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Decreased glutathione in patients with anorexia nervosa. Risk factor for toxic liver injury?

European Journal of Clinical Nutrition volume 58, pages 238–243 (2004)Cite this article

Abstract

Objective: To investigate glutathione and amino acids related to glutathione metabolism in patients with anorexia nervosa in order to test the hypothesis that these patients exhibit a deficiency of glutathione and therefore might be at an increased risk of developing toxic liver injury.

Design: Controlled observatory study and case report.

Setting: University Hospital.

Subjects: Subjects included 11 female patients with anorexia nervosa and 12 healthy female controls.

Interventions: Determination of fasting free and total glutathione, homocysteine, vitamins B6 and B12 and folic acid in plasma.

Results: A 14-y-old patient with a body mass index of 12.6 kg/m2 presented with markedly elevated transaminases (ALAT >50 × upper limit of normal), and paracetamol was detected in her blood. Patients with anorexia nervosa exhibited lower circulating concentrations of free cysteine (8.9±1.5 vs 12.0±1.4 μmol/l) and free and total glutathione (5.0±1.3 vs 7.1±1.2 and 11.2±3.8 vs 16.2±5.0 μmol/l, respectively). The plasma concentrations of homocysteine (17.5±4.9 vs 12.0±3.8 μmol/l) and also of glycine (194±37 vs 143±41 μmol/l) and glutamine (422±51 vs 353±51 μmol/l) were significantly higher in patients with anorexia nervosa who were not deficient in folic acid, vitamin B6 and B12.

Conclusions: Lower plasma concentrations of glutathione suggest lower intracellular concentrations of the tripeptide. Higher homocysteine, glycine and glutamine concentrations point to a decreased utilization of these amino acids for glutathione synthesis and an impairment of trans-sulfuration. Consequently, the capacity of patients with anorexia nervosa to detoxify electrophilic metabolites and reactive oxygen species via glutathione may be impaired.

Sponsorship: Supported by Grant 32-52608.97 from the Swiss National Foundation for Scientific Research.

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Authors and Affiliations

  1. Department of Clinical Pharmacology, University of Bern, Switzerland

    F Zenger, S Russmann, E Junker & B H Lauterburg

  2. Department of Pediatrics, University of Bern, Switzerland

    C Wüthrich

  3. Swiss Vitamin Institute, Epalinges, Switzerland

    M H Bui

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  1. F Zenger
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  2. S Russmann
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  3. E Junker
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  4. C Wüthrich
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  5. M H Bui
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  6. B H Lauterburg
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Correspondence to B H Lauterburg.

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Zenger, F., Russmann, S., Junker, E. et al. Decreased glutathione in patients with anorexia nervosa. Risk factor for toxic liver injury?. Eur J Clin Nutr 58, 238–243 (2004). https://doi.org/10.1038/sj.ejcn.1601772

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