Brief report
Blunted erythropoietic response in the anemia of anorexia nervosa
Disminución de la respuesta eritropoyética en pacientes con anorexia nerviosa y anemia
Read
3
Timeswas read the article
2
Total PDF
1
Total HTML
Share statistics
array:24 [ "pii" => "S2387020616002047" "issn" => "23870206" "doi" => "10.1016/j.medcle.2015.03.002" "estado" => "S300" "fechaPublicacion" => "2015-11-20" "aid" => "3304" "copyright" => "Elsevier España, S.L.U.. All rights reserved" "copyrightAnyo" => "2015" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2015;145:433-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0025775315002547" "issn" => "00257753" "doi" => "10.1016/j.medcli.2015.03.015" "estado" => "S300" "fechaPublicacion" => "2015-11-20" "aid" => "3304" "copyright" => "Elsevier España, S.L.U." "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2015;145:433-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 13 "formatos" => array:2 [ "HTML" => 8 "PDF" => 5 ] ] "es" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original breve</span>" "titulo" => "Disminución de la respuesta eritropoyética en pacientes con anorexia nerviosa y anemia" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "433" "paginaFinal" => "435" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Blunted erythropoietic response in the anemia of anorexia nervosa" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Jordi Juncà, Marc Sorigué, Inés Rodríguez-Hernández, Marta Aldea, María Luisa Granada, Lluis Sánchez-Planell" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Jordi" "apellidos" => "Juncà" ] 1 => array:2 [ "nombre" => "Marc" "apellidos" => "Sorigué" ] 2 => array:2 [ "nombre" => "Inés" "apellidos" => "Rodríguez-Hernández" ] 3 => array:2 [ "nombre" => "Marta" "apellidos" => "Aldea" ] 4 => array:2 [ "nombre" => "María Luisa" "apellidos" => "Granada" ] 5 => array:2 [ "nombre" => "Lluis" "apellidos" => "Sánchez-Planell" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2387020616002047" "doi" => "10.1016/j.medcle.2015.03.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616002047?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315002547?idApp=UINPBA00004N" "url" => "/00257753/0000014500000010/v1_201510290045/S0025775315002547/v1_201510290045/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2387020616002059" "issn" => "23870206" "doi" => "10.1016/j.medcle.2016.03.015" "estado" => "S300" "fechaPublicacion" => "2015-11-20" "aid" => "3252" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "sco" "cita" => "Med Clin. 2015;145:436-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial article</span>" "titulo" => "Physical activity in leisure time in the prevention of peripheral artery disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "436" "paginaFinal" => "437" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "La actividad física en tiempo libre en la prevención de la enfermedad arterial periférica" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Luis García-Ortiz" "autores" => array:1 [ 0 => array:2 [ "nombre" => "Luis" "apellidos" => "García-Ortiz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775315001104" "doi" => "10.1016/j.medcli.2015.02.008" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315001104?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616002059?idApp=UINPBA00004N" "url" => "/23870206/0000014500000010/v1_201604230100/S2387020616002059/v1_201604230100/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2387020616002035" "issn" => "23870206" "doi" => "10.1016/j.medcle.2014.11.004" "estado" => "S300" "fechaPublicacion" => "2015-11-20" "aid" => "3215" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Med Clin. 2015;145:427-32" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Comparative study of concordance and costs between tuberculin skin test and QuantiFERON<span class="elsevierStyleSup">®</span>-TB Gold In-Tube in the diagnosis of latent tuberculosis infection among contacts of patients with pulmonary tuberculosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "427" "paginaFinal" => "432" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Estudio comparativo de concordancia y costes entre la prueba de la tuberculina y QuantiFERON<span class="elsevierStyleSup">®</span>-TB Gold In-Tube en el diagnóstico de la infección latente tuberculosa en contactos de pacientes con tuberculosis pulmonar" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Xavier Martinez Lacasa, Roser Canals Font, Angels Jaen Manzanera, Eva Cuchi Burgos, Josep Lite Lite" "autores" => array:5 [ 0 => array:2 [ "nombre" => "Xavier" "apellidos" => "Martinez Lacasa" ] 1 => array:2 [ "nombre" => "Roser" "apellidos" => "Canals Font" ] 2 => array:2 [ "nombre" => "Angels" "apellidos" => "Jaen Manzanera" ] 3 => array:2 [ "nombre" => "Eva" "apellidos" => "Cuchi Burgos" ] 4 => array:2 [ "nombre" => "Josep" "apellidos" => "Lite Lite" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0025775315000354" "doi" => "10.1016/j.medcli.2014.11.027" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775315000354?