Is plasma citrulline a good marker of hemodynamic status in malnourished patients with anorexia nervosa?

Objective

Malnourished patients with anorexia nervosa (AN) have lower plasma citrulline level compared to healthy controls. Citrulline is a non-essential amino-acid synthetized by the enterocyte and has functions affecting cardiovascular status. The aim of the study is to describe citrulline plasma level and to assess its relationship with hemodynamic status in a cohort of malnourished adult patients with AN.

Methods

A retrospective observational study including malnourished patients with AN hospitalized between January 2018 and January 2019 for the treatment of severe malnutrition was carried out. Anthropometric measures, biochemical tests, and cardiac function indicators including doppler echocardiographic parameters were evaluated.

Results

Forty-eight patients with a median age of 29 [21–35.5] years old and body mass index (BMI) of 12 [10.5–-13.4] kg/m² were included. Median systolic blood pressure (SBP) and median diastolic blood pressure (DBP) were respectively 99 [90–110] mmHg and 68 [59–73] mmHg. Median left ventricular ejection fraction (LVEF) was at 65 [58–69] %. Plasma citrulline level was under the normal range in 58% of patients and was positively correlated with fat mass, stroke volume, and left ventricular end diastolic volume, but not BMI.

Conclusion

Citrulline level may be an innovative associated marker of hemodynamic status in malnourished patients with AN. Further research and prospective studies are needed to elucidate the specific pathways involved.