Liver Function Tests and Complete Blood Counts Among Adolescents With Restrictive Eating Disorders: What Are the Differences?

PURPOSE: Anorexia nervosa (AN) has been associated with abnormal liver function tests (LFTs) and hematologic tests; less is known about similar associations with avoidant/restrictive food intake disorder (ARFID). We explored associations between the diagnosis of AN versus ARFID and liver function tests and complete blood counts.

METHODS

Data from adolescent patients presenting to a disordered eating program in a southwestern state from 2013 to 2023 were examined for associations between alanine aminotransferase, aspartate aminotransferase (AST), lipase, hemoglobin (Hgb), platelet count (PLT), and white blood cell count (WBC) and diagnostic category, body mass index (BMI), age of diagnosis, illness duration, and calorie-dense food intake. Chi-square tests, generalized linear models, and logistic regression analyses were conducted.

RESULTS

Patients with AN (n = 123) and ARFID (n = 100) did not differ statistically on % median BMI for age (%mBMI; means, standard deviations (SDs) 83.0 (11.6) versus 83.1 (21.2), respectively; 95% confidence interval (CI) [-4.4, 4.5], p = 0.98). Patients with AN had higher mean alanine aminotransferase than those with ARFID (26.0 (22.5) versus 17.7 (13.6) U/L; 95% CI [2.1, 14.3], p = 0.009). Mean WBC and PLT were higher in patients with ARFID (WBC, 7.2 cells/mL (2.2); PLT, 259.7 mcL (57.6)) versus AN (WBC, 5.7 (1.8), mean difference 95% CI [0.9, 2.1], p <0 .001; PLT, 234.7 (58.3), 95% CI [6.4, 43.5], p = 0.009). Reported calorie-dense food consumption was associated with higher WBC and PLT levels; the ARFID group had higher levels compared to AN.

DISCUSSION: These findings indicate differences in alanine aminotransferase, WBC, and PLT for patients of similar %mBMI presenting with AN versus ARFID. Studies comparing macronutrient intake are warranted to further characterize the differences in laboratory results.