Microvascular Abnormalities in Adolescents With Anorexia Nervosa: Nailfold Video Capillaroscopic Evidence at Acute and Remission States.

Objective

Chronic malnutrition, hypothermia, and hormonal imbalance in anorexia nervosa (AN) may impair capillary structure and perfusion. This study aimed to describe the nailfold videocapillaroscopy (NVC) findings in adolescents with AN and atypical AN (AAN), to assess their association with Raynaud's phenomenon (RP), and evaluate longitudinal capillary changes following medical remission.

Methods

We evaluated the NVC findings of 26 adolescents with AN, 24 with AAN and 9 with primary RP as a control group (12-18 years). Additionally, 23 patients with AN and AAN were reevaluated after achieving medical remission and weight restoration.

Results

While both the AN and AAN group had significant capillary changes, most NVC parameters were comparable between the groups, except for a higher prevalence of early scleroderma pattern in AN (p = 0.037). RP was associated with higher enlarged capillary scores in AN (p = 0.018) and higher prevalence of early scleroderma pattern in AAN (p = 0.007). Univariate analysis showed vital instability significantly heightened odds of having hemorrhages (OR = 5.79), giant capillaries (OR = 3.93) and tortuosity (OR = 3.82). Longitudinal assessment showed improvement in almost all capillary changes, with all early scleroderma patterns completely resolving after medical remission (p = 0.001).

Discussion

Our findings suggest the presence of microvascular alterations in adolescents with AN, particularly during the acute phase. Although weight restoration improved microvascular changes, long-term monitoring is necessary to determine whether all findings resolve over time or there is an increased risk of developing sequelae in the future.