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Total Serum Cholesterol and Suicidality in Anorexia Nervosa

From the Department of Neuroscience (A.F., P.S.) and Clinical and Experimental Medicine (L.C., L.D.P.), University of Padua, Padua, Italy; and the Department of Neuroscience (F.B.), Sacco Hospital, Milan, Italy.

Address correspondence and reprint requests to Paolo Santonastaso, Psychiatric Clinic, Department of Neurology and Psychiatry, Via Giustiniani 3, 35128 Padova, Italy. E-mail: paolo.santonastaso{at}unipd.it

OBJECTIVE: No published study has evaluated the relationship between serum cholesterol and suicidality in anorexia nervosa (AN).

AIMS: To assess psychiatric and nutritional correlates of serum cholesterol in a sample of AN patients.

METHODS: Serum cholesterol and nutritional status were evaluated in a sample of 74 AN patients, before starting any type of refeeding. All subjects underwent a structured clinical interview and completed the Hopkins Symptom Checklist.

RESULTS: Subjects who reported previous suicide attempts, impulsive self-injurious behavior, or current suicidal ideation showed significantly lower cholesterol levels than subjects without suicidality. Cholesterol levels were negatively correlated with the severity of depressive symptoms in all the patients with the exception of those with recurrent binge eating. A multivariate analysis showed that the relationships between cholesterol levels and suicidal behavior and ideation do not seem to be affected by the nutritional and metabolic factors considered in the study.

CONCLUSIONS: Notwithstanding the influence of important metabolic factors affecting cholesterolemia in AN, our research tends to confirm previous studies that have found an association between low cholesterol levels and suicidality.

Key Words: anorexia nervosa, • serum cholesterol, • self-injurious behavior, • suicidality, • depression.

Abbreviations: AN = anorexia nervosa;; ANR = restricting-type AN;; ANBP = binge eating/purging-type AN;; BMI = body mass index;; DSM-IV = Diagnostic and Statistical Manual for Mental Disorders, 4th edition;; SCL = Hopkins Symptom Checklist;; T₃ = free triiodotyronine;; T₄ = free tyroxine.

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