{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T01:13:18Z","timestamp":1774401198861,"version":"3.50.1"},"reference-count":15,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2013,8,7]],"date-time":"2013-08-07T00:00:00Z","timestamp":1375833600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Hepatology Research"],"published-print":{"date-parts":[[2014,10]]},"abstract":"<jats:sec><jats:title>Aim<\/jats:title><jats:p>The number of <jats:styled-content style=\"fixed-case\">J<\/jats:styled-content>apanese patients with anorexia nervosa (<jats:styled-content style=\"fixed-case\">AN<\/jats:styled-content>) is increasing as society changes. Mild liver injury is a complication of <jats:styled-content style=\"fixed-case\">AN<\/jats:styled-content> in around 30% of cases. In some rare instances, patients present with severe liver injury similar to acute liver failure. However, there are numerous uncertainties over the clinical characteristics of this condition. The objective of the present study was to clarify the clinical characteristics of <jats:styled-content style=\"fixed-case\">AN<\/jats:styled-content> complicated by liver injury and to investigate the factors related to hepatic complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Thirty\u2010seven patients hospitalized at our institution with a diagnosis of <jats:styled-content style=\"fixed-case\">AN<\/jats:styled-content> were enrolled as the study subjects. The study used clinical data obtained at the time of hospitalization. The enrolled patients underwent subgroup analysis and were categorized into three groups: (i) normal alanine aminotransferase (<jats:styled-content style=\"fixed-case\">ALT)<\/jats:styled-content>, (ii) moderately elevated <jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content>, and (iii) highly elevated <jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>All of the study subjects were female with a median age of 24 years and presenting with marked weight loss (mean body mass index, 13\u2009kg\/m<jats:sup>2<\/jats:sup>). Thirteen of the subjects had liver injury. We found that patients in the highly elevated <jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content> group had a significantly high blood urea nitrogen (<jats:styled-content style=\"fixed-case\">BUN)<\/jats:styled-content>\/creatinine ratio, and a low blood sugar level.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our present findings indicate that <jats:styled-content style=\"fixed-case\">AN<\/jats:styled-content> patients with highly elevated <jats:styled-content style=\"fixed-case\">ALT<\/jats:styled-content> have a severe dehydration. This suggests that dysfunction of hepatic circulation accompanying severe dehydration due to malnutrition may be an important factor in the development of liver injury in <jats:styled-content style=\"fixed-case\">AN<\/jats:styled-content> patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/hepr.12202","type":"journal-article","created":{"date-parts":[[2013,7,11]],"date-time":"2013-07-11T11:01:45Z","timestamp":1373540505000},"source":"Crossref","is-referenced-by-count":32,"title":["Clinical manifestations of liver injury in patients with anorexia nervosa"],"prefix":"10.1111","volume":"44","author":[{"given":"Kyoko","family":"Tomita","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Yamagata University Faculty of Medicine  Yamagata Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hiroaki","family":"Haga","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Yamagata University Faculty of Medicine  Yamagata 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