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Potassium and Anorexia

Potassium and Anorexia. Christina Ferraiuolo HLSC 415. Thesis Question. What is the association between potassium levels in the body and Anorexia Nervosa?. Ice Breaker. Take two What kind of micronutrient is potassium? What relationship would it have with the heart?

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Potassium and Anorexia

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  1. Potassium and Anorexia Christina Ferraiuolo HLSC 415

  2. Thesis Question What is the association between potassium levels in the body and Anorexia Nervosa?

  3. Ice Breaker Take two What kind of micronutrient is potassium? What relationship would it have with the heart? Do you think there is a connection between anorexia and potassium?

  4. Potassium • Potassium is a micronutrient and an electrolyte • Infant RDI 0.4 g/day • Children RDI 3-4 g/day • Adult RDI 4.7 g/day • Breastfeeding RDI 5.1 g/day (Zieve,2009)

  5. Potassium Sources • All meats and fish • Soy products • Fruits: cantaloupe, banana, kiwi, avocado • Vegetables: broccoli, sweet potato, and tomatoes • Milk and yogurt • Nuts(Zieve,2010)

  6. Hypokalemia and Hyperkalemia • Too little potassium in the body is called Hypokalemia • Too much potassium in the body is called Hyperkalemia(Zieve,2009)

  7. Anorexia • An eating disorder • Body Dimorphic • Obsession with weight and food • Starvation • Exercise excessively • Abuse laxatives and diuretics

  8. DSM IV TR Diagnostic Criteria for Anorexia • Intense fear of gaining weight • Distorted self image • Absence of menstrual cycle • Refusal to maintain body weight at healthy range (Dryden-Edwards, 2010)

  9. Anorexia complications • Death • Anemia • Bone loss • Kidney Problems • Brain damage • Heart failure or abnormal heart rhythm • Electrolyte abnormalities (Dryden-Edwards, 2010)

  10. Anorexia and Hypokalemia • Potassium is an electrolyte • Found in food sources • Anorexia patients lose potassium though weight regulation • Fatal electrical alterations of the heart

  11. Thesis Question What is the association between potassium levels in the body and Anorexia Nervosa?

  12. Effect of Weight-Regulating Practices on Potassium Level in Patients with Anorexia or Bulimia Nervosa Imbierowicz,K., Curkovic, I., Braks, K., Gesier, F., Liedtke, R., & Ernst Jacoby, G. (2004). Effects of weight-regulating practices on potassium levels in patients with anorexia or bulimia nervosa. European Eating Disorders Review, 12(5), 300-306. doi: 10.1002/erv.591.

  13. Purpose • To define several diagnostic and symptomatic groups and test them separately for their potassium levels • Anorexia with vomiting • Anorexia with vomiting and laxative abuse • Anorexia without vomiting

  14. Research Design • Descriptive Epidemiological • Cross sectional survey • Examining causal factors associated with different anorexia and bulimic groups with Hypokalemia • Retrospective study

  15. Methods • 397 patients with preexisting eating disorder • Klinik am Korso in Bad Oeynhausen, Germany • Subgroups based on complete symptomatology • Similarities in BMI, age, disease duration • Hypokalemic: < 3.4 mmol/l plasma potassium

  16. Identification of Statistics • Descriptive • Inferential • Correlation tests

  17. Descriptive Statistics • Standard Deviation • Mean • Range • Median

  18. Inferential Statistics • Mann-Whitney U test • Kruskal-Wallis test • Analysis of Variance test (ANOVA) • Post-hoc test (Scheffe’)

  19. Correlation tests • Pearson’s two-tailed testing • Spearman’s correlation testing • Multiple linear regression • Stepwise Linear Regression (R2) • Standardized regression coefficient • Coefficient of determination

  20. Interpretation of Results • Hypokalemia in purging anorexic (p = 0.001) • Hypokalemia in non-purging anorexic (p=0.82) • Higher frequency (p = 0.001) • Severity (p = 0.001) • Differences between anorexic subgroups (p = 0.001)

  21. Results continued • Potassium levels and BMI (r) 0.27 (p=0.001) • Vomiting frequency, laxative abuse and potassium levels (r) -0.38 (p = 0.005) • Mean potassium 2.8 mmol/l

  22. Table 2. Potassium levels and hypokalemia proportion in the subgroups

  23. Weaknesses of the Study • Number of participants • Internal Validity • Recall bias • Selection bias • Confounding variables

  24. Strengths of the Study • Organization • External Validity • Results represent an entire population

  25. Conclusion • Hypokalemia more common in binging and purging anorexics • Potassium losses through stool, urine and vomit • Possibly other factors associated with potassium loss not tested

  26. Thesis Question What is the association between potassium levels in the body and Anorexia Nervosa?

  27. Effects of Anorexia Nervosa on Clinical, Hematological, Biochemical, and Bone Density Parameters in Community-Dwelling Adolescent Girls Mirsa, M., Aggarwal, A., Miller, K., Almazan, C., Worley, M., Soyka, L., et al. (2004). Effects of anorexia nervosa on clinical, hematological, biochemical, and bone density parameters in community-dwelling adolescent girls. Pediatrics, 114(6), 1574-1583. doi:10.1542/peds.2004-0540.

  28. Purpose • To determine the medical effects of anorexia on a young population in terms of normal body function

  29. Research Design • Descriptive Epidemiological study • Cross sectional • Prospective • Community dwelling adolescent girls • Anorexia with outpatient care vs. healthy adolescents • 118 adolescent girls • 60 with DSM IV diagnosed anorexia • 58 healthy- no past history of eating disorder

  30. Methods • Referred by treatment programs in Boston, MA • Prospective data collection at baseline visit • Three month or more community dwelling • Biochemical • Potassium levels • Anthropometric • BMI

  31. Identification of Statistics • Descriptive statistics • Inferential statistics

  32. Descriptive Statistics • Mean • Standard Deviation

  33. Inferential Statistics • T-test • Univariate regression analysis • Correlation between variables • Stepwise regression analysis • Significant predictors

  34. Interpretation of Results • Mean serum potassium levels higher in anorexic • AN: 3.8 +/- 0.3 mmol/l • Healthy: 3.6 +/- 0.2 mmol/l • no subject Hypokalemic • Serum potassium< 3.0 mmol/l • Two subjects with history of purging behavior

  35. Weaknesses of the Study • Weakness in planning • No hypothesis stated • Limited external validity

  36. Strengths of the Study • Comparability to the control and observed group • Diverse referrals decrease selection bias • Limited external validity • Caucasian Adolescent female specific

  37. Conclusion • Normal serum potassium levels • Higher in anorexic • Due to dehydration • Total potassium levels may still be low • Not at risk even with low BMI • Still at risk for cardiac abnormalities • No purging behaviors observed

  38. Thesis Question What is the association between potassium levels in the body and Anorexia Nervosa?

  39. Overall Conclusion • Potassium levels are influenced by Anorexia • Both suggested potential cardiac risk • Differences in studies • Set potassium level as Hypokalemic • Population studied

  40. Did I answer my question? • Yes! • Both saw changes in extracellular potassium in the Anorexic populations

  41. Future Direction • More research in diverse groups • Identify relationship of purging and potassium levels • Identify other variables not accounted for • Measuring total potassium vs. only plasma

  42. Questions?

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