Acta Pzdiatr Scand 67: 225-228, 1978
LIME3 CIRCULATION IN ANOREXIA NERVOSA U. FREYSCHUSS,’ L. FOHLIN and C. THOREN From the Department of Clinical Physiology, Karolinska Sjukhuset and the Department of Paediatrics, St. Goran’s Children’s Hospital, Karolinska Institutet, Stockholm, Sweden
ABSTRACT. Freyschuss, U., Fohlin, L. and Tboren, C. (Departments of Clinical Physiology, Karolinska Hospital and Paediatrics, St. Goran’s Hospital, Karolinska Institutet, Stockholm, Sweden). Limb circulation in anorexia nervosa. Acta Paediatr Scand, 67: 225, 1978.-Blood flow, skin temperature and blood pressure of the lower limbs and the effect of indirect, radiant heat on calf blood flow and leg skin temperature was determined in sixteen children with anorexia nervosa (group A) and fourteen healthy children (group H) of the same age and body height. Calf blood flow was measured by venous occlusion plethysmography. Arm blood pressure was obtained by tourniquet and toe pressure and digital plethysmograms by a strain-gauge. Skin temperature was measured with a thermocouple. In group A calf blood flow was about 5&60% lower than the mean values observed in group H and a marked difference was maintained after the heat load. Skin temperature of the knees and toes were higher in group H. Systolic arm blood pressure and toe pressure were on the average 20 mmHg and 13 mmHg lower in group A. It is suggested that there is a heat-conserving, selective peripheral vasoconstriction in the anorexic patients.
KEY WORDS: Anorexia nervosa, peripheral circulation, occlusion pletbysmography, healthy school children, blood pressure, temperature regulation, digital plethysmography
It is well known that patients with anorexia nervosa (AN) often complain of cold hands and feet (2). The thermoregulation has been reported altered in AN (7, 9, 12) and in a previous study of the thermal responses to exercise of a group of AN patients (3) it was noted that though core temperature rose normally in a thermal neutral environment during work there was some evidence of peripheral vasoconstriction. It was concluded that the patients attempt to limit the size of the body core in order to conserve body heat by maintaining active vasoconstrictor tone in the extremities. Under these conditions heat can be exchanged by a “counter current” mechanism since blood is diverted from the superficial to deep veins which lie in close proximity to the arteries (10). If this theory is correct and anorexia pa-
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’ Present address: Department of Clinical Physiology, Serafimerlasarettet, Karolinska Institutet, Stockholm, Sweden. 15-112a12
tients adapt to their condition, one might expect peripheral blood flow to the limbs to be decreased at rest and show a reduced response to localised heating. A selective control of peripheral blood flow was suggested to occur for the compensation of the decreased thermal insulation due to the loss of body fat. Wakeling & Russel (12) showed that the oral and finger temperatures of eleven girls with AN responded slowly to localised heat stress imposed by placing the arm up to the elbow in water at 45°C. In order to study this problem further we have investigated the effects of localised radiant heat on peripheral (calf) blood flow measured by venous occlusion plethysmography in 16 AN patients.
MATERIAL The twelve girls and four boys with AN (group A), who were investigated belonged to a larger series which has Acta Pzdiatr Scand 67
224 1
Table 1 . Physical characteristics of sixteen anorexic (group A ) and fourteen healthy children (group H ) Mean values 2S.D. and significance of inter-group differences are given
10.
Table 3 . s direct he6 The mean values of the circulatory data in the children (1 anorexic and healthy children and the differ. Mean value: ence between the two groups are given in ferencesare Tables 2 and 3. In group H data of resting calf blood flow and inclination time in the digital plethysmo TemperatUl Knee gram were similar to the composite material of Toe healthy adults and children described by ThoDiff. kne ren & Wahren (1 1). Temp. aft€ In group A calf blood flow was slightly less Knee Toe than half (p
LIME3 CIRCULATION IN ANOREXIA NERVOSA U. FREYSCHUSS,’ L. FOHLIN and C. THOREN From the Department of Clinical Physiology, Karolinska Sjukhuset and the Department of Paediatrics, St. Goran’s Children’s Hospital, Karolinska Institutet, Stockholm, Sweden
ABSTRACT. Freyschuss, U., Fohlin, L. and Tboren, C. (Departments of Clinical Physiology, Karolinska Hospital and Paediatrics, St. Goran’s Hospital, Karolinska Institutet, Stockholm, Sweden). Limb circulation in anorexia nervosa. Acta Paediatr Scand, 67: 225, 1978.-Blood flow, skin temperature and blood pressure of the lower limbs and the effect of indirect, radiant heat on calf blood flow and leg skin temperature was determined in sixteen children with anorexia nervosa (group A) and fourteen healthy children (group H) of the same age and body height. Calf blood flow was measured by venous occlusion plethysmography. Arm blood pressure was obtained by tourniquet and toe pressure and digital plethysmograms by a strain-gauge. Skin temperature was measured with a thermocouple. In group A calf blood flow was about 5&60% lower than the mean values observed in group H and a marked difference was maintained after the heat load. Skin temperature of the knees and toes were higher in group H. Systolic arm blood pressure and toe pressure were on the average 20 mmHg and 13 mmHg lower in group A. It is suggested that there is a heat-conserving, selective peripheral vasoconstriction in the anorexic patients.
KEY WORDS: Anorexia nervosa, peripheral circulation, occlusion pletbysmography, healthy school children, blood pressure, temperature regulation, digital plethysmography
It is well known that patients with anorexia nervosa (AN) often complain of cold hands and feet (2). The thermoregulation has been reported altered in AN (7, 9, 12) and in a previous study of the thermal responses to exercise of a group of AN patients (3) it was noted that though core temperature rose normally in a thermal neutral environment during work there was some evidence of peripheral vasoconstriction. It was concluded that the patients attempt to limit the size of the body core in order to conserve body heat by maintaining active vasoconstrictor tone in the extremities. Under these conditions heat can be exchanged by a “counter current” mechanism since blood is diverted from the superficial to deep veins which lie in close proximity to the arteries (10). If this theory is correct and anorexia pa-
-
’ Present address: Department of Clinical Physiology, Serafimerlasarettet, Karolinska Institutet, Stockholm, Sweden. 15-112a12
tients adapt to their condition, one might expect peripheral blood flow to the limbs to be decreased at rest and show a reduced response to localised heating. A selective control of peripheral blood flow was suggested to occur for the compensation of the decreased thermal insulation due to the loss of body fat. Wakeling & Russel (12) showed that the oral and finger temperatures of eleven girls with AN responded slowly to localised heat stress imposed by placing the arm up to the elbow in water at 45°C. In order to study this problem further we have investigated the effects of localised radiant heat on peripheral (calf) blood flow measured by venous occlusion plethysmography in 16 AN patients.
MATERIAL The twelve girls and four boys with AN (group A), who were investigated belonged to a larger series which has Acta Pzdiatr Scand 67
224 1
Table 1 . Physical characteristics of sixteen anorexic (group A ) and fourteen healthy children (group H ) Mean values 2S.D. and significance of inter-group differences are given
10.
Table 3 . s direct he6 The mean values of the circulatory data in the children (1 anorexic and healthy children and the differ. Mean value: ence between the two groups are given in ferencesare Tables 2 and 3. In group H data of resting calf blood flow and inclination time in the digital plethysmo TemperatUl Knee gram were similar to the composite material of Toe healthy adults and children described by ThoDiff. kne ren & Wahren (1 1). Temp. aft€ In group A calf blood flow was slightly less Knee Toe than half (p