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616002035?idApp=UINPBA00004N" "url" => "/23870206/0000014500000010/v1_201604230100/S2387020616002035/v1_201604230100/en/main.assets" ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Blunted erythropoietic response in the anemia of anorexia nervosa" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "433" "paginaFinal" => "435" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Jordi Juncà, Marc Sorigué, Inés Rodríguez-Hernández, Marta Aldea, María Luisa Granada, Lluis Sánchez-Planell" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Jordi" "apellidos" => "Juncà" "email" => array:1 [ 0 => "jordijunca@comb.cat" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Marc" "apellidos" => "Sorigué" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Inés" "apellidos" => "Rodríguez-Hernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Marta" "apellidos" => "Aldea" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "María Luisa" "apellidos" => "Granada" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Lluis" "apellidos" => "Sánchez-Planell" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Laboratorio de Hematología, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Laboratorio de Análisis Clínicos, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Psiquiatría, Hospital Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Disminución de la respuesta eritropoyética en pacientes con anorexia nerviosa y anemia" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Anorexia nervosa (AN) is an eating disorder that affects 0.5 to 1% of all adolescents, mostly women. In addition to its psychiatric dimension, AN is accompanied by various biological abnormalities. Among the hematologic consequences of AN, anemia has been documented with variable frequency, from 21 to 39%, depending on the series,<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">1</span></a> although its mechanism is not fully established. In most patients, anemia is not accompanied by iron, folate or cobalamin deficiency,<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">2,3</span></a> and the severity of the condition of the bone marrow due to hypoplasia or gelatinous degeneration is not parallel to the onset of anemia (or other cytopenias) in peripheral blood.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The physiological response to anemia, increased serum erythropoietin (EPO), has not been studied thoroughly in the AN. In fact, only one of the series published<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">2</span></a> reports the values of EPO in 44 patients with AN, 15 of them with anemia, but without establishing a relationship with hemoglobin (Hb). Recombinant EPO was administered to patients with anemia in the context of AN with satisfactory results.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5,6</span></a> Recently, the excellent results obtained with darbepoetin in one anemic patient with AN in our institution (unpublished data) led us to revise the erythropoietic response in a small series of anemic patients diagnosed with AN.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Patients, material and methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">The study was approved by the hospital's Ethics Committee.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Forty-one female patients consecutively visited due to AN in the Eating Disorders Unit of our hospital between 1995 and 1997 were included in the study. All met the AN diagnostic criteria according to DSM-IV<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">7</span></a> and had a BMI of less than 18.5<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>. In all patients a complete blood count and biochemical analysis was performed, including ferritin (normal values between 15 and 90<span class="elsevierStyleHsp" style=""></span>ng/ml), cobalamin (normal values between 250 and 850<span class="elsevierStyleHsp" style=""></span>ng/ml), serum folate (normal values between 2.2 and 18<span class="elsevierStyleHsp" style=""></span>mg/ml) and erythrocyte folate (normal values between 150 and 575<span class="elsevierStyleHsp" style=""></span>mg/ml) and creatinine (STKR Coulter counter [Beckman Coulter, Hialeah, FL, USA.] for hematimetric data, folates and cobalamin RIA assay [Ciba Corning, Medfield, MA, USA.], Ferritin [IMX, Abbot, Abbott Park, IL USA] and Technicon SMA (Tarrytown, NY, USA), for creatinine and other biochemical determinations). An aliquot of serum stored at −80<span class="elsevierStyleHsp" style=""></span>°C was used in this study for EPO measurement (Access II, Beckman Coulter, Hialeah, FL, USA). Eleven of these patients (17–43 years, age range; BMI range 12.8–17.8<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>) had anemia (less than 120<span class="elsevierStyleHsp" style=""></span>g/l<span class="elsevierStyleHsp" style=""></span>Hb), while the other 30 patients (16 to 40 years, age range; BMI range 12.1–18.4<span class="elsevierStyleHsp" style=""></span>kg/m<span class="elsevierStyleSup">2</span>) had a normal hemogram and were used as controls for EPO values.</p><p id="par0025" class="elsevierStylePara elsevierViewall">To calculate the expected EPO in 40 patients with iron deficiency anemia but normal renal function, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) its concentration was determined to ensure that the erythropoietic response was not altered by inflammation or kidney disease. A curve was obtained relating the severity of anemia, according to Hb concentration, with EPO levels by the mathematical function <span class="elsevierStyleItalic">y</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>3.919<span class="elsevierStyleSup">−0.4538<span class="elsevierStyleItalic">x</span></span>, where <span class="elsevierStyleItalic">x</span> is the EPO produced and <span class="elsevierStyleItalic">y</span> is the expected EPO.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Data were expressed as median (5th and 95th percentiles). The groups were compared using the Mann–Whitney test. Statistical analyzes were performed using the MedCalc<span class="elsevierStyleSup">®</span> program, version 13.0.0.0 (MedCalc Statistical Software). All tests were 2-sided, and a <span class="elsevierStyleItalic">p</span> value of <0.05 was considered statistically significant.