Plasma cholesterol and endogenous cholesterol synthesis during refeeding in anorexia nervosa

Normal or high levels of cholesterol have been measured in patients with an orexia nervosa (AN). Given that cholesterol intake in AN is usually very lo w, the reasons for this anomaly are not clearly understood. We studied lipi d and lipoprotein profiles and endogenous cholesterol synthesis, estimated by serum lathosterol, in a population of 14 girls with AN, before and durin g a period of 30 days refeeding. The initial body mass index (BMI) of the p atients was 13.41+/-1.62 kg/m(2). No changes were observed during refeeding in endocrine parameters (ACTH, cortisol and estradiol). At Day 0 the lipid s data measured here showed normal levels of triglycerides, and total chole sterol at the upper limits of the normal range (5.44+/-1 mmol/l). At this t ime, total and LDL cholesterol were negatively correlated with transthyreti n and BMI. Serum lathosterol (a precursor in cholesterol synthesis pathway) increased significantly (5.99+/-1.75 (Day 0) vs. 8.39+/-2.96 (Day 30); P = 0.02) while there was a significant decrease in apo B (0.79+/-0.33 (Day 0) vs. 0.60+/-0.17 g/l (Day 30), P = 0.02) with refeeding. Thus, patients wit h initial high cholesterol levels have the worst nutritional status and hig h cholesterol levels are not related to a de novo synthesis. This profile r eturns to normal with refeeding. An increase of cellular cholesterol uptake may be responsible for this apparently paradoxical evolution with increase of cholesterol synthesis and decrease of apo B during renutrition. (C) 200 0 Elsevier Science B.V. All rights reserved.