Plasma total-homocysteine in anorexia nervosa D Moyano 1 , MA Vilaseca 1 . R Artuch 1 , C Valls 1 and N Lambruschini 2 1 Serveis de Bioquõ Âmica i, 2 Pediatria, Hospital Universitari Sant Joan de De Âu, Barcelona, Spain Objective: The measurement of plasma total-homocysteine (tHcy) as a marker of folate and cobalamin status in patients with anorexia nervosa. Design: Plasma tHcy, folate, cobalamin and other determinats of tHcy of a random group of patients with anorexia nervosa were compared with our own reference values. Setting: The study was performed at the tertiary children's Hospital Sant Joan de De Âu. Sujects: All the female adolescents (n  43) coming to the Hospital during a one-year period, who were diagnosed with anorexia nervosa. Reference values for tHcy were simultaneously performed with apparently healthy adolescents (by history and analytical data) who underwent presurgical analysis for minor interventions, and other magnitudes we used our own reference values. Interventions: Plasma tHcy was measured by reverse fase HPLC with ¯uorescence detection of the SBDF derivatives. Folate and cobalamin concentrations were determined by radioimmunoassay. Results: tHcy was signi®cantly increased in anorexic patients compared to reference values (Mann±Whitney, P < 0.0001±0.001). Values were above reference range in 34% of patients, and high-normal range in 53% of patients. tHcy concentrations lowered in 8 and 11 patients after nutritional rehabilitation. Cobalamin and folate were in the reference range except for one case. No signi®cant correlation was found among tHcy, vitamins and other determinants of tHcy concentration. Conclusions: tHcy concentrations appear signi®cantly increased in adolescents with anorexia nervosa, most probably owing to subclinical folate de®ciency. This might be caused by both, intracellular folate de®ciency and impaired availability. Abnormal plasma tHcy values were completely corrected after nutritional rehabilitation. Sponsorship: D Moyano was the recipient of a grant from Hospital Sant Joan de De Âu, Barcelona. Descriptors: Anorexia nervosa; folate; cobalamin; total-homocysteine; malnutrition Introduction Anorexia nervosa is a severe nutritional disorder, affecting mostly female adolescents, characterized by excessive food restriction that results in a marked loss of weight. Although diets (self-designed and strictly controlled by the anorectic patients) are not uniform, as is the case of macrobiotic nutrition (Schneede et al, 1994), the experience of several groups conclude that there is a general trend to a marasmic malnutrition in anorexia nervosa (Madruga et al, 1993; Nussbaum, 1992). Therefore, either protein and energy, as well as micronutrients may result defective in this condi- tion. However, in spite of being a severe eating disorder, it is associated with rather mild abnormalities in the classical parameters of malnutrition (Schebendach et al, 1992; Nussbaum, 1992). Studies of biochemical data on vitamin and mineral status found in the literature are fragmentary and contradictory and most often reported for adults, however, subclinical vitamin de®ciencies might be consid- ered in this disorder (Fisher et al, 1995). The search for new diagnostic tools to detect the defective dietary components of diet may help to apply the adequate treatment that avoids the neurologic sequelae involved in these vitamin de®cien- cies (Carmel, 1989). Folate and cobalamin (as methylcobalamin) are involved as substrate and coenzyme, respectively, in the remethylation of homocysteine to methionine. Plasma total homocysteine (tHcy), the sum of all the homocysteine species that release this amino acid by reduction, increases considerably when there is an intracellular de®ciency of folate or cobalamin (Ueland et al, 1993). Our aim in this study was the detection of possible de®ciencies of folate and cobalamin in anorexia nervosa by the measurement of plasma tHcy. Cobalamin and folate concentrations as well as other tHcy determinants (Refsum et al, 1997) were also determined in an attempt to ®nd a relationship with tHcy values. Materials and methods Subjects The female adolescents (n  43) coming to the Department of Pediatrics of our hospital during a one-year period, who were diagnosed of anorexia nervosa according to the criteria of the American Psychiatric Association (1994). They were analysed at diagnosis as a part of the biochem- ical evaluation of their nutritional status. Body mass index (BMI) calculated as weight divided by the square of height (kg=m 2 ) was 17 (12±19) (median (range); normal popula- tion > 20). Renal function was normal in all the patients. Reference values for tHcy were simultaneously performed with apparently healthy adolescents (by history and analy- tical data) who underwent presurgical analysis for minor interventions (n  90). For the other biochemical and hematological magnitudes we used our own age-matched reference values. Blood was collected again in a group of 11 patients after six months of nutritional rehabilitation without special vitamin supplementation. Samples of patients and controls used for reference values were Correspondence: Dr MA Vilaseca, Servei de Bioquõ Âmica, Hospital Universitari Sant Joan de De Âu, P. Sant Joan de De Âu 2, 08950 Esplugues (Barcelona), Spain. Received 4 April 1997; revised 29 August 1997; accepted 5 October 1997 European Journal of Clinical Nutrition (1998) 52, 172±175 ß 1998 Stockton Press. All rights reserved 0954±3007/98 $12.00