Plasma total-homocysteine in anorexia nervosa

Objective: The measurement of plasma total-homocysteine (tHcy) as a marker of folate and cobalamin status in patients with anorexia nervosa. Design: Plasma tHcy, folate, cobalamin and other determinats of tHcy of a random group of patients with anorexia nervosa were compared with our own reference values. Setting: The study was performed at the tertiary children's Hospital Sant Joan de Deu. Subjects: All the female adolescents (n=43) coming to the Hospital during a one-year period, who were diagnosed with anorexia nervosa. Reference values for tHcy were simultaneously performed with apparently healthy adolescents (by history and analytical data) who underwent presurgical analysis for minor interventions, and other magnitudes we used our own reference values. Interventions: Plasma tHcy was measured by reverse fase HPLC with fluorescence detection of the SBDF derivatives, Folate and cobalamin concentrations were determined by radioimmunoassay. Results: tHcy was significantly increased in anorexic patients compared to reference values (Mann-Whitney, P < 0.0001-0.001). Values were above reference range in 34% of patients, and high-normal range in 53% of patients. tHcy concentrations lowered in 8 and 11 patients after nutritional rehabilitation. Cobalamin and folate were in the reference range except for one case. No significant correlation was found among tHcy, vitamins and other determinants of tHcy concentration. Conclusions: tHcy concentrations appear significantly increased in adolescents with anorexia nervosa, most probably owing to subclinical folate deficiency. This might be caused by both, intracellular folate deficiency and impaired availability. Abnormal plasma tHcy values were completely corrected after nutritional rehabilitation.