Hypokalemia in patients with anorexia nervosa during refeeding is associated with binge–purge behavior, lower body mass index, and hypoalbuminemia

Background Hypokalemia is frequently found in patients with anorexia nervosa and sometimes leads to life-threatening conditions. Although their serum potassium levels are considered to further decrease during refeeding, no previous studies have addressed actual changes in the serum potassium levels and potential mechanisms underlying hypokalemia during the refeeding period of patients with anorexia nervosa. In this study, we investigated factors associated with hypokalemia during refeeding of patients with anorexia nervosa. Methods We recruited 52 independent patients from 89 admissions with anorexia nervosa (body mass index, 13.0 ± 3.3) from the psychiatry unit in Ashikaga Red Cross Hospital during the period from April 2003 to March 2018 and analyzed serum potassium levels at admission. Of the 89 admissions, 66 admissions with > 1-week hospitalization were recruited to determine the lowest potassium levels during the refeeding period. We analyzed these levels with multiple linear regression analysis with explanatory variables, including data upon admission and treatment-related indicators. Results The initial serum potassium level of 3.6 ± 0.9 mg/dl decreased to 3.1 ± 0.7 mg/dl at nadir hypophosphatemia, which was observed an average of 2.5 days after admission. A lower serum potassium level at admission and a lower nadir potassium level during refeeding were associated with a lower body mass index, hypoalbuminemia, and binge–purge behavior. Similar results were obtained when the analysis included restrictive or binge–purge types as well as the independent patient group. Conclusions Lower body mass index, hypoalbuminemia, and binge–purge behavior might be used as indicators to guide clinical approaches for controlling serum potassium levels in patients with anorexia nervosa during refeeding. Plain English summary Hypokalemia, low levels of serum potassium, in patients with anorexia nervosa sometimes leads to life-threatening conditions. Thus, it is of great importance to predict the risk of hypokalemia in patients with anorexia nervosa during the refeeding period. Our study found that hypokalemia in patients with anorexia nervosa during refeeding is associated with a lower body mass index and hypoalbuminemia (low levels of serum albumin), in addition to binge–purge behavior.

Hypokalemia in Patients With Eating Disorders Is Associated With Binge-Purge Behavior, Lower Body Mass Index, and Hypoalbuminemia ~Predicting Hypokalemia During Refeeding~

Aim To identify potential mechanisms underlying hypokalemia in patients with eating disorders Background Hypokalemia is frequently found in patients with eating disorders and sometimes leads to life-threatening conditions. The mechanisms underlying hypokalemia have yet to be elucidated except for binge-purge behavior, although other factors, e.g., malnutrition and refeeding, are proposed to induce hypokalemia. In this study, we investigated factors associated with hypokalemia during acute treatment of patients with eating disorders. Methods We recruited 52 independent patients from 89 admissions with eating disorders (body mass index, 13.0 ± 3.3) and analyzed serum potassium levels at admission. Similarly, 66 admissions with > 1-week hospitalization were recruited to determine the lowest potassium levels during the refeeding period. We analyzed these levels with multiple linear regression analysis with explanatory variables, including data upon admission and treatment-related indicators. Results A lower serum potassium level at admission and a lower nadir potassium level during refeeding were associated with a lower body mass index, hypoalbuminemia, and binge-purge behavior. Similar results were obtained when the analysis included restrictive or binge-purge types as well as the independent patient group. The lowest potassium levels during the refeeding period was observed an average of 2.5 days after admission. Conclusions Thus lower body mass index, hypoalbuminemia, and binge-purge behavior might predict hypokalemia among patients with eating disorders both at admission and during refeeding. Our study is the first to demonstrate that malnutrition and refeeding themselves might induce hypokalemia among patients with eating disorders. These factors might be used as indicators to guide clinical approaches for controlling serum potassium levels during refeeding.

Predictors of farther mobilization on day of surgery and shorter length of stay after total joint arthroplasty

Background: Mobilization on the day of total joint arthroplasty (TJA) is associated with shorter length of stay. The question of whether incrementally farther mobilization on the day of surgery (POD0) contributes to shorter length of stay has not been widely studied. The purpose of this study was to determine if farther mobilization on POD0 led to shorter length of stay and to identify the predictors of farther mobilization and length of stay. Methods: A retrospective chart review was undertaken using data for patients who had a primary TJA and mobilized on POD0. Patients were categorized into the following 4 mobilization groups: sat on the bedside (Sat), stood by the bed or walked in place (Stood), walked in the room (Room) and walked in the hall (Hall). The primary outcome was length of stay. Predictors of farther mobilization on POD0 and length of stay were identified using regression analyses. Results: The sample comprised 283 patients. The Hall group had significantly shorter length of stay than all other groups. There were sex differences across the mobilization groups. Simultaneous regression analysis showed that farther mobilization was predicted by younger age, male sex, lower body mass index, spinal anesthesia and fewer symptoms limiting mobilization. Hierarchical regression showed that shorter length of stay was predicted by male sex, lower body mass index, lower American Society of Anaesthesiologists physical status classification score, less pain/stiffness and farther mobilization on POD0. Conclusion: Understanding the modifiable and nonmodifiable predictors of mobilization after TJA and length of stay can help identify patients more likely to mobilize farther on the day of surgery, which would contribute to better resource allocation and discharge planning. Focusing on symptom management could increase opportunities for farther mobilization on POD0 and thereby decrease length of stay.

Active Transportation and Obesity Indicators in Adults from Latin America: ELANS Multi-Country Study

Purpose: The aim of this study was to determine the association between active transportation and obesity indicators in adults from eight Latin American countries. Methods: Data from the ELANS study, an observational multi-country study (n: 8336; 18–65 years), were used. Active transportation (walking and cycling) and leisure time physical activity was assessed using the International Physical Activity Questionnaire (long version). The obesity indicators considered were: body mass index, and waist and neck circumference. Results: In the total sample, the average time dedicated to active transportation was 24.3 min/day, with the highest amount of active transportation being Costa Rica (33.5 min/day), and the lowest being Venezuela (15.7 min/day). The countries with the highest proportion of active transportation were Ecuador (71.9%), and the lowest was Venezuela (40.5%). Results from linear regression analyses suggest that active transportation was significantly and independently associated with a lower body mass index (β: −0.033; 95% CI: −0.064; −0.002), but not with waist circumference (β: −0.037; 95% CI: −1.126; 0.390 and neck circumference (β: −0.007; 95% CI: −0.269; 0.130). Conclusions: Active transportation is significantly associated with a lower body mass index. Governments should incentivize this type of transportation as it could help to reduce the obesity pandemic in Latin America.