Background. Patients with anorexia nervosa (AN) run a
high risk of becoming chronically ill and of dying. In the acute phase
of their illness they present with numerous physical and laboratory
abnormalities. However, little is known about the long-term prognostic
value of these findings or about the medical morbidity in large
samples of consecutively treated patients in the long-term.
Methods. We evaluated 84 consecutive female patients with
AN who were studied again an average of 11·9 years later. The
ability of some of the laboratory data obtained at the initial
examination to predict a fatal or chronic course was analysed by
discriminant and multiple regression analyses.
Results. Abnormally low serum albumin levels ([les ] 36
g/l) and a low weight ([les ] 60% of average body weight) at the
initial examination were variables best able to predict a lethal
course. In addition, high serum creatinine and uric acid levels
predicted a chronic course. Most of the initial abnormal laboratory
findings were reversible with a normal food intake. At a 12-year
follow-up 67% of the chronic anorexic patients and 27% of those in the
good/intermediate outcome group (compared to 8% morbidity in
normal controls) presented with medical co-morbidity, in particular
osteoporosis and renal disease. The standardized mortality ratio was
9·6.
Conclusions. Laboratory findings obtained at the initial
examination may be helpful in predicting a fatal or chronic course of
AN. An evaluation of the long-term outcome of eating disorders should
include an assessment of the medical co-morbidity.