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Steinglass JE, Fei W, Foerde K, Touzeau C, Ruggiero J, Lloyd C, Attia E, Wang Y, Walsh BT. Change in food choice during acute treatment and the effect on longer-term outcome in patients with anorexia nervosa. Psychol Med 2024; 54:1133-1141. [PMID: 37781904 DOI: 10.1017/s0033291723002933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
BACKGROUND Restriction of food intake is a central pathological feature of anorexia nervosa (AN). Maladaptive eating behavior and, specifically, limited intake of calorie-dense foods are resistant to change and contribute to poor long-term outcomes. This study is a preliminary examination of whether change in food choices during inpatient treatment is related to longer-term clinical course. METHODS Individuals with AN completed a computerized Food Choice Task at the beginning and end of inpatient treatment to determine changes in high-fat and self-controlled food choices. Linear regression and longitudinal analyses tested whether change in task behavior predicted short-term outcome (body mass index [BMI] at discharge) and longer-term outcome (BMI and eating disorder psychopathology). RESULTS Among 88 patients with AN, BMI improved significantly with hospital treatment (p < 0.001), but Food Choice Task outcomes did not change significantly. Change in high-fat and self-controlled choices was not associated with BMI at discharge (r = 0.13, p = 0.22 and r = 0.10, p = 0.39, respectively). An increase in the proportion of high-fat foods selected (β = 0.91, p = 0.02) and a decrease in the use of self-control (β = -1.50, p = 0.001) predicted less decline in BMI over 3 years after discharge. CONCLUSIONS Short-term treatment is associated with improvement in BMI but with no significant change, on average, in choices made in a task known to predict actual eating. However, the degree to which individuals increased high-fat choices during treatment and decreased the use of self-control over food choice were associated with reduced weight loss over the following 3 years, underscoring the need to focus on changing eating behavior in treatment of AN.
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Affiliation(s)
- Joanna E Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Wenbo Fei
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Karin Foerde
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Caroline Touzeau
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Julia Ruggiero
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Caitlin Lloyd
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Evelyn Attia
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - Yuanjia Wang
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
| | - B Timothy Walsh
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, USA
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Di Lodovico L, Vansteene C, Poupon D, Gorwood P, Duriez P. Food avoidance in anorexia nervosa: associated and predicting factors. Eat Weight Disord 2023; 28:24. [PMID: 36821001 PMCID: PMC9950187 DOI: 10.1007/s40519-023-01545-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/25/2023] [Indexed: 02/24/2023] Open
Abstract
PURPOSE Qualitative food avoidance is a significant issue in patients with anorexia nervosa (AN) and restoring diet diversity is an important part of the treatment process. We aimed to identify clinical factors which drive food avoidance and predict its maintenance in patients with AN. METHODS In this multicentre longitudinal study, 130 female outpatients with AN were assessed before and after 4 months of care in clinical centres specialized in AN. We assessed levels of avoidance of 16 food items, as well as body mass index (BMI), eating disorder severity, symptoms of depression and anxiety, emotional state, daily-life functioning, and body image perception. RESULTS We found that qualitative food avoidance was associated with the clinical severity of AN, anxiety and mood dimensions, and BMI- and body image-related factors. A younger age at onset predicted the maintenance of food avoidance after 4 months of treatment. Additional exploratory analyses suggested that anxiety and negative affect caused food avoidance more than the opposite. CONCLUSION Qualitative food avoidance can be an indicator of illness severity. During treatment, focusing on reducing anxiety and negative affect may be a way to indirectly reduce food avoidance and restore diet diversity. LEVEL OF EVIDENCE Level III: Evidence obtained from cohort or case-control analytic studies.
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Affiliation(s)
- L Di Lodovico
- GHU Paris Psychiatry and Neurosciences, Clinic of Mental Illnesses and Brain Disorders, 75014, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, University of Paris, 75014, Paris, France
| | - C Vansteene
- GHU Paris Psychiatry and Neurosciences, Clinic of Mental Illnesses and Brain Disorders, 75014, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, University of Paris, 75014, Paris, France
| | - D Poupon
- GHU Paris Psychiatry and Neurosciences, Clinic of Mental Illnesses and Brain Disorders, 75014, Paris, France
| | - P Gorwood
- GHU Paris Psychiatry and Neurosciences, Clinic of Mental Illnesses and Brain Disorders, 75014, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, University of Paris, 75014, Paris, France
| | - P Duriez
- GHU Paris Psychiatry and Neurosciences, Clinic of Mental Illnesses and Brain Disorders, 75014, Paris, France. .,Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, University of Paris, 75014, Paris, France. .,CMME, GHU Paris Psychiatry and Neurosciences, 100 Rue de La Santé, 75674, Paris Cedex 14, France.
