Persistent hypercholesterolemia due to weight maintenance via a ketogenic diet in anorexia nervosa: A case report

We report a case of a young female with anorexia nervosa (AN) who continued to excessively restrict carbohydrate intake and had persistently high low-density lipoprotein cholesterol (LDL-C) levels even after weight gain.

A 12-year-old female was diagnosed with AN. She began losing weight at the age of 10 years and weighed 24.7 kg (body mass index [BMI], 12.8 kg/m²; standard weight ratio [SWR], 58.2%) on her first visit to the psychiatry department. Over the next 3 months after this visit, her weight decreased to 21.1 kg (BMI: 11.1 kg/m²; SWR: 50.4%), and she was admitted to the pediatric ward, where her LDL-C level was 475 mg/dL on admission. Upon consuming a diet containing carbohydrates, her weight gradually increased (26.4 kg), and her LDL-C levels decreased (61 mg/dL). However, her carbohydrate intake decreased after discharge, and her LDL-C levels gradually increased, although her weight was maintained at approximately 30 kg. Her LDL-C level rose to 675 mg/dL, and her weight decreased to 25.8 kg, necessitating readmission. After admission, her LDL-C level improved to 185 mg/dL with carbohydrate intake. Her carbohydrate intake gradually decreased after discharge. She stopped eating meat and started eating avocado, tofu, and large amounts of vegetables. Thus, her LDL-C level remained at approximately 100 mg/dL, but her weight gradually decreased. Therefore, the patient was readmitted to the pediatric ward.

Excessive ketogenic diets may pose some risks for patients with AN, even if they do not lead to weight loss.