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0035" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarizes the demographics and values of BMI and EPO of all patients.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Anemia was detected (defined as below 120<span class="elsevierStyleHsp" style=""></span>Hb<span class="elsevierStyleHsp" style=""></span>g/l) in 11 patients: Hb level was less than 100<span class="elsevierStyleHsp" style=""></span>g/l in 2 patients, and between 100 and 120<span class="elsevierStyleHsp" style=""></span>g/l in the remaining 9.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The other hematologic parameters, ferritin, cobalamin and folate concentrations (serum and erythrocytic) were within normal limits in all cases.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Increased creatinine was detected in an anemic patient (2.2<span class="elsevierStyleHsp" style=""></span>mg/dl; normal between 0.5 and 1.4<span class="elsevierStyleHsp" style=""></span>mg/dl).</p><p id="par0055" class="elsevierStylePara elsevierViewall">The acute phase reactants (ESR, CRP, fibrinogen) were normal in all patients.</p><p id="par0060" class="elsevierStylePara elsevierViewall">EPO values: the median concentrations of EPO in non-anemic patients was not lower than in anemic patients: 8.7<span class="elsevierStyleHsp" style=""></span>mU/ml (3.9–20.93) compared to 20.63<span class="elsevierStyleHsp" style=""></span>mU/ml (4.04–28.46), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.0088. However, although the average concentration of EPO increased in anemic patients, it did so to a lesser extent than expected: 20.63<span class="elsevierStyleHsp" style=""></span>mU/ml (4.04–28.46) compared to 27.85<span class="elsevierStyleHsp" style=""></span>mU/ml (17.7–118.9), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.014.</p><p id="par0065" class="elsevierStylePara elsevierViewall">A significant inverse relationship between BMI and the difference between the concentration of EPO and EPO expected (<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.0006; <span class="elsevierStyleItalic">r</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>−0.86) was observed.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Although anemia is a common finding in the AN1, its mechanism is unclear. A consistent association with iron,<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> folate or cobalamin deficiency has not been found, nor is there a correlation with the degree of bone marrow hypoplasia or gelatinous degeneration.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">4</span></a> In light of some previous reports<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5,6</span></a> and our own experience, anemia could be explained in part by an inadequate EPO synthesis. EPO synthesis is inversely related to Hb levels, and there is a semilogarithmic relationship between the response (log) and the degree of anemia (linear). EPO synthesis in chronic disorders anemia (inflammatory) is inadequate for the degree of anemia in most situations.<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">9</span></a> Interleukin (IL)-1 and TNF-α directly inhibit the <span class="elsevierStyleItalic">in vitro</span><a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">10</span></a> secretion of EPO. Although EPO is increased in our anemic patients, this increase is not suitable for Hb deficit, evidencing a decrease in the erythropoietic response. Generally, this decrease is due to two main factors: renal failure (not present in our patients with AN) or an inflammatory response, which in our patients was not reflected in the increase in conventional inflammation markers (ESR and/or CRP).</p><p id="par0075" class="elsevierStylePara elsevierViewall">Several authors have studied the changes in the levels of certain cytokines in the AN, but with contradictory results. While some of them have found normal values for IL-3, IL-6 or no significant increases in TNF-α,<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">8,11</span></a> others have documented increases in IL-6.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">12</span></a> EPO levels have also been studied by Vaisman et al.,<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">11</span></a> in his series of 7 AN patients with an Hb average of 128<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>11<span class="elsevierStyleHsp" style=""></span>g/l and EPO of 13.38<span class="elsevierStyleHsp" style=""></span>±<span class="elsevierStyleHsp" style=""></span>1.97<span class="elsevierStyleHsp" style=""></span>mU/ml (normal range 3–33). EPO concentrations increased with feedback, while the Hb did not. Although the number of patients in our study is low, no differences in BMI between anemic and non-anemic patients were detected, according to data provided by these authors.</p><p id="par0080" class="elsevierStylePara elsevierViewall">In conclusion, the cause of the anemia that accompanies up to 39% of cases of AN remains difficult to explain, and although the decreased levels of EPO give evidence of having a similar origin to that seen in the anemia of inflammatory diseases, such inflammation has not been documented by traditional inflammation markers, therefore, other mechanisms may be partially responsible. Recently, high adiponectin levels in patients with AN<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">13</span></a> has been described, and an inverse relationship between adiponectin and Hb has been documented.