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He Q, Lian C, Peng S, Chen H, Kang Q, Chen J. Hypermethylation of the serotonin transporter gene and paternal parenting styles in untreated anorexia nervosa patients: A pilot study. Heliyon 2023; 9:e12635. [PMID: 36747546 PMCID: PMC9898629 DOI: 10.1016/j.heliyon.2022.e12635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 10/28/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
Purpose It has been reported that serotonergic systems and parenting styles are involved in the pathogenesis of anorexia nervosa (AN). The present study made attempts to examine the DNA methylation profiles in the promoter region of serotonin transporter (5-HTT) encoding gene SLC6A4, and explore the association between the methylation level and severity of symptoms, 5-HTT linked polymorphic region (5-HTTLPR) genotypes and parenting styles in untreated Chinese Han AN patients. Methods Ninety-one untreated female AN patients (ANs) and eighty-seven matched healthy controls (HCs) were analyzed for DNA methylation status at CpG islands in the promoter region of SLC6A4 using MassARRY EpiTYPER, and genotypes of 5-HTTLPR using PCR-RFLP. The severity of eating disorder (ED) symptoms was evaluated by body mass index (BMI) and Questionnaire Version of the Eating Disorders Examination (EDE-Q 6.0), and part of participants were assessed parenting styles using the short Chinese Egna Minnen av Barndoms Uppfostra (s-EMBU-C). Results ANs had greater methylation levels at CpG26.27.28, CpG 31.32, and CpG 37 than HCs (P = 0.039, 0.042, 0.018 respectively). A positive association of methylation level at CpG26.27.28 with ED symptoms detected by EDEQ-6.0 was discovered in AN group (r = 0.216, P = 0.047). Methylation level at CpG26.27.28 was showed to be or tend to be positively correlated with the parenting styles of paternal rejection (r = 0.425, P = 0.038) and paternal overprotection (r = 0.362, P = 0.062) in ANs. No significant differences were found in SLC6A4 promoter region methylation levels among 5-HTTLPR genotypes in our samples (P > 0.05) and no interaction effect between 5-HTTLPR genotypes and parenting styles on SLC6A4 promoter region methylation was observed (P > 0.05). Conclusions This study suggested that hypermethylation of SLC6A4 promoter region may be implicated in the pathological mechanisms of untreated Chinese Han female ANs, which is possibly associated with poor parenting styles. This finding may provide a direction for the epigenetic and family treatments for ANs and further investigation with larger samples is warranted.
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Suzuki S. Constructing value signals for food rewards: determinants and the integration. Curr Opin Behav Sci 2022. [DOI: 10.1016/j.cobeha.2022.101178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Foerde K, Schebendach JE, Davis L, Daw N, Walsh BT, Shohamy D, Steinglass JE. Restrictive eating across a spectrum from healthy to unhealthy: behavioral and neural mechanisms. Psychol Med 2022; 52:1755-1764. [PMID: 33046142 PMCID: PMC8449514 DOI: 10.1017/s0033291720003542] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Restriction of food intake is a central feature of anorexia nervosa (AN) and other eating disorders, yet also occurs in the absence of psychopathology. The neural mechanisms of restrictive eating in health and disease are unclear. METHODS This study examined behavioral and neural mechanisms associated with restrictive eating among individuals with and without eating disorders. Dietary restriction was examined in four groups of women (n = 110): healthy controls, dieting healthy controls, patients with subthreshold (non-low weight) AN, and patients with AN. A Food Choice Task was administered during fMRI scanning to examine neural activation associated with food choices, and a laboratory meal was conducted. RESULTS Behavioral findings distinguished between healthy and ill participants. Healthy individuals, both dieting and non-dieting, chose significantly more high-fat foods than patients with AN or subthreshold AN. Among healthy individuals, choice was primarily influenced by tastiness, whereas, among both patient groups, healthiness played a larger role. Dorsal striatal activation associated with choice was most pronounced among individuals with AN and was significantly associated with selecting fewer high-fat choices in the task and lower caloric intake in the meal the following day. CONCLUSIONS A continuous spectrum of behavior was suggested by the increasing amount of weight loss across groups. Yet, data from this Food Choice Task with fMRI suggest there is a behavioral distinction between illness and health, and that the neural mechanisms underlying food choice in AN are distinct. These behavioral and neural mechanisms of restrictive eating may be useful targets for treatment development.
