Twenty patients with anorexia nervosa and a body weight below 60% of the standard weight were studied. One died of starvation; the others survived. Four patients, including the deceased, had such severe weakness that they could not sit up without support, and another five could sit up only from a lateral position. Serum albumin or hemoglobin levels at the beginning of therapy could not be used for nutritional assessment because of dehydration, while increased blood urea nitrogen was associated with acute illness. The present results together with data from previous studies of fatal anorexia indicate that the risk of mortality may be quite low when body weight is above 60% of the standard. We suggest that gross muscle weakness in addition to body weight for height can be a valuable indicator to assess the criticalness in anorexia nervosa.
(Internal Medicine 32: 837-842, 1993)