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 ID: 658624
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Slide1
Potassium and Anorexia
Christina FerraiuoloHLSC 415Slide2
Thesis Question
What is the association between potassium levels in the body and Anorexia Nervosa?Slide3
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?Slide4
Potassium
Potassium is a micronutrient and an electrolyte
Infant RDI 0.4 g/dayChildren RDI 3-4 g/dayAdult RDI 4.7 g/dayBreastfeeding RDI 5.1 g/day
(Zieve,2009)Slide5
Potassium Sources
All meats and fishSoy productsFruits: cantaloupe, banana, kiwi, avocado
Vegetables: broccoli, sweet potato, and tomatoesMilk and yogurtNuts (Zieve,2010)Slide6
Hypokalemia
and Hyperkalemia
Too little potassium in the body is called HypokalemiaToo much potassium in the body is called
Hyperkalemia
(Zieve,2009)Slide7
Anorexia
An eating disorder Body DimorphicObsession with weight and food
StarvationExercise excessively Abuse laxatives and diureticsSlide8
DSM IV TR Diagnostic Criteria for Anorexia
Intense fear of gaining weight
Distorted self imageAbsence of menstrual cycleRefusal to maintain body weight at healthy range
(Dryden-Edwards, 2010)Slide9
Anorexia complications
DeathAnemiaBone loss
Kidney ProblemsBrain damageHeart failure or abnormal heart rhythmElectrolyte abnormalities (Dryden-Edwards, 2010)Slide10
Anorexia and Hypokalemia
Potassium is an electrolyte
Found in food sourcesAnorexia patients lose potassium though weight regulationFatal electrical alterations of the heartSlide11
Thesis Question
What is the association between potassium levels in the body and Anorexia Nervosa?Slide12
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.Slide13
Purpose
To define several diagnostic and symptomatic groups and test them separately for their potassium levels
Anorexia with vomitingAnorexia with vomiting and laxative abuseAnorexia without vomiting Slide14
Research Design
Descriptive EpidemiologicalCross sectional survey
Examining causal factors associated with different anorexia and bulimic groups with HypokalemiaRetrospective studySlide15
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 potassiumSlide16Slide17
Identification of Statistics
DescriptiveInferentialCorrelation testsSlide18
Descriptive Statistics
Standard DeviationMeanRange
MedianSlide19
Inferential Statistics
Mann-Whitney U testKruskal-Wallis test
Analysis of Variance test (ANOVA)Post-hoc test (Scheffe’)Slide20
Correlation tests
Pearson’s two-tailed testing Spearman’s correlation testing
Multiple linear regressionStepwise Linear Regression (R2)Standardized regression coefficient Coefficient of determination Slide21
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
)Slide22
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/lSlide23
Table 2. Potassium levels and
hypokalemia
proportion in the subgroups Slide24
Weaknesses of the Study
Number of participantsInternal Validity
Recall biasSelection biasConfounding variablesSlide25
Strengths of the Study
OrganizationExternal ValidityResults represent an entire populationSlide26
Conclusion
Hypokalemia more common in binging and purging anorexics
Potassium losses through stool, urine and vomitPossibly other factors associated with potassium loss not tested Slide27
Thesis Question
What is the association between potassium levels in the body and Anorexia Nervosa?Slide28
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.Slide29
Purpose
To determine the medical effects of anorexia on a young population in terms of normal body functionSlide30
Research Design
Descriptive Epidemiological studyCross
sectionalProspective Community dwelling adolescent girlsAnorexia with outpatient care vs. healthy adolescents
118 adolescent girls
60 with DSM IV diagnosed anorexia
58 healthy- no past history of eating disorderSlide31
Methods
Referred by treatment programs in Boston, MA
Prospective data collection at baseline visitThree month or more community dwellingBiochemicalPotassium levelsAnthropometric
BMISlide32
Identification of Statistics
Descriptive statisticsInferential statisticsSlide33
Descriptive Statistics
Mean Standard DeviationSlide34
Inferential Statistics
T-testUnivariate regression analysis
Correlation between variablesStepwise regression analysisSignificant predictorsSlide35
Interpretation of Results
Mean serum potassium levels higher in anorexicAN: 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 behaviorSlide36
Weaknesses of the Study
Weakness in planningNo hypothesis statedLimited external validitySlide37
Strengths of the Study
Comparability to the control and observed groupDiverse referrals decrease selection bias
Limited external validityCaucasian Adolescent female specificSlide38
Conclusion
Normal serum potassium levelsHigher in anorexic
Due to dehydrationTotal potassium levels may still be lowNot at risk even with low BMIStill at risk for cardiac abnormalities
No purging behaviors observedSlide39
Thesis Question
What is the association between potassium levels in the body and Anorexia Nervosa?Slide40
Overall Conclusion
Potassium levels are influenced by AnorexiaBoth suggested potential cardiac risk
Differences in studiesSet potassium level as HypokalemicPopulation studiedSlide41
Did I answer my question?
Yes!Both saw changes in extracellular potassium in the Anorexic populationsSlide42
Future Direction
More research in diverse groups
Identify relationship of purging and potassium levels Identify other variables not accounted forMeasuring total potassium vs. only plasmaSlide43
Questions?