Can being too thin increase risk of cardiovascular disease?

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There has been tremendous focus on childhood obesity and its relationship to future acquired cardiovascular disease. One might assume that decreased adiposity will always result in decreased risk for cardiovascular disease. However, what about extremely low adiposity as seen in anorexia nervosa? Does this provide a favorable risk profile?

In this issue of The Journal, Misra et al evaluated risk factors for cardiovascular disease in adolescent girls with anorexia nervosa. They compared patients with anorexia nervosa to a control group and also evaluated the patients prior to and after weight gain. They found a somewhat mixed picture—apolipoprotein-B and interleukin-6 increased and C-reactive protein decreased in patients with anorexia nervosa compared to controls. IL-6 normalized with weight gain. These results highlight the complex relationships between adiposity and cardiovascular disease risk factors.