1
|
Foinant D, Lafraire J, Thibaut JP. Relationships between executive functions and food rejection dispositions in young children. Appetite 2022; 176:106102. [PMID: 35660076 DOI: 10.1016/j.appet.2022.106102] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/13/2022] [Accepted: 05/30/2022] [Indexed: 11/27/2022]
Abstract
This study examined the associations between the two main kinds of food rejection, neophobia and pickiness, and executive functions in young children. Caregivers of children (n = 240) aged 3-6 years completed measures of their children's food neophobia and pickiness. A battery of tests measured children's executive functions and world knowledge. Children with higher levels of neophobia and pickiness had lower cognitive flexibility scores than children with lower levels of food rejection. Moreover, the association between food neophobia and cognitive flexibility was stronger than the association between food pickiness and cognitive flexibility. Working memory, inhibition, and world knowledge were not related to children's food rejection. These findings unraveled for the first time the negative relationship between cognitive flexibility and the main psychological barriers to dietary variety. These results contribute to a better understanding of the set of cognitive factors that are associated with food rejection in young children.
Collapse
Affiliation(s)
- Damien Foinant
- Université Bourgogne Franche-Comté, LEAD - CNRS UMR-5022, Dijon, France; Institut Paul Bocuse Research Center, Ecully, France.
| | | | | |
Collapse
|
2
|
Broomfield C, Stedal K, Touyz S. The Neuropsychological Profile of Severe and Enduring Anorexia Nervosa: A Systematic Review. Front Psychol 2021; 12:708536. [PMID: 34408714 PMCID: PMC8365190 DOI: 10.3389/fpsyg.2021.708536] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 06/30/2021] [Indexed: 11/13/2022] Open
Abstract
Characteristics of Severe and Enduring Anorexia Nervosa (SE-AN) are being investigated to differentiate the patients experiencing SE-AN from those at earlier stages of the AN disease. The current systematic review was the first step in exploring neuropsychological functioning as a potentially identifying characteristic for long-term presentations. With a subgroup of AN patients reflecting a unique neuropsychological profile that is proportionate to the quantity of patients that go on to develop SE-AN, it was the aim of this review to assess neuropsychological functioning in the later stage of the disease. In accordance with PRISMA guidelines, a literature search was conducted using four electronic databases (PsycINFO, MEDLINE, Web of Science, and Scopus) for neuropsychological research on AN participants with a seven or more year illness duration. Datasets that met inclusion criteria were screened for SE-AN participants (N = 166) and neuropsychological data extracted together with potentially confounding variables and information required to conduct a quality assessment. In research investigating decision-making, participants with a SE-AN presentation demonstrated significantly lower functioning compared to healthy controls. There was conflicting evidence for differences in intellectual functioning and set-shifting abilities with no variability indicated in central coherence, memory, attention, reasoning, or processing speed. If findings from this preliminary analysis are confirmed through empirical research, implications include earlier identification of SE-AN patients and more effective treatment development.
Collapse
Affiliation(s)
| | - Kristin Stedal
- Regional Department for Eating Disorders, Oslo University Hospital, Ullevål, Norway
| | - Stephen Touyz
- Inside Out Institute, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
3
|
Kerr-Gaffney J, Halls D, Leppanen J, Tchanturia K. Exploring neuropsychological and socio-emotional task performance in anorexia nervosa: A cluster analytic approach. EUROPEAN EATING DISORDERS REVIEW 2021; 29:802-810. [PMID: 34245076 DOI: 10.1002/erv.2851] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/20/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of this study was to characterise heterogeneity in neuropsychological and socio-emotional task performance in young women with anorexia nervosa (AN) using hierarchical cluster analysis. Further, we aimed to test whether cognitive profiles were associated with differences in clinical variables (body mass index, illness duration and age at diagnosis), psychopathology (eating disorder, autistic symptoms, anxiety and depression) and functional impairment. METHOD Set-shifting, central coherence and theory of mind abilities were measured in 118 women with acute or remitted AN. A hierarchical cluster analysis using Ward's method with a Euclidean distance measure was performed with the neuropsychological and socio-emotional variables. Differences between clusters were assessed using ANOVAs. RESULTS Four clusters emerged, with significant differences in neuropsychological and socio-emotional task performance. There were no significant differences between clusters in clinical variables, psychopathology or functional impairment, however, these analyses lacked power due to small cluster sizes. CONCLUSIONS Our results demonstrate significant heterogeneity in cognitive profiles in AN, supporting a more personalised approach to treatment. Studies in larger samples are required to establish whether these variables map onto clinically significant differences in aetiology, clinical presentation, comorbidity patterns and/or treatment responses.
