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Background: Abnormalities in Heart Rate Variability analysis (HRV) and orthostatic intolerance have been found in patients with anorexia nervosa (AN), indicating impaired autonomic function. Methods: The patients were 34 adolescents with AN, who were hospitalized (mean age=16.4±1.8 years; body mass index (BMI) =16.3±1.9 kg/m2) compared to a healthy control group (N=32; mean age=15.4±3.7 years; BMI=20.6±2.9 kg/m2). All adolescents had an active standing test with continuous measurement of heart rate during 5 minutes in supine position and ten minutes during active standing using the HRV ScannerTM. 13 patients with AN have a second tilt test after 4 weeks refeeding on average. Using a questionnaire, physical activity (Hours of sport/week), nausea and dizziness were queried. Results: We found nearly no differences of HRV between AN and control in the supine position but significantly higher heart rate increments in AN while standing (5 minutes: 26.4±15.1 versus 16.1±7.3** bpm, p<0,001; 10 minutes: 31.6±14.1 versus 20.1±8.0*** bpm, p<0.0001). Heart rate increment while standing are significantly related to the stress index (R2=0.916***). Heart rate increment while 5-minutes standing are related to the BMI (r=-0.304*), physical activity (r=-0.376**) and orthostatic dizziness (r=-0.479**). 13 patients after one-month refeeding have significantly reduced heart rate increments (20.9±9.4 versus 35.7±16.3***, p<0.001). Conclusion: AN have significantly enhanced heart rate increment while standing that are related to the stress index and clinical symptoms.

Excessive Heart Rate Increments during Active Standing Test in Children with Anorexia Nervosa: An Indicator of a Postural Orthostatic Tachycardia Syndrome and a New Therapeutic Target?