Purpose: Although atypical anorexia nervosa (AAN) is as common as anorexia nervosa (AN) it is often underrecognized due to normal or above-normal weight at presentation. We aimed to compare disease characteristics between adolescents with AN and AAN using a comprehensive panel of anthropometric, vital-sign, biochemical, and clinical variables. Methods: A retrospective chart review was performed for adolescents aged 12–18 years diagnosed with AN and AAN according to DSM-5 criteria. Anthropometric, vital-sign, and laboratory measurements, and hospitalization data at presentation were recorded. The weight loss percentage and rate, and vital instability data were categorized using the SAHM 2022 guideline.Results: Of 230 adolescents, 82 had AN (35.7%) and 148 had AAN (64.3%). No significant differences were found in terms of weight loss percentage (p = 0.453) or rate (p = 0.348). While the hypotension (p < 0.001) and hypothermia (p = 0.017) rates were significantly higher in AN, bradycardia and orthostatic changes did not differ. AN showed higher rates of elevated creatinine (p = 0.006), hyponatremia (p = 0.006), hypokalemia (p = 0.017), and hypercholesterolemia (p = 0.003), and hypogonadism (p < 0.001). Other laboratory abnormalities did not differ between the two groups. Hospitalization rates and time for vital instability recovery were similar between AN and AAN. However, adolescents with AN were eight-fold more likely to experience refeeding syndrome (p = 0.002). Conclusion: While adolescents with AN demonstrate more overt physiological compromise, those with AAN demonstrated comparably significant medical severity. These findings underscore that body weight alone is a misleading indicator of disease severity. Reducing weight bias and improving clinician awareness are critical to ensure timely recognition and care for AAN.<Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> What is known: • Anorexia nervosa is a life-threatening disease characterized by pronounced weight loss and substantial multisystem medical risk. • Anorexia nervosa is a life-threatening disease characterized by pronounced weight loss and substantial multisystem medical risk. • Atypical AN can show medical instability comparable to AN; weight loss percentage and rate predict risk beyond body mass index. </entry> </row> <row> <entry align="left" colname="c1"> What is new: • Our study highlights the cross-cultural similarity of AN and AAN. Although AN presents more profound multisystem issues, AAN is comparable to AN regarding vital signs, laboratory measurements, hospitalization, and endocrine dysfunction. </entry> </row> </tbody> </tgroup> </Table>

Comparison of disease severity in adolescents with anorexia nervosa and atypical anorexia nervosa

期刊论文
发表日期：

2025年11月13日

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Eylem Şerife Kalkan,
Sinem Akgül,
Ayşe Bilge Baklacı,
Yelda Kılıç,
Melis Pehlivantürk Kızılkan

摘要

Purpose: Although atypical anorexia nervosa (AAN) is as common as anorexia nervosa (AN) it is often underrecognized due to normal or above-normal weight at presentation. We aimed to compare disease characteristics between adolescents with AN and AAN using a comprehensive panel of anthropometric, vital-sign, biochemical, and clinical variables. Methods: A retrospective chart review was performed for adolescents aged 12–18 years diagnosed with AN and AAN according to DSM-5 criteria. Anthropometric, vital-sign, and laboratory measurements, and hospitalization data at presentation were recorded. The weight loss percentage and rate, and vital instability data were categorized using the SAHM 2022 guideline.Results: Of 230 adolescents, 82 had AN (35.7%) and 148 had AAN (64.3%). No significant differences were found in terms of weight loss percentage (p = 0.453) or rate (p = 0.348). While the hypotension (p < 0.001) and hypothermia (p = 0.017) rates were significantly higher in AN, bradycardia and orthostatic changes did not differ. AN showed higher rates of elevated creatinine (p = 0.006), hyponatremia (p = 0.006), hypokalemia (p = 0.017), and hypercholesterolemia (p = 0.003), and hypogonadism (p < 0.001). Other laboratory abnormalities did not differ between the two groups. Hospitalization rates and time for vital instability recovery were similar between AN and AAN. However, adolescents with AN were eight-fold more likely to experience refeeding syndrome (p = 0.002). Conclusion: While adolescents with AN demonstrate more overt physiological compromise, those with AAN demonstrated comparably significant medical severity. These findings underscore that body weight alone is a misleading indicator of disease severity. Reducing weight bias and improving clinician awareness are critical to ensure timely recognition and care for AAN.

What is known:

• Anorexia nervosa is a life-threatening disease characterized by pronounced weight loss and substantial multisystem medical risk.

• Atypical AN can show medical instability comparable to AN; weight loss percentage and rate predict risk beyond body mass index.

What is new:

• Our study highlights the cross-cultural similarity of AN and AAN. Although AN presents more profound multisystem issues, AAN is comparable to AN regarding vital signs, laboratory measurements, hospitalization, and endocrine dysfunction.