Collapse
Affiliation(s)
- Jess Kerr-Gaffney
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Daniel Halls
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Jenni Leppanen
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Kate Tchanturia
- Department of Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, London, UK.,Department of Psychology, Ilia State University, Tbilisi, Georgia
| |
Collapse
|
4
|
Wang H, He H, Yu Y, Su X, Li F, Li J. Maternal diabetes and the risk of feeding and eating disorders in offspring: a national population-based cohort study. BMJ Open Diabetes Res Care 2020; 8:8/1/e001738. [PMID: 33077476 PMCID: PMC7574887 DOI: 10.1136/bmjdrc-2020-001738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 09/02/2020] [Accepted: 09/23/2020] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Previous studies have suggested that maternal diabetes may have programming effect on fetal brain development. However, little is known about the association between maternal diabetes and neurodevelopmental disorders in offspring that mainly manifest in infancy or early childhood. We aimed to examine the association between maternal diabetes before or during pregnancy and feeding and eating disorders (FED) in offspring. RESEARCH DESIGN AND METHODS This population-based cohort study included 1 193 891 singletons born in Denmark during 1996-2015. These children were followed from birth until the onset of FED, the sixth birthday, death, emigration, or 31 December 2016, whichever came first. Relative risk of FED was estimated by HRs using Cox proportional hazards model. RESULTS A total of 40 867 (3.4%) children were born to mothers with diabetes (20 887 with pregestational diabetes and 19 980 with gestational diabetes). The incidence rates of FED were 6.8, 4.6 and 2.9 per 10 000 person-years among children of mothers with pregestational diabetes, gestational diabetes and no diabetes, respectively. Offspring of mothers with diabetes had a 64% increased risk of FED (HR 1.64; 95% CI 1.36 to 1.99; p<0.001). The HR for maternal pregestational diabetes and gestational diabetes was 2.01 (95% CI 1.59 to 2.56; p<0.001) and 1.28 (95% CI 0.95 to 1.72; p=0.097), respectively. The increased risk was more pronounced among offspring of mothers with diabetic complications (HR 2.97; 95% CI 1.54 to 5.72; p=0.001). CONCLUSIONS Maternal diabetes was associated with an increased risk of FED in offspring in infancy and early childhood. Our findings can inform clinical decisions for better management of maternal diabetes, in particular before pregnancy, which can reduce early neurodevelopmental problems in the offspring.
Collapse
Affiliation(s)
- Hui Wang
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hua He
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Developmental and Behavioural Pediatric Department & Child Primary Care Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yongfu Yu
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Xiujuan Su
- Clinical Research Center, Shanghai First Maternity and Infant Hospital Affiliated to Tongji University, Shanghai, China
| | - Fei Li
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Developmental and Behavioural Pediatric Department & Child Primary Care Department, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jiong Li
- MOE-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
- School of Global Health, Chinese Center for Tropical Disease Research, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
5
|
A further assessment of decision-making in anorexia nervosa. Eur Psychiatry 2020; 30:121-7. [DOI: 10.1016/j.eurpsy.2014.08.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 05/20/2014] [Accepted: 08/18/2014] [Indexed: 11/20/2022] Open
Abstract
AbstractObjective:Anorexia nervosa (AN) may be associated with impaired decision-making. Cognitive processes underlying this impairment remain unclear, mainly because previous assessments of this complex cognitive function were completed with a single test. Furthermore, clinical features such as mood status may impact this association. We aim to further explore the hypothesis of altered decision-making in AN.Method:Sixty-three adult women with AN and 49 female controls completed a clinical assessment and were assessed by three tasks related to decision-making [Iowa Gambling Task (IGT), Balloon Analogue Risk Task (BART), Probabilistic Reversal Learning Task (PRLT)].Results:People with AN had poorer performance on the IGT and made less risky choices on the BART, whereas performances were not different on PRLT. Notably, AN patients with a current major depressive disorder showed similar performance to those with no current major depressive disorder.Conclusion:These results tend to confirm an impaired decision making-process in people with AN and suggest that various cognitive processes such as inhibition to risk-taking or intolerance of uncertainty may underlie this condition Furthermore, these impairments seem unrelated to the potential co-occurent major depressive disorders.
