Corresponding author: Madeeha Kamal, (Department of Adolescent Medicine, Sidra Medicine, Doha, Qatar) — mkamal1@sidra.org
Submitted: 26 Nov 2025 · Accepted: 13 Jan 2026
Anorexia nervosa (AN) is a severe mental health disorder characterized by persistent energy intake restriction, intense fear of weight gain, and a distorted body image. AN affects nearly every organ system, with the cardiovascular system being affected in up to 80% of cases [1]. AN carries the highest mortality among psychiatric disorders, with sudden cardiac death as a major cause [2]. Bradycardia is the most common cardiovascular manifestation in AN.1 Nutritional rehabilitation reverses these abnormalities, but rapid weight gain can pose risks such as electrolyte imbalance and arrhythmias. Early detection and monitoring of bradycardia are therefore crucial [3].
We conducted a retrospective cohort study using data from Sidra Medicine and Hamad General Hospital in Qatar. Patients admitted between December 2016 and June 2024 with AN and bradycardia (Heart Rate (HR) <60 beats per minute (bpm)) were included. Patients with incomplete records were excluded. Ethical approval was obtained from the institutional review board of Sidra Medicine (IRB 1929504). Data were extracted and analyzed by independent reviewers.
Of 222 screened patients (aged 10–18 years), 46 met the inclusion criteria. The majority were female (91.3%), with a mean age of onset at 14 years and a percentile of median BMI for age (%mBMI) of 9.1% (z-score -2.36) (Table 1). The average admission HR was 49.96bpm, confirming bradycardia as a frequent complication. All patients underwent nutritional rehabilitation with caloric intake starting from around 1200kCal/day and increasing by 200kCal/day/day. At 1–2 weeks follow-up, the mean HR improved significantly to 78.63bpm (Table 1). Figure 1 shows the correlation between %mBMI and the change in HR (R2=0.07, p=0.133).
| Baseline Characteristics of Study Population | |
|---|---|
| Characteristics | Value |
| Number of patients | 46 |
| Median age at admission, years | 14 |
| BMI at admission, kg/m2 | 15.56 |
| %mBMI at admission (z-score) | 9.1 (-2.36) |
| AN subtype: Restricting, % | 89.1 |
| AN subtype: Binge/Purge, % | 10.9 |
| Heart rate at admission, bpm | 49.96 |
| Severe bradycardia (<40 bpm), %(n) | 3 (6) |
| Lowest recorded HR, bpm | 37 |
| Nutrition Rehabilitation and Hospital Course | |
| Parameter | Value |
| Median initial caloric prescription, kcal/day (range) | 1150 (700-1500) |
| Daily caloric increase, kcal | 200 if tolerated |
| Median caloric intake at discharge, kcal/day (range) | 2500 (1500-4000) |
| Duration of hospitalization, days (mean) | 38 |
| %mBMI at discharge (z-score) | 23.7 (-0.95) |
| %mBMI change during stay | 14.6 |
| Heart rate at discharge, bpm (±SD) | 78.63 |
| Improvement in heart rate | 28.67 |
This study highlights the burden of bradycardia among adolescents with AN in Qatar. Nutritional rehabilitation was effective in restoring HR, emphasizing the need for early recognition and careful monitoring. Future studies with larger sample size are needed to validate these findings and improve generalizability.
1. Department of Adolescent Medicine, Sidra Medicine, Doha, Qatar
2. Department of Family medicine, Hamad Medical Corporation, Doha, Qatar
3. Department. of Genomics and Precision Medicine, Sidra Medicine, Doha, Qatar.
All authors contributed equally and validated the final version of record.
The authors would like to acknowledge the contribution of the
following colleagues in relation to the work presented: Amal Al-Kuwari, Noor Al-Jaber, Amine Zaidi, Ali Ahmad Al-Najjar, Malissa Ali, Shad Jaouni, Muad Hassan, and Cherradee Barcenas, Amna Ahmed, Tasnim Milhem, Reem Bachir from Sidra Medicine, and, Asmaa Al-Mulla, Roudha Al-Khayarin, Khaled Alzawawi, Amira Mohamed, Sama Al-Dori, and Alanoud Al Ansari from Hamad Medical
Corporation.
The Authors declare that there is no conflict of interest.
This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
No registration applicable.
The data that support the findings of this study are available from the corresponding author upon reasonable request.
This study was approved by the Institutional Review Board of Sidra Medicine (1929504).