books Ltd, London, pp 30–46
Bowers TK, Eckert E (1978) Leukopenia in anorexia nervosa: lack of risk of increased infection. Arch Intern Med 138:1520–1523
Wade S, Bleiberg F, Mossé A et al (1985) Thymulin (Zn-Facteur Thymique Serique) activity in anorexia nervosa patients. Am J Clin Nutr 42:275–280
Nova E, Samartín S, Gómez S, Morandé G, Marcos A (2002) The adaptive response of the immune system to the particular malnutrition of eating disorders. Eur J Clin Nutr 56(Supl):34S–37S
Hart BL (1990) Behavioral adaptations to pathogens and parasites: five strategies. Neurosci Biobehav Rev 14:273–294
Marcos A (1997) The immune system in eating disorders: an overview. Nutrition 13:853–862
Birmingham CL, Hodgson DM, Fung J et al (2003) Reduced febrile response to bacterial infection in anorexia nervosa patients. Int J Eat Disord 34:269–272
Pászthy B, Svec P, Vásárhelyi B, Túry F, Mazzag J, Tulassay T, Treszl A (2007) Investigation of regulatory T cells in anorexia nervosa. Eur J Clin Nutr 61(11):1245–1249
Grimble RF (1994) Malnutrition and the immune response. 2. Impact of nutrients on cytokine biology in infection. Trans R Soc Trop Med Hyg 88:615–619
Holden RJ, Pakula IS (1996) The role of tumour necrosis factor-α in the pathogenesis of anorexia and bulimia nervosa, cancer cachexia and obesity. Med Hypotheses 47:423–438
Holden RJ, Pakula IS (1999) Tumor necrosis factor-alpha: is there a continuum of liability between stress, anxiety states and anorexia nervosa? Med Hypotheses 52:155–162
Emeric-Sauval E, Polack E, Bello M et al (1989) Anorexia nervosa y bulimia-un modelo para el estudio de las interaciones immunoneuroendocrinas en respecto al CRH humano. Rev Argent Endocrinol Metab 26:72–73
Mitchell JE, Eckert E, Pomeroy C (1994) The role of cytokines in anorexia nervosa. Neuropsychopharmacology 10:206S (Abstract)
Pomeroy C, Eckert E, Shuxian H et al (1994) Role of interleukine-6 and transforming growth factor-α in anorexia nervosa. Soc Biol Psychiatry 36:836–839
Nakai Y, Hamagaki S, Tagaki R, Taniguchi A, Kurimoto F (1999) Plasma concentrations of tumor necrosis factor α (TNF-α) and soluble TNF receptors in patients with anorexia nervosa. J Clin Endocrinol Metab 84:1226–1228
Vaisman N, Barak Y, Hahn T, Karov Y, Malach L, Barak V(1996) Defective in vitro granulopoiesis in patients with anorexia nervosa. Pediatr Res 40:108–111
Brambilla F, Bellodi L, Brunetta M, Perna G (1998) Plasma concentrations of interleukin-1 beta, interleukin-6 and tumor necrosis factor-alpha in anorexia and bulimia nervosa. Psychoneuroendocrinology 23:439–447
Brambilla F, Monti D, Franceschi C (2001) Plasma concentrations of interleukin-1-beta, interleukin 6 and tumor necrosis factor-alpha, and of their soluble receptors and receptor antagonist in anorexia nervosa. Psychiatry Res 103:107–114
Monteleone P, Maes M, Fabrazzo M et al (1999) Immunoendocrine findings in patients with eating disorders. Neuropsychobiology 40:115–120
Nagata T, Tobitani W, Kiriike N, Iketani T, Yamagami S (1999) Capacity to produce cytokines during weight restoration in patients with anorexia nervosa. Psychosom Med 61:371–377
Corcos M, Guilbaud O, Chaouat G et al (2001) Cytokines and anorexia nervosa. Psychosom Med 63:502–504
Schattner A, Tepper R, Steinbock M, Vaisman N, Hahn T, Schonfeld A (1990) TNF, interferon-γ, and cell-mediated cytotoxicity in anorexia nervosa; effect of refeeding. J Clin Lab Immunol 32:183–184