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">14,15</span></a> A recent study<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">8</span></a> detected a parallel hepcidin and ferritin increase in anorexic patients and a significant decrease of the 2 parameters after nutritional rehabilitation. Perhaps, as indicated by the authors, the stress of malnutrition could be an inflammatory stimulus which does not condition increased levels of ESR, CRP or IL-6, but partially blocks the production of EPO, as it occurs with inflammatory disorders. Inadequate EPO synthesis appears to be related to the severity of the eating disorder (largest difference between expected and observed EPO when lower BMI). Although ours is a preliminary study, including only a small number of patients, this decrease in EPO secretion could explain the response to the administration of recombinant EPO reported in the medical literature.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">5,6</span></a> More and larger studies are needed to determine the mechanisms of inadequate EPO production in the anemia of some patients with AN, and the possible marrow response to treatment with recombinant EPO.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Conflict of interests</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:10 [ 0 => array:3 [ "identificador" => "xres630790" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec643607" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres630791" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec643608" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Patients, material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Conflict of interests" ] 9 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2015-02-04" "fechaAceptado" => "2015-03-19" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec643607" "palabras" => array:3 [ 0 => "Anemia" 1 => "Erythropoietin" 2 => "Anorexia nervosa" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec643608" "palabras" => array:3 [ 0 => "Anemia" 1 => "Eritropoyetina" 2 => "Anorexia nerviosa" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background and objective</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The cause of the anemia in anorexia nervosa (AN) has not been fully ascertained. Ferritin, folate and cobalamin values are usually within normal ranges. Anemia does not have a relationship with bone marrow changes and erythropoietin (EPO) levels have not been investigated. The objective of this study was to evaluate the EPO response in a small group of AN patients.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Patients and methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">EPO levels were measured in serum samples of 41 female AN patients (11 with anemia, and 30 with normal blood cell count). The adequacy of EPO response was assessed by comparing the increase observed in a group of normal weight patients with anemia.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">EPO concentrations in anemic AN patients were higher than in non-anemic: 20.63<span class="elsevierStyleHsp" style=""></span>mU/ml (4.04–28.46) vs 8.7<span class="elsevierStyleHsp" style=""></span>mU/ml (3.9–20.93), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.0088, but the increase in EPO was lower than expected (27.85<span class="elsevierStyleHsp" style=""></span>mU/ml [17.7–118.9]), <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>.014. BMI and the difference between actual and expected EPO were inversely correlated.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Inadequate EPO response may partly explain anemia in AN, but further studies are necessary.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background and objective" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Patients and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Fundamento y objetivo</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">La causa o causas de la anemia que acompaña a la anorexia nerviosa (AN) no ha sido establecida, pero no parece relacionarse con deficiencias nutricionales ni cambios medulares. El objetivo de este trabajo fue evaluar la producción de eritropoyetina (EPO) en respuesta a la anemia en un pequeño grupo de pacientes con AN y anemia.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Pacientes y métodos</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Los niveles de EPO en muestras de suero de 41 mujeres con AN (11 con anemia y 30 sin alteraciones en los parámetros de la serie eritroide) se compararon con la respuesta observada en un grupo de pacientes de peso normal con anemia.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Las concentraciones de EPO en pacientes con AN anémicas fueron mayores que en las no anémicas: 20,63<span class="elsevierStyleHsp" style=""></span>mU/ml (4,04 a 28,46) frente a 8,7<span class="elsevierStyleHsp" style=""></span>mU/ml (3,9 a 20,93), p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,0088, pero el aumento de EPO fue menor de lo esperado (27,85<span class="elsevierStyleHsp" style=""></span>mU/ml [17,7 a 118,9]), p<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0,014. La correlación entre el IMC y la diferencia entre la EPO y la EPO esperada es inversa.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Una producción inadecuada de EPO puede explicar en parte la anemia en la AN. Son necesarios más estudios para investigar la causa de esta respuesta.