Collapse
|
6
|
Harrison A, Stavri P, Ormond L, McEnemy F, Akyol D, Qureshi A, Al-Khairulla H. Cognitive remediation therapy for adolescent inpatients with severe and complex anorexia nervosa: A treatment trial. EUROPEAN EATING DISORDERS REVIEW 2018. [PMID: 29542258 DOI: 10.1002/erv.2584] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Cognitive remediation therapy (CRT) is a low-intensity treatment adjunct for individuals with severe and complex anorexia nervosa (AN) with difficulties in globally oriented, flexible thinking. Previously trialled in adults, this study investigated whether individual and group CRT was a feasible, acceptable, and beneficial treatment for 125 adolescent inpatients with severe and complex AN. Seventy patients (mean age = 15.22, SD = 1.44) received 10 sessions of individual CRT, and 55 patients (mean age = 14.89, SD = 1.74) received 10 sessions of group CRT. In individual CRT, 1 patient (1.43%) dropped out, and there were medium-sized improvements in bigger picture thinking and set-shifting, small to large-sized improvements in switching-related initiation and inhibition skills, and large-sized improvements in motivation to recover. Group CRT had higher dropout (9.09%; n = 5) and produced small-sized improvements in global information processing and medium-sized improvements in self-reported cognitive flexibility and high acceptability ratings. Data suggest that a randomised controlled trial for adolescents with AN is warranted.
Collapse
Affiliation(s)
- Amy Harrison
- Department of Psychology and Human Development, University College London, London, UK.,Ellern Mede Service for Eating Disorders, London, UK
| | - Pamela Stavri
- Ellern Mede Service for Eating Disorders, London, UK
| | - Lynn Ormond
- Ellern Mede Service for Eating Disorders, London, UK
| | | | - Dilan Akyol
- Ellern Mede Service for Eating Disorders, London, UK
| | - Annum Qureshi
- Ellern Mede Service for Eating Disorders, London, UK
| | | |
Collapse
|
7
|
Giombini L, Turton R, Turco M, Nesbitt S, Lask B. The use of cognitive remediation therapy on a child adolescent eating disorder unit: Patients and therapist perspectives. Clin Child Psychol Psychiatry 2017; 22:288-300. [PMID: 27432543 DOI: 10.1177/1359104516657859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Cognitive remediation therapy (CRT) is an intervention for anorexia nervosa (AN) that focuses on ameliorating the neuropsychological inefficiencies that underlie the illness. The current literature has reported promising results regarding its efficacy as an intervention for AN. However, there is a scarcity of studies considering the implementation of CRT in a child and adolescent population. This article describes an individual CRT therapy programme for children and adolescents with AN delivered on an inpatient unit for eating disorders. It considers the therapeutic process including the differing viewpoints of the patients and the therapists. The article concludes that CRT can be viewed as an engaging therapeutic intervention that could be useful as an additional treatment for AN.
Collapse
Affiliation(s)
| | - Robert Turton
- 2 Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Matteo Turco
- 1 Rhodes Wood Hospital, Partnerships in Care, UK
| | | | - Bryan Lask
- 1 Rhodes Wood Hospital, Partnerships in Care, UK
| |
Collapse
|
8
|
Herbrich L, van Noort B, Pfeiffer E, Lehmkuhl U, Winter S, Kappel V. Follow-up Assessment of Cognitive Remediation Therapy in Adolescent Anorexia Nervosa: A Pilot Study. EUROPEAN EATING DISORDERS REVIEW 2017; 25:104-113. [DOI: 10.1002/erv.2501] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 11/18/2016] [Accepted: 12/02/2016] [Indexed: 11/10/2022]
Affiliation(s)
- Laura Herbrich
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
| | - Betteke van Noort
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
| | - Ernst Pfeiffer
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
| | - Ulrike Lehmkuhl
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
| | - Sibylle Winter
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
| | - Viola Kappel
- Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy; Charité - Universitätsmedizin Berlin; Germany
| |
Collapse
|
9
|
Mishra A, Anand M, Umesh S. Neurobiology of eating disorders - an overview. Asian J Psychiatr 2017; 25:91-100. [PMID: 28262179 DOI: 10.1016/j.ajp.2016.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 09/03/2016] [Accepted: 10/09/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Anand Mishra
- Central Institute of Psychiatry, Ranchi, Jharkhand, India.
