Gli Azzardi della Bulimia

COMMENTI A LATERE DI UN CASO CLINICO

A COSA SERVE IL MEDICO

DATI ANAGRAFICI E ANTROPOMETRICI ETA’ al momento della richiesta di consulenza : 14 7/12 anniPESO Kg 63,2 ; ALTEZZA cm 166; BMI 22,8Frequenza scolastica :1° anno Liceo Linguistico

Ad anni 13 10/12 Chiara pesa 84 kg, è alta 165 cm e il BMI 30,88 ( >97°pc)A questa età inizia una “dieta autogestita” associata ad intensificazione dell’attività fisica a cui segue un calo ponderale significativo e rinforzato da parenti ed amici. Dopo 5 mesi di restrizione alimentare e un calo di circa 20 Kg compare amenorrea, nonostante presenti ancora un BMI nella norma.

Non vorrebbe superare le 800 calorie al giorno

Amenorrea

Diradamento del capillizio

Elementi di valutazione

Intake nutrizionale rilevato da diario di autosservazione

0

200

400

600

800

1000

1200

1400

1600

1800

2000

04-giu 05-giu 06-giu 07-giu 08-giu 09-giu 10-giu 11-giu 12-giu Media

236

653 649

536

206

353

225

525

349415

152

176 152424

88

100300

60

128

176288

486

279

252

108

126

324162

306

259

Intake calorico giornaliero

Gluc.Kcal Prot. Kcal Lip. Kcal

FT3. FT4, TSH

FSH,LH

Estradiolo

Progesterone

FT3. FT4, TSH

FSH,LH

Estradiolo

Progesterone

FT3. FT4, TSH

FSH,LH

Estradiolo

Progesterone

Esami clinici con alterazioni

Ft3LH, fshEstradioloProgesteroneVitamina D

Esercizio Fisico giornaliero aerobico

2 Facce di uno stesso problema

Anoressia Bulimia

E un incrocio di situazioni patologiche

Restrizione+

Comportamento bulimicoIn questo caso

Esercizio fisico compulsivo

Effetti cutanei indotti da AN/BN

DigiunoMalnutrizioneCon BMI<15/16

Alopecia androgenetica

Inflammatory cytokines and anorexia nervosa: A meta-analysis of cross-sectional and longitudinal studies

Marco Solmia, Nicola Veronese, Angela Favaro,Paolo Santonastaso, Enzo Manzato, Giuseppe Sergi,Christoph U. Correll

Department of Neurosciences, University of Padova, Padova, Italy, Department of Medicine—–DIMED, Geriatrics Section, University of Padova, Zucker Hillside Hospital, Psychiatry Research, NorthShore—–Long Island JewishHealth System, GlenOaks, NY, USAdHofstra North Shore LIJ School of Medicine, Hempstead, NY, USAeThe Feinstein Institute for Medical Research, Manhasset, NY, USAfAlbert Einstein College of Medicine, Bronx, NY, USA

Psychoneuroendocrinology (2015) 51, 237—252

…Continua

� Inflammation could at least partially account for the decreased appetite in anorexiapatients, since an interaction between these cytokines and neuropeptides mediatinghunger and satiety has been described (Wallenius et al., 2002; Inui, 2001; Nakai et al., 1999; Wisse et al., 2003).

� it is also conceivable that increased inflammation due to the psychological stress and hypercortisolemia (Misra and Klibanski, 2014) or other factors associated with AN can lead to weight loss and that an improvement in the inflammatory status may make weight gain more likely.

� Finally, inflammation can be associated with depression, which is an important comorbidity in AN (Hughes et al., 2013). Since anorexia is a symptom of depression, the association between AN and depression could partially explain why patients with AN can resist extreme starvation.

Elementi pro infiammatori in questo casoEsercizio fisico compulsivo“During physical exercise, inflammatory status is elevated due to muscle productionof pro-inflammatory cytokines, which promote fatty acid mobilization from adiposetissue to meet the muscle energy demand…”Rev Endocr Metab Disord. 2015 Mar;16(1):47-54. doi: 10.1007/s11154-014-9306-8

Malnutrizione

Deficit Vitamina DStudies have also shown that T cell proliferation and function is inhibited in response to 1,25(OH)2D3

(calcitriol) by a reduction in IL-2 production. T cells treated directly with calcitriolor its analogues had decreased expression (in the absence of antigen-presenting cells) of Th1 (IL-2, TNF-α, IFN-γ),Th9 (IL-9) and Th22 (IL-22) cytokines , but increased production of anti-inflammatory Th2 cytokines (IL-3, IL-4, IL-5, IL-10) . While the immunosuppressive effects of vitamin D on Th1 cells are clear, the effects of vitamin D on Th2 cytokine expression are contradictory and yet to be clarified

Nutrients 2015,7, 6088-6108; doi:10.3390/nu7085271World J Gastroenterol. 2016 Jan 21;22(3):933-48. doi: 10.3748/wjg.v22.i3.933Nutr Metab Insights. 2016 Feb 1;8(Suppl 1):11-21. doi: 10.4137/NMI.S29526. eCollection 2015.

Alterazioni del microbiota intestinale?

Gut Dysbiosis in Patients withAnorexia NervosaChihiro Morita, Hirokazu Tsuji, Tomokazu Hata,1 Motoharu Gondo, Shu Takakura, Keisuke Kawai, KazufumiYoshihara, Kiyohito Ogata, Koji Nomoto, Kouji Miyazaki, and Nobuyuki SudoJan S Suchodolski, Editor

PLoS One. 2015; 10(12): e0145274. Published online 2015 Dec 18. doi: 10.1371/journal.pone.0145274

In the current study, AN patients had significantly lower amounts of total bacteria, C. coccoides group, C. leptum subgroup, B. fragilis, and Streptococcus than age-matched healthy women. In addition, acetic acid and propionic acid levels were significantly lower in the AN group than in the control group. The detection rate of the Lactobacillus plantarum subgroup was also significantly lower in the AN group than in the control group.

In the AN subtype analysis, the counts of the Bacteroides fragilis group in both the ANR and ANBP groups and the counts of the Clostridiumcoccoides in the ANR group were significantly lower than those in the control group.The PCA results showed that the patterns of gut microbiota in the AN group were different from those in the control group. Collectively, these results indicate that microbial imbalancei.e. dysbiosis, does exist in the gut of AN patients.

Ricolonizzazione intestinale

� Saccaromices cervisiae sub.boulardii

� Enterococco fecium

� Bifidobacterium bifidus

breve

lactis

lactis infantis

� lactobacillus rhamnosus

� lactobacillus acidophilus

15 giorni

15 giorni

15 giorni