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Fundamento y objetivo" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Pacientes y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Juncà J, Sorigué M, Rodríguez-Hernández I, Aldea M, Granada ML, Sánchez-Planell L. Disminución de la respuesta eritropoyética en pacientes con anorexia nerviosa y anemia. Med Clin (Barc). 2015;145:433–435.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">EPO: erythropoietin; Hb: hemoglobin; BMI: body mass index; ns: not significant.</p><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Values expressed as mean (range).</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="" valign="top" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Non-anemic patients (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>11) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Anemic patients (n<span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>30) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24.2 (16–40) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">25.1 (17–43) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">BMI (kg/m<span class="elsevierStyleSup">2</span>) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.18 (12.1–18.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">16.16 (12.8–17.8) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ns \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Hb (g/l) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">132 (121–136) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">105 (77–119) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">EPO (mU/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">8.7 (3.9–20.93) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">20.63 (4.04–28.46)* \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top">Expected EPO (mU/ml) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">27.85 (17.7–118.9)** \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top"><span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001 between EPO* and expected EPO** \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1034923.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">BMI, hemoglobin, erythropoietin and expected erythropoietin values in patients with non-anemic and anemic anorexia nervosa.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0080" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The hematology of anorexia nervosa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Hütter" 1 => "S. Ganepola" 2 => "W.K. Hofmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/eat.20610" "Revista" => array:6 [ "tituloSerie" => "Int J Eat Disord" "fecha" => "2009" "volumen" => "42" "paginaInicial" => "293" "paginaFinal" => "300" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19040272" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0085" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Iron status and haematological changes in adolescent female inpatients with anorexia nervosa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "A. Kennedy" 1 => "M. Kohn" 2 => "A. Lammi" 3 => "S. Clarke" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1754.2004.00432.x" "Revista" => array:6 [ "tituloSerie" => "J Paediatr Child Health" "fecha" => "2004" "volumen" => "40" "paginaInicial" => "430" "paginaFinal" => "432" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15265182" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0090" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nutritional status in anorexia nervosa: clinical chemistry, vitamins, iron and zinc" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C.J. Van Binsbergen" 1 => "J. Odink" 2 => "H. van den Berg" 3 => "H. Koppeschaar" 4 => "H.J. Coelingh Bennink" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Clin Nutr" "fecha" => "1988" "volumen" => "42" "paginaInicial" => "929" "paginaFinal" => "937" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3074921" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0095" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bone marrow changes in anorexia nervosa are correlated with the amount of weight loss and not with other clinical findings" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E. Abella" 1 => "E. Feliu" 2 => "I. Granada" 3 => "F. Millá" 4 => "A. Oriol" 5 => "J.M. Ribera" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1309/2Y7X-YDXK-006B-XLT2" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Pathol" "fecha" => "2002" "volumen" => "118" "paginaInicial" => "582" "paginaFinal" => "588" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12375646" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0100" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Reversal of bone marrow hypoplasia in anorexia nervosa: case report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "E. Orlandi" 1 => "P. Boselli" 2 => "R. Covezzi" 3 => "G. Bonaccorsi" 4 => "G.P. Guaraldi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Eat Disord" "fecha" => "2000" "volumen" => "27" "paginaInicial" => "480" "paginaFinal" => "482" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10744856" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0105" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Successful management of gelatinous transformation of the bone marrow in anorexia nervosa with hematopoietic growth factors" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "R.S. Charania" 1 => "W.F. Vern" 2 => "S. Charkrabarty" 3 => "J. Holter" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/eat.20833" "Revista" => array:6 [ "tituloSerie" => "Int J Eat