| | - Manu Anand
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Shreekantiah Umesh
- K.S. Mani Centre for Cognitive Neurosciences, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| |
Collapse
|
10
|
Rößner A, Juniak I, van Noort BM, Pfeiffer E, Lehmkuhl U, Kappel V. Cognitive Flexibility in Juvenile Anorexia Nervosain Relation to Comorbid Symptoms of Depression, Obsessive Compulsive Symptoms and Duration of Illness. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2016; 45:371-380. [PMID: 27937062 DOI: 10.1024/1422-4917/a000493] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Whereas the evidence in adolescents is inconsistent, anorexia nervosa (AN) in adults is characterized by weak cognitive flexibility. This study investigates cognitive flexibility in adolescents with AN and its potential associations with symptoms of depression, obsessive compulsive disorder (OCD), and duration of illness. METHODS 69 patients and 63 age-matched healthy controls (HC) from 9 till 19 years of age were assessed using the Trail-Making Test (TMT) and self-report questionnaires. RESULTS In hierarchical regression analyses, set-shifting ability did not differ between AN and HC, whereas AN patients reported significantly higher rates of depression symptoms and OCD symptoms. Age significantly predicted set-shifting in the total sample. Only among AN patients aged 14 years and older did set-shifting decline with increasing age. DISCUSSION The presence of AN with depression or OCD symptoms or the duration of illness do not influence cognitive flexibility in children and adolescents. Early interventions may be helpful to prevent a decline in cognitive flexibility in adolescent AN with increasing age.
Collapse
Affiliation(s)
- Anne Rößner
- 1 Charité-Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy.,2 These authors contributed equally to this manuscript
| | - Izabela Juniak
- 1 Charité-Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy.,2 These authors contributed equally to this manuscript
| | | | | | | | - Viola Kappel
- 2 These authors contributed equally to this manuscript
| |
Collapse
|
11
|
Sultson H, van Meer F, Sanders N, van Elburg AA, Danner UN, Hoek HW, Adan RAH, Smeets PAM. Associations between neural correlates of visual stimulus processing and set-shifting in ill and recovered women with anorexia nervosa. Psychiatry Res Neuroimaging 2016; 255:35-42. [PMID: 27518327 DOI: 10.1016/j.pscychresns.2016.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 04/27/2016] [Accepted: 07/07/2016] [Indexed: 11/18/2022]
Abstract
Women ill with anorexia nervosa (AN) have been shown to exhibit altered cognitive functioning, particularly poor set-shifting (SS). In this study, we investigated whether brain activation in frontal and parietal regions during visual stimulus processing correlates with SS ability. Women currently ill with AN (AN; N=14), recovered women (REC; N=14) and healthy controls (HC; N=15), viewed alternating blocks of food and non-food pictures during functional magnetic resonance imaging (fMRI). The Berg's Card Sorting Task was completed outside the scanner to measure SS. A priori regions of interest (ROIs) were defined in frontal and parietal regions. The activation during visual stimulus processing in several ROIs correlated positively with poor SS ability in REC, particularly in the left dorsal anterior cingulate cortex (dACC). The correlations with poor SS ability were opposite in AN patients, particularly in the right dACC. These findings underscore that addressing heightened levels of cognitive control associated with higher frontal activation could reduce cognitive inflexibility in recovered women. In AN, greater activation in frontal and parietal regions might be necessary to perform at normal levels during various tasks. Thus, weight restoration could be necessary for AN patients prior to addressing cognitive inflexibility.
Collapse
Affiliation(s)
- Hedvig Sultson
- Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, Q02.4.45, 3584 CX Utrecht, The Netherlands
| | - Floor van Meer
- Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, Q02.4.45, 3584 CX Utrecht, The Netherlands
| | - Nicole Sanders
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annemarie A van Elburg
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands; Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Unna N Danner
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands
| | - Hans W Hoek
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands; Parnassia Psychiatric Institute, The Hague, The Netherlands; Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Roger A H Adan
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul A M Smeets
- Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, Q02.4.45, 3584 CX Utrecht, The Netherlands; Division of Human Nutrition, Wageningen University & Research Center, Wageningen, The Netherlands.
