A systematic review and meta-analysis of routine white blood cell concentrations in people with eating disorders.
Johanna L Keeler, Can Xu, Rebecca Morris et al.
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In 30 seconds
This systematic review and meta-analysis examined white blood cell (WBC) concentrations and subtypes in people with anorexia nervosa (AN) or bulimia nervosa (BN), compared with healthy controls, and during weight restoration in AN. It included 38 studies. Cross-sectionally, AN was associated with lower concentrations of WBCs, lymphocytes, basophils, monocytes and neutrophils, while eosinophils were unchanged. In BN, WBCs and most subtypes were similar to controls, with lower basophils. WBC concentrations increased significantly only with longer-term weight restoration, when BMI approached 18.5 kg/m².
Key findings
- In AN, WBCs, lymphocytes, basophils, monocytes and neutrophils were lower than in healthy controls; eosinophils were unchanged.
- In BN, WBCs and most subtypes were unaltered compared with healthy controls, although basophils were decreased.
- In AN, WBC concentrations were unchanged after short- or medium-term weight gain but increased significantly when BMI approached 18.5 kg/m²; lymphocytes were unchanged at all time-points.
- Meta-regressions found no association between AN-group age or BMI and cross-sectional differences in WBC or lymphocyte concentrations.
Why it matters
The findings indicate that low WBC concentrations in AN may accompany undernutrition and may not normalise with early weight gain. Interpreting blood counts in the context of nutritional status and the course of weight restoration may therefore help clinicians understand these immune-parameter changes. The largely unchanged findings in BN suggest that this pattern is not shared across both disorders.
What to keep in mind
The review combined studies with cross-sectional and longitudinal designs; the abstract does not report the size or quality of the individual studies.