Disord" "fecha" => "2011" "volumen" => "44" "paginaInicial" => "469" "paginaFinal" => "472" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20593416" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0110" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnostic and statistical manual of mental disorders: DSM-4" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "American Psychiatric Association" 1 => "DSM-4 Task Force" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:3 [ "fecha" => "1994" "editorial" => "American Psychiatric Association" "editorialLocalizacion" => "Arlington, VA" ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0115" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Iron metabolism in patients with anorexia nervosa: elevated serum hepcidin concentrations in the absence of inflammation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Papillard-Marechal" 1 => "M. Sznajder" 2 => "M. Hurtado-Nedelec" 3 => "Y. Alibay" 4 => "C. Martin-Schmitt" 5 => "M. Dehoux" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3945/ajcn.111.025817" "Revista" => array:6 [ "tituloSerie" => "Am J Clin Nutr" "fecha" => "2012" "volumen" => "95" "paginaInicial" => "548" "paginaFinal" => "554" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22301927" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0120" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Anemia of chronic disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "G. Weiss" 1 => "L.T. Goodnough" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMra041809" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2005" "volumen" => "352" "paginaInicial" => "1011" "paginaFinal" => "1023" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15758012" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0125" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proinflammatory cytokines lowering erythropoietin production" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "W. Jelkmann" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1089/jir.1998.18.555" "Revista" => array:6 [ "tituloSerie" => "J Interferon Cytokine Res" "fecha" => "1998" "volumen" => "18" "paginaInicial" => "555" "paginaFinal" => "559" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9726435" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0130" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Changes in cytokine production and impaired hematopoiesis in patients with anorexia nervosa: the effect of refeeding" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N. Vaisman" 1 => "T. Hahn" 2 => "Y. Karov" 3 => "E. Sigler" 4 => "Y. Barak" 5 => "V. Barak" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.cyto.2004.03.006" "Revista" => array:6 [ "tituloSerie" => "Cytokine" "fecha" => "2004" "volumen" => "26" "paginaInicial" => "255" "paginaFinal" => "261" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15183843" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0135" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cytokine production in patients with anorexia nervosa, bulimia nervosa and obesity" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.C. Raymond" 1 => "M. Dysken" 2 => "K. Bettin" 3 => "E.D. Eckert" 4 => "S.J. Crow" 5 => "K. Markus" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Int J Eat Disord" "fecha" => "2000" "volumen" => "28" "paginaInicial" => "293" "paginaFinal" => "302" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10942915" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0140" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Endocrine consequences of anorexia nervosa" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "M. Misra" 1 => "A. Klibanski" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S2213-8587(13)70180-3" "Revista" => array:6 [ "tituloSerie" => "Lancet Diabetes Endocrinol" "fecha" => "2014" "volumen" => "2" "paginaInicial" => "581" "paginaFinal" => "592" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24731664" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0145" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "High serum adiponectin is associated with low hemoglobin in elderly man; the MrOS Sweden Study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Lewerin" 1 => "H. Johansson" 2 => "U.H. Lerner" 3 => "M.K. Karlsson" 4 => "M. Lorentzon" 5 => "E. Barrett-Connor" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.111/joim.12340" "Revista" => array:2 [ "tituloSerie" => "J Intern Med" "fecha" => "2014" ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0150" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of erythropoiesis: cross-sectional study of the relationships between erythropoiesis and nutrition, physical features, and adiponectin in 3519 Japanese people" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Kohno" 1 => "H. Narimatsu" 2 => "Y. Shiono" 3 => "I. Suzuki" 4 => "Y. Kato" 5 => "A. Fukao" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/ejh.12250" "Revista" => array:6 [ "tituloSerie" => "Eur J Haematol" "fecha" => "2014" "volumen" => "92" "paginaInicial" => "298" "paginaFinal" => "307" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24329589" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000014500000010/v1_201604230100/S2387020616002047/v1_201604230100/en/main.assets" "Apartado" => array:4 [ "identificador" => "44146" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Brief report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000014500000010/v1_201604230100/S2387020616002047/v1_201604230100/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020616002047?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2023 March | 1 | 2 | 3 |