| |
Collapse
|
12
|
Stedal K, Dahlgren CL. Neuropsychological assessment in adolescents with anorexia nervosa - exploring the relationship between self-report and performance-based testing. J Eat Disord 2015; 3:27. [PMID: 26269743 PMCID: PMC4533954 DOI: 10.1186/s40337-015-0062-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 06/30/2015] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Research investigating the relationship between neuropsychological test performances and self-reported cognitive functioning in patients with anorexia nervosa (AN) is limited, and existing experimental studies only demonstrate a low-to-moderate relationship between the performance based tests and everyday behaviour. The objective of the current study was to explore the association between neuropsychological test performance and self-reports of executive functioning in adolescents with AN. METHOD Twenty adolescent females diagnosed with AN, aged 13 to 18, completed neuropsychological test battery "the Ravello Profile" and the self-report version of the Behaviour Rating Inventory of Executive Function (BRIEF-SR). The BRIEF Parent Form (BRIEF-PF) was employed to provide additional information of the patients' executive functioning. RESULTS Based on group level analyses, the results support the existing literature in failing to find consistent weaknesses in neuropsychological functioning in adolescents with AN. Further, with few exceptions, the Ravello Profile was insubstantially correlated with the majority of the BRIEF clinical scales, indicative of a lack of association between these two assessment methods. CONCLUSION The current study accentuates the need for concern regarding the generalizability of neuropsychological assessments in adolescent patients with AN.
Collapse
Affiliation(s)
- Kristin Stedal
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Postboks 4956 Nydalen, 0424 Oslo, Norway
| | - Camilla Lindvall Dahlgren
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Postboks 4956 Nydalen, 0424 Oslo, Norway
| |
Collapse
|
13
|
von Hausswolff-Juhlin Y, Brooks SJ, Larsson M. The neurobiology of eating disorders--a clinical perspective. Acta Psychiatr Scand 2015; 131:244-55. [PMID: 25223374 DOI: 10.1111/acps.12335] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/18/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To provide a neurobiological basis of eating disorders for clinicians and to enlighten how comparing neurobiology and eating disorders with neurobiology of other psychiatric illnesses can improve treatment protocols. METHOD A selective review on the neurobiology of eating disorders. The article focuses on clinical research on humans with consideration of the anatomical, neural, and molecular basis of eating disorders. RESULTS The neurobiology of people with eating disorders is altered. Many of the neurobiological regions, receptors, and chemical substrates that are affected in other mental illnesses also play an important role in eating disorders. More knowledge about the neurobiological overlap between eating disorders and other psychiatric populations will help when developing treatment protocols not the least regarding that comorbidity is common in patients with EDs. CONCLUSION Knowledge about the underlying neurobiology of eating disorders will improve treatment intervention and will benefit from comparisons with other mental illnesses and their treatments.
Collapse
Affiliation(s)
- Y von Hausswolff-Juhlin
- Center for Psychiatry Research, Karolinska Institute, Stockholm, Sweden; Stockholm Centre for Eating Disorders, Stockholm, Sweden
| | | | | |
Collapse
|
14
|
Renwick B, Musiat P, Lose A, DeJong H, Broadbent H, Kenyon M, Loomes R, Watson C, Ghelani S, Serpell L, Richards L, Johnson-Sabine E, Boughton N, Treasure J, Schmidt U. Neuro- and social-cognitive clustering highlights distinct profiles in adults with anorexia nervosa. Int J Eat Disord 2015; 48:26-34. [PMID: 25363476 DOI: 10.1002/eat.22366] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/19/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study aimed to explore the neuro- and social-cognitive profile of a consecutive series of adult outpatients with anorexia nervosa (AN) when compared with widely available age and gender matched historical control data. The relationship between performance profiles, clinical characteristics, service utilization, and treatment adherence was also investigated. METHOD Consecutively recruited outpatients with a broad diagnosis of AN (restricting subtype AN-R: n = 44, binge-purge subtype AN-BP: n = 33 or Eating Disorder Not Otherwise Specified-AN subtype EDNOS-AN: n = 23) completed a comprehensive set of neurocognitive (set-shifting, central coherence) and social-cognitive measures (Emotional Theory of Mind). Data were subjected to hierarchical cluster analysis and a discriminant function analysis. RESULTS Three separate, meaningful clusters emerged. Cluster 1 (n = 45) showed overall average to high average neuro- and social- cognitive performance, Cluster 2 (n = 38) showed mixed performance characterized by distinct strengths and weaknesses, and Cluster 3 (n = 17) showed poor overall performance (Autism Spectrum disorder (ASD) like cluster). The three clusters did not differ in terms of eating disorder symptoms, comorbid features or service utilization and treatment adherence. A discriminant function analysis confirmed that the clusters were best characterized by performance in perseveration and set-shifting measures. DISCUSSION The findings suggest that considerable neuro- and social-cognitive heterogeneity exists in patients with AN, with a subset showing ASD-like features. The value of this method of profiling in predicting longer term patient outcomes and in guiding development of etiologically targeted treatments remains to be seen.