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Affiliation(s)
- Karin Foerde
- Department of Psychiatry, New York State Psychiatric Institute, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - Janet E. Schebendach
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - Lauren Davis
- Department of Psychiatry, New York State Psychiatric Institute, New York, USA
| | - Nathaniel Daw
- Department of Psychology, Princeton Neuroscience Institute, Princeton University, Princeton, USA
| | - B. Timothy Walsh
- Department of Psychiatry, New York State Psychiatric Institute, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
| | - Daphna Shohamy
- Psychology Department and Zuckerman Mind Brain and Behavior Institute, Columbia University, New York, USA
| | - Joanna E. Steinglass
- Department of Psychiatry, New York State Psychiatric Institute, New York, USA
- Department of Psychiatry, Columbia University Irving Medical Center, New York, USA
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Xue AM, Foerde K, Walsh BT, Steinglass JE, Shohamy D, Bakkour A. Neural Representations of Food-Related Attributes in the Human Orbitofrontal Cortex during Choice Deliberation in Anorexia Nervosa. J Neurosci 2022; 42:109-120. [PMID: 34759030 PMCID: PMC8741166 DOI: 10.1523/jneurosci.0958-21.2021] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 11/21/2022] Open
Abstract
Decisions about what to eat recruit the orbitofrontal cortex (OFC) and involve the evaluation of food-related attributes such as taste and health. These attributes are used differently by healthy individuals and patients with disordered eating behavior, but it is unclear whether these attributes are decodable from activity in the OFC in both groups and whether neural representations of these attributes are differentially related to decisions about food. We used fMRI combined with behavioral tasks to investigate the representation of taste and health attributes in the human OFC and the role of these representations in food choices in healthy women and women with anorexia nervosa (AN). We found that subjective ratings of tastiness and healthiness could be decoded from patterns of activity in the OFC in both groups. However, health-related patterns of activity in the OFC were more related to the magnitude of choice preferences among patients with AN than healthy individuals. These findings suggest that maladaptive decision-making in AN is associated with more consideration of health information represented by the OFC during deliberation about what to eat.SIGNIFICANCE STATEMENT An open question about the OFC is whether it supports the evaluation of food-related attributes during deliberation about what to eat. We found that healthiness and tastiness information was decodable from patterns of neural activity in the OFC in both patients with AN and healthy controls. Critically, neural representations of health were more strongly related to choices in patients with AN, suggesting that maladaptive overconsideration of healthiness during deliberation about what to eat is related to activity in the OFC. More broadly, these results show that activity in the human OFC is associated with the evaluation of relevant attributes during value-based decision-making. These findings may also guide future research into the development of treatments for AN.
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Affiliation(s)
- Alice M Xue
- Mortimer B. Zuckerman Mind, Brain, Behavior Institute, Columbia University, New York, New York 10027
- Department of Psychology, Columbia University, New York, New York 10027
| | - Karin Foerde
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York 10032
- New York State Psychiatric Institute, New York, New York 10032
| | - B Timothy Walsh
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York 10032
- New York State Psychiatric Institute, New York, New York 10032
| | - Joanna E Steinglass
- Department of Psychiatry, Columbia University Irving Medical Center, New York, New York 10032
- New York State Psychiatric Institute, New York, New York 10032
| | - Daphna Shohamy
- Mortimer B. Zuckerman Mind, Brain, Behavior Institute, Columbia University, New York, New York 10027
- Department of Psychology, Columbia University, New York, New York 10027
- Kavli Institute for Brain Science, Columbia University, New York, New York 10027
| | - Akram Bakkour
- Mortimer B. Zuckerman Mind, Brain, Behavior Institute, Columbia University, New York, New York 10027
- Department of Psychology, Columbia University, New York, New York 10027
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Schnepper R, Richard A, Georgii C, Arend AK, Naab S, Voderholzer U, Wilhelm FH, Blechert J. Bad mood food? Increased versus decreased food cue reactivity in anorexia nervosa and bulimia nervosa during negative emotions. EUROPEAN EATING DISORDERS REVIEW 2021; 29:756-769. [PMID: 34176193 DOI: 10.1002/erv.2849] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/02/2021] [Accepted: 05/31/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Emotion regulation difficulties in anorexia nervosa (AN) and bulimia nervosa (BN) might underlie bingeing and purging in BN, extreme fasting in AN, or combinations of these symptoms in binge-purge type AN. In this study, we tested for decreased food cue reactivity in response to negative emotions in AN, and the opposite pattern for BN. Furthermore, we explored subgroup differences (restrictive vs. binge-purging AN; history of AN in BN). METHOD Patients with AN (n = 41), BN (n = 39), and matched controls (n = 70) completed an emotional eating questionnaire. In a laboratory experiment, we induced negative emotions and measured food cue reactivity (pleasantness, desire to eat (DTE), and corrugator muscle activity). RESULTS AN reported emotional undereating, while BN reported emotional overeating. In the laboratory task, BN showed increased DTE and an appetitive corrugator response during negative emotions, selectively towards high-calorie foods. AN showed generalized reduced cue reactivity to high-calorie food regardless of emotional state. This pattern appears to be characteristic of restrictive AN, while cue reactivity of both BN subgroups pointed towards emotional overeating. CONCLUSIONS The emotional over- versus undereating framework might help to explain bingeing and restricting along the anorectic-bulimic disorder spectrum, which calls for novel transdiagnostic theories and subgroup-specific treatments.