Limone P, Biglino A, Bottino F et al (2000) Evidence for a positive correlation between serum cortisol levels and IL-1beta production by peripheral mononuclear cells in anorexia nervosa. J Endocrinol Invest 23:422–427
Marcos A, Nova E, Lopez-Varela S (2008) The immune system in eating disorders. In: Fuller R, Perdigon G (eds) Gut flora, nutrition, immunity and health. Blackwell Publishing, Oxford, pp 137–154
Nova E, Gómez-Martínez S, Morandé G, Marcos A (2002) Cytokine production by blood mononuclear cells from in-patients with anorexia nervosa. Br J Nutr 88:183–188
Yirmiya R, Chiappelli F, Tio DL, Tritt SH, Taylor AN (1998) Effects of prenatal alcohol and pair feeding on lipopolysaccharide-induced secretion of TNF-alpha and corticosterone. Alcohol 15:327–335
Corcos M, Guilbaud O, Paterniti S et al (2003) Involvement of cytokines in eating disorders: a critical review of the human literature. Psychoneuroendocrinology 28:229–249
Bessler H, Karp L, Notti I et al (1993) Cytokine production in anorexia nervosa. Clin Neuropharmacol 16:237–243
Licinio J, Litsvak S, Altemus ME et al (1990) Serum and CSF interleukin-1 in bulimia nervosa. Biol Psychiatry 27(Suppl 9A):147A (Abstract)
Pászthy B, Svec P, Túry F, Kovács L, Vásárhelyi B, Tulassay T, Treszl A (2007) Impact of anorexia nervosa on activation characteristics of lymphocytes. Neuro Endocrinol Lett 28(4):422–426
Licinio J, Altemus ME, Wong M, Gold PW (1991) Circulating levels of interleukin-2 in patients with anorexia nervosa. Biol Psychiatry 29(Suppl 9A):56A (Abstract)
Savendhal L, Underwood LE (1997) Decreased interleukin-2 production from cultured peripheral blood mononuclear cells in human acute starvation. J Clin Endocrinol Metab 82:1177–1180
Shintani F, Kanba S, Nakaki T et al (1993) Interleukin-1 beta augments release of norepinephrine, dopamine, and serotonin in the rat anterior hypothalamus. J Neurosci 13:3574–3581
Smagin GN, Swiergiel AH, Dunn AJ (1996) Peripheral administration of interleukin-1 increases extracellular concentrations of norepinephrine in rat hypothalamus: comparison with plasma corticosterone. Psychoneuroendocrinology 21:83–93
McCarthy HD, Dryden S, Williams G (1995) Interleukin-1 beta induced anorexia and pyrexia in rats: relationship to hypothalamic neuropeptide Y. Am J Physiol 269:E852–E857
Reyes TM, Sawchenko PE (2000) Is the arcuate nucleus involved in cytokine-induced anorexia? Soc Neurosci Abstr 26:4413
Konsman JP, Dantzer R (2001) How the immune and nervous systems interact during disease-associated anorexia. Nutrition 17:664–668
Kahl KG, Kruse N, Rieekmann P, Schmidt MH (2004) Cytokine mRNA expression patterns in the disease course of female adolescents with anorexia nervosa. Psychoneuroendocrinology 29:13–20
Schattner A, Steinbock M, Tepper R, Schonfeld A, Vaisman N, Hahn T (1990) Tumour necrosis factor production and cell-mediated immunity in anorexia nervosa. Clin Exp Immunol 79:62–66
Vaisman N, Hahn T (1991) Tumor necrosis factor-α and anorexia-cause or effect? Metabolism 40:720–723
Dostálová I, Kaválková P, Papezová H, Domluvilová D, Zikán V, Haluzík M (2010) Association of macrophage inhibitory cytokine-1 with nutritional status, body composition and bone mineral density in patients with anorexia nervosa: the influence of partial realimentation. Nutr Metab (Lond) 23:7–34