Collapse
Affiliation(s)
- Beth Renwick
- Department of Psychological Medicine, Section of Eating Disorders, King's College London, Institute of Psychiatry, London, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Kjaersdam Telléus G, Jepsen JR, Bentz M, Christiansen E, Jensen SOW, Fagerlund B, Thomsen PH. Cognitive profile of children and adolescents with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2014; 23:34-42. [PMID: 25504443 PMCID: PMC4309487 DOI: 10.1002/erv.2337] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 12/21/2022]
Abstract
Objective Few studies of cognitive functioning in children and adolescents with anorexia nervosa (AN) have been conducted. The aim of this study was to examine the neurocognitive and intelligence profile of this clinical group. Method The study was a matched case–control (N = 188), multi-centre study including children and adolescents with AN (N = 94) and healthy control participants (N = 94). Results The results suggest that Full Scale Intelligence Quotient (Wechsler Intelligence Scale for Children-III/Wechsler Adult Intelligence Scale-III) in this patient group is close to the normal population mean of 100. Individuals with AN exhibited significantly worse performance in nonverbal intelligence functions (i.e. Wechsler Intelligence Scale for Children-III/Wechsler Adult Intelligence Scale-III, Perceptual Organization Index) and in verbal memory (Test of Memory and Learning—Second Edition, Memory for Stories) and motor speed (Cambridge Neuropsychological Test Automated Battery, Simple and Choice Reaction Time) compared with healthy control participants. No significant difference in set-shifting ability (Cambridge Neuropsychological Test Automated Battery, Intra-Extra Dimensional Set Shift and Trail Making Test B) was found. Conclusions Inefficiency in nonverbal intelligence functions and in specific cognitive functions was found in this study of children and adolescents with AN. © 2014 The Authors. European Eating Disorders Review published by John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Gry Kjaersdam Telléus
- Unit for Psychiatric Research, Aalborg University Hospital, Aalborg, Denmark; Section of Eating Disorders, Unit for Child and Adolescent Psychiatry, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | | | | | | | | | | | | |
Collapse
|
16
|
Abbate-Daga G, Buzzichelli S, Marzola E, Amianto F, Fassino S. Clinical investigation of set-shifting subtypes in anorexia nervosa. Psychiatry Res 2014; 219:592-7. [PMID: 25017616 DOI: 10.1016/j.psychres.2014.06.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 06/08/2014] [Accepted: 06/17/2014] [Indexed: 11/17/2022]
Abstract
While evidence continues to accumulate on the relevance of cognitive inflexibility in anorexia nervosa (AN), its clinical correlates remain unclear. We aimed at examining the relationship between set-shifting and clinical variables (i.e., eating psychopathology, depression, and personality) in AN. Ninety-four individuals affected by AN and 59 healthy controls (HC) were recruited. All participants were assessed using: Eating Disorders Inventory-2 (EDI-2), Temperament and Character Inventory (TCI), Beck Depression Inventory (BDI), and Wisconsin Card Sorting Test (WCST). The AN group scored worse than HCs on set-shifting. According to their neuropsychological performances, AN patients were split into two groups corresponding to poor (N=30) and intact (N=64) set-shifting subtypes. Interoceptive awareness, impulse regulation, and maturity fears on the EDI-2 and depression on the BDI differed across all groups (HC, intact, and poor set-shifting subtype). Self-directedness on the TCI differed significantly among all groups. Cooperativeness and reward dependence differed instead only between HC and AN poor set-shifting subtype. After controlling for depression, only interoceptive awareness remained significant with reward dependence showing a trend towards statistical significance. These findings suggest that multiple clinical variables may be correlated with set-shifting performances in AN. The factors contributing to impaired cognitive inflexibility could be more complex than heretofore generally considered.
Collapse
Affiliation(s)
- Giovanni Abbate-Daga
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy.