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Affiliation(s)
- Rebekka Schnepper
- Department of Psychology, Division of Health Psychology, Paris-Lodron-University of Salzburg, Salzburg, Austria
| | - Anna Richard
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Claudio Georgii
- Department of Psychology, Division of Health Psychology, Paris-Lodron-University of Salzburg, Salzburg, Austria
| | - Ann-Kathrin Arend
- Department of Psychology, Division of Health Psychology, Paris-Lodron-University of Salzburg, Salzburg, Austria
| | - Silke Naab
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany
| | - Ulrich Voderholzer
- Schoen Clinic Roseneck, Prien am Chiemsee, Germany.,Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany.,Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Freiburg, Germany
| | - Frank H Wilhelm
- Department of Psychology, Division of Clinical Psychology and Psychopathology, Paris-Lodron-University of Salzburg, Salzburg, Austria
| | - Jens Blechert
- Department of Psychology, Division of Health Psychology, Paris-Lodron-University of Salzburg, Salzburg, Austria
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Healthy decisions in the cued-attribute food choice paradigm have high test-retest reliability. Sci Rep 2021; 11:12844. [PMID: 34145325 PMCID: PMC8213742 DOI: 10.1038/s41598-021-91933-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/02/2021] [Indexed: 12/01/2022] Open
Abstract
Food choice paradigms are commonly used to study decision mechanisms, individual differences, and intervention efficacy. Here, we measured behavior from twenty-three healthy young adults who completed five repetitions of a cued-attribute food choice paradigm over two weeks. This task includes cues prompting participants to explicitly consider the healthiness of the food items before making a selection, or to choose naturally based on whatever freely comes to mind. We found that the average patterns of food choices following both cue types and ratings about the palatability (i.e. taste) and healthiness of the food items were similar across all five repetitions. At the individual level, the test-retest reliability for choices in both conditions and healthiness ratings was excellent. However, test-retest reliability for taste ratings was only fair, suggesting that estimates about palatability may vary more from day to day for the same individual.
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Foerde K, Walsh BT, Dalack M, Daw N, Shohamy D, Steinglass JE. Changes in brain and behavior during food-based decision-making following treatment of anorexia nervosa. J Eat Disord 2021; 9:48. [PMID: 33865441 PMCID: PMC8052661 DOI: 10.1186/s40337-021-00402-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/31/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Anorexia nervosa is a severe illness with a high mortality rate, driven in large part by severe and persistent restriction of food intake. A critical challenge is to identify brain mechanisms associated with maladaptive eating behavior and whether they change with treatment. This study tested whether food choice-related caudate activation in anorexia nervosa changes with treatment. METHODS Healthy women (n = 29) and women hospitalized with anorexia nervosa (n = 24), ages 18 to 40 years, completed a Food Choice Task during fMRI scanning at two timepoints. Among patients, procedures occurred upon hospital admission (Time 1) and again after patients had gained to normal weight (Time 2). Healthy controls were tested twice at an interval group-matched to patients. Choice-related caudate activation was assessed at each timepoint, using parametric analyses in an a priori region of interest. RESULTS Among patients, the proportion of high-fat foods selected did not change over time (p's > 0.47), but decreased neural activity in the caudate after treatment was associated with increased selection of high-fat foods (r23 = - 0.43, p = 0.037). Choice-related caudate activation differed among women with anorexia nervosa vs healthy control women at Time 1 (healthy control: M = 0.15 ± 0.87, anorexia nervosa: M = 0.70 ± 1.1, t51 = - 2.05, p = 0.045), but not at Time 2 (healthy control: M = 0.18 ± 1.0, anorexia nervosa: M = 0.37 ± 0.99, t51 = - 0.694, p = 0.49). CONCLUSIONS Caudate activity was more strongly associated with decisions about food among individuals with anorexia nervosa relative to healthy comparison individuals prior to treatment, and decreases in caudate engagement among individuals with anorexia nervosa undergoing treatment were associated with increases in high-fat food choices. The findings underscore the need for treatment development that more successfully alters both eating behavior and the neural mechanisms that guide it.
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Affiliation(s)
- Karin Foerde
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA.,Psychiatry Department, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA
| | - B Timothy Walsh
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA.,Psychiatry Department, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA
| | - Maya Dalack
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA
| | - Nathaniel Daw
- Princeton Neuroscience Institute, Department of Psychology, Princeton University, Princeton, NJ, 08540, USA
| | - Daphna Shohamy
- Psychology Department and Zuckerman Mind Brain and Behavior Institute, Columbia University, 3227 Broadway, New York, NY, 10027, USA
| | - Joanna E Steinglass
- New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA. .,Psychiatry Department, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA.
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