Monteleone P, Di Lieto A, Tortorella A, Longobardi N, Maj M (2000) Circulating leptin in patients with anorexia nervosa, bulimia nervosa or binge eating disorder: relationship to body weight, eating patterns, psychopathology and endocrine changes. Psychiatry Res 94:121–129
Matarese G (2000) Leptin and the immune system: how nutritional status influences the immune response. Eur Cytokine Netw 11:7–13
Matarese G, Moschos S, Mantzoros CS (2005) Leptin in immunology. J Immunol 174(6):3137–3142
Loffreda S, Yang SQ, Lin HZ et al (1998) Leptin regulates proinflammatory immune responses. FASEB J 12:57–65
Fantuzzi G (2005) Adipose tissue, adipokines and inflammation. J Allergy Clin Immunol 115(5):911–919
Herpertz S, Norbert A, Richard W et al (2000) Longitudinal changes of circadian leptin, insulin and cortisol plasma levels and their correlation during refeeding in patients with anorexia nervosa. Eur J Endocrinol 142:373–379
Diez JJ, Iglesias P (2003) The role of the novel adipocyte-derived hormone adiponectin in human disease. Eur J Endocrinol 148:293–300
Yokota T, Oritani K, Takahashi I et al (2000) Adiponectin, a new member of the family of soluble defense collagens, negatively regulates the growth of myelomonocytic progenitors and the functions of macrophages. Blood 96:1723–1732
Brichard SM, Delporte ML, Lambert M (2003) Adipocytokines in anorexia nervosa: a review focusing on leptin and adiponectin. Horm Metab Res 35(6):337–342
Pannacciulli N, Vettor R, Milan G et al (2003) Anorexia nervosa is characterized by increased adiponectin plasma levels and reduced nonoxidative glucose metabolism. J Clin Endocrinol Metab 88:1748–1752
Iwahashi H, Funahashi T, Kurokawa N, Sayama K, Fukuda E, Okita K et al (2003) Plasma adiponectin levels in women with anorexia nervosa. Horm Metab Res 35:537–540
Tagami T, Satoh N, Usui T, Yamada K, Shimatsu A, Kuzuya H (2004) Adiponectin in anorexia nervosa and bulimia nervosa. J Clin Endocrinol Metab 89:1833–1837
Nogueira JP, Maraninchi M, Lorec AM, Corroller AB, Nicolay A, Gaudart J, Portugal H, Barone R, Vialettes B, Valéro R (2010) Specific adipocytokines profiles in patients with hyperactive and/or binge/purge form of anorexia nervosa. Eur J Clin Nutr 64(8):840–844
Patel L, Buckels AC, Kinghorn IJ et al (2003) Resistin is expressed in human macrophages and directly regulated by PPAR gamma activators. Biochem Biophys Res Commun 300(2):472–476
Dolezalova R, Lacinova Z, Dolinkova M, Kleiblova P, Haluzikova D, Housa D, Papezova H, Haluzik M (2007) Changes of endocrine function of adipose tissue in anorexia nervosa: comparison of circulating levels versus subcutaneous mRNA expression. Clin Endocrinol (Oxf) 67(5):674–678
Kim Y, Michael AF (1975) Hypocomplementemia in anorexia nervosa. J Pediatr 87(4):582–585
Pomeroy C, Mitchell J, Eckert E, Raymond N, Crosby R,Dalmasso AP (1997) Effect of body weight and caloric restriction on serum complement proteins, including Factor D/adipsin: studies in anorexia nervosa and obesity. Clin Exp Immunol 108:507–515
Nova E, Lopez-Vidriero I, Varela P, Toro O, Casas J, Marcos A (2004) Indicators of nutritional status in restricting-type anorexia nervosa patients. A one-year follow-up study. Clin Nutr 23:1353–1359
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Nova, E., Marcos, A. (2013). Nutritional Status and Immunocompetence in Eating Disorders. In: Strumia, R. (eds) Eating Disorders and the Skin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-29136-4_5
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