| | - Sara Buzzichelli
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Enrica Marzola
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Federico Amianto
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| | - Secondo Fassino
- Eating Disorders Center for Treatment and Research, Department of Neuroscience, University of Turin, Turin, Italy
| |
Collapse
|
17
|
Lindvall Dahlgren C, Rø O. A systematic review of cognitive remediation therapy for anorexia nervosa - development, current state and implications for future research and clinical practice. J Eat Disord 2014; 2:26. [PMID: 25254110 PMCID: PMC4173002 DOI: 10.1186/s40337-014-0026-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 08/27/2014] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To systematically review studies of cognitive remediation therapy (CRT) for anorexia nervosa (AN), and to discuss findings with references to clinical practice and future research. METHOD The literature was reviewed using the PubMed, Web of Science and PsycINFO search terms "cognitive remediation therapy" AND "anorexia nervosa". Papers published online between 2005 and 2013 were selected on the basis of three inclusion criteria: 1) studies of any design focusing on CRT for AN, 2) papers that were written in English or had an available published English translation, and 3) papers published in peer reviewed journals. RESULTS A total of 45 papers were identified of which 21 were recognized as being relevant for the review. Relevant papers were divided into three different categories 1) single case reports, 2) case series and 3) randomised controlled trials (RCTs). Single case studies and case series yielded strong evidence of feasibility and acceptability of CRT for AN despite great variety in sample compositions. Four RCTs demonstrate that CRT has the potential of enhancing the effectiveness of current treatments, reduce attrition, increase cognitive set-shifting abilities and quality of life, as well as reduce eating disorder psychopathology. DISCUSSION The number of CRT studies published is growing rapidly, in particular RCTs. Further research is needed to define the primary aim of delivering CRT to patients with eating disorders, and to establish how to best measure the effect of the intervention. Moreover, researchers and clinicians should focus on identifying and assessing specific versus non-specific CRT contributions, and explore long-term effects of the intervention. It is imperative that adolescent RCTs are conducted to evaluate how CRT may be effective as a treatment for this young patient group.
Collapse
Affiliation(s)
- Camilla Lindvall Dahlgren
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål HF, Oslo, Norway ; Department of Psychiatry, Centre for Research on Eating Disorders at Oxford (CREDO), University of Oxford, Warneford Hospital, Oxford, UK
| | - Oyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Ullevål HF, Oslo, Norway ; Division of Mental Health and Addiction, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
18
|
Dahlgren CL, Lask B, Landrø NI, Rø Ø. Patient and Parental Self-reports of Executive Functioning in a Sample of Young Female Adolescents with Anorexia Nervosa Before and After Cognitive Remediation Therapy. EUROPEAN EATING DISORDERS REVIEW 2013; 22:45-52. [DOI: 10.1002/erv.2265] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 09/03/2013] [Accepted: 09/23/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Camilla Lindvall Dahlgren
- Regional Department for Eating Disorders, Division of Mental Health and Addiction; Oslo University Hospital Ullevål HF; Oslo Norway
| | - Bryan Lask
- Regional Department for Eating Disorders, Division of Mental Health and Addiction; Oslo University Hospital Ullevål HF; Oslo Norway
- Feeding and Eating Disorders Service, Department of Child and Adolescent Mental Health; Great Ormond Street Hospital for Children, NHS Trust; London UK
- Care UK; London UK
| | - Nils Inge Landrø
- Clinical Neuroscience Research Group, Department of Psychology; University of Oslo; Oslo Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction; Oslo University Hospital Ullevål HF; Oslo Norway
| |
Collapse
|
19
|
Kanakam N, Treasure J. A review of cognitive neuropsychiatry in the taxonomy of eating disorders: state, trait, or genetic? Cogn Neuropsychiatry 2013; 18:83-114. [PMID: 22994309 DOI: 10.1080/13546805.2012.682362] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A greater understanding of neuropsychological traits in eating disorders may help to construct a more biologically based taxonomy. The aim of this paper is to review the current evidence base of neuropsychological traits in people with eating disorders. Evidence of difficulties in set shifting, weak central coherence, emotional processing difficulties, and altered reward sensitivity is presented for people both in the acute and recovered phase of the illness. These traits are also seen in first degree relatives. At present there is limited research linking these neuropsychological traits with genetic and neuroanatomical measures. In addition to improving the taxonomy of eating disorders, neuropsychological traits may be of value in producing targeted treatments.
Collapse
Affiliation(s)
- Natalie Kanakam
- Section of Eating Disorders, Psychological Medicine, Institute of Psychiatry, King's College London, London, UK.
| | | |
Collapse
|
20
|
Galimberti E, Fadda E, Cavallini MC, Martoni RM, Erzegovesi S, Bellodi L. Executive functioning in anorexia nervosa patients and their unaffected relatives. Psychiatry Res 2013; 208:238-44. [PMID: 23122554 DOI: 10.1016/j.psychres.2012.10.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Revised: 10/01/2012] [Accepted: 10/03/2012] [Indexed: 11/26/2022]
Abstract
Formal genetic studies suggested a substantial genetic influence for anorexia nervosa (AN), but currently results are inconsistent. The use of the neurocognitive endophenotype approach may facilitate our understanding of the AN pathophysiology. We investigated decision-making, set-shifting and planning in AN patients (n=29) and their unaffected relatives (n=29) compared to healthy probands (n=29) and their relatives (n=29). The Iowa Gambling Task (IGT), the Tower of Hanoi (ToH) and the Wisconsin Card Sorting Test (WCST) were administered. Concordance rates and heritability indices were also calculated in probands/relatives. Impaired performance on the IGT and the WCST were found in both AN probands and their relatives, although planning appeared to be preserved. The IGT heritability index suggested the presence of genetic effects that influence this measure. No evidence for genetic effects was found for the WCST. The results suggest the presence of a shared dysfunctional executive profile in women with AN and their unaffected relatives, characterized by deficient decision-making and set-shifting. Concordance analysis strongly suggests that these impairments aggregate in AN families, supporting the hypothesis that they may constitute biological markers for AN. Decision-making impairment presents a moderate heritability, suggesting that decision-making may be a candidate endophenotype for AN.
Collapse
Affiliation(s)
- Elisa Galimberti
- Experimental Neurology Institute, INSPE, Vita-Salute San Raffaele University, Milan, Italy.
| | | | | | | | | | | |
Collapse
|
21
|
Is impaired set-shifting a feature of "pure" anorexia nervosa? Investigating the role of depression in set-shifting ability in anorexia nervosa and unipolar depression. Psychiatry Res 2012; 200:538-43. [PMID: 22748187 DOI: 10.1016/j.psychres.2012.06.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Revised: 05/25/2012] [Accepted: 06/07/2012] [Indexed: 11/24/2022]
Abstract
Impaired set-shifting has been reported in patients with anorexia nervosa (AN) and in patients with affective disorders, including major depression. Due to the prevalent comorbidity of major depression in AN, this study aimed to examine the role of depression in set-shifting ability. Fifteen patients with AN without a current comorbid depression, 20 patients with unipolar depression (UD) and 35 healthy control participants were assessed using the Trail Making Test (TMT), the Wisconsin Card Sorting Test (WCST) and a Parametric Go/No-Go Test (PGNG). Set-shifting ability was intact in patients with AN without a comorbid depression. However, patients with UD performed significantly poorer in all three tasks compared to AN patients and in the TMT compared to healthy control participants. In both patient groups, set-shifting ability was moderately negatively correlated with severity of depressive symptoms, but was unrelated to BMI and severity of eating disorder symptoms in AN patients. Our results suggest a pivotal role of comorbidity for neuropsychological functioning in AN. Impairments of set-shifting ability in AN patients may have been overrated and may partly be due to comorbid depressive disorders in investigated patients.
Collapse
|
22
|
Fagundo AB, de la Torre R, Jiménez-Murcia S, Agüera Z, Granero R, Tárrega S, Botella C, Baños R, Fernández-Real JM, Rodríguez R, Forcano L, Frühbeck G, Gómez-Ambrosi J, Tinahones FJ, Fernández-García JC, Casanueva FF, Fernández-Aranda F. Executive functions profile in extreme eating/weight conditions: from anorexia nervosa to obesity. PLoS One 2012; 7:e43382. [PMID: 22927962 PMCID: PMC3424186 DOI: 10.1371/journal.pone.0043382] [Citation(s) in RCA: 157] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 07/23/2012] [Indexed: 12/31/2022] Open
Abstract
Background Extreme weight conditions (EWC) groups along a continuum may share some biological risk factors and intermediate neurocognitive phenotypes. A core cognitive trait in EWC appears to be executive dysfunction, with a focus on decision making, response inhibition and cognitive flexibility. Differences between individuals in these areas are likely to contribute to the differences in vulnerability to EWC. The aim of the study was to investigate whether there is a common pattern of executive dysfunction in EWC while comparing anorexia nervosa patients (AN), obese subjects (OB) and healthy eating/weight controls (HC). Methods Thirty five AN patients, fifty two OB and one hundred thirty seven HC were compared using the Wisconsin Card Sorting Test (WCST); Stroop Color and Word Test (SCWT); and Iowa Gambling Task (IGT). All participants were female, aged between 18 and 60 years. Results There was a significant difference in IGT score (F(1.79); p<.001), with AN and OB groups showing the poorest performance compared to HC. On the WCST, AN and OB made significantly more errors than controls (F(25.73); p<.001), and had significantly fewer correct responses (F(2.71); p<.001). Post hoc analysis revealed that the two clinical groups were not significantly different from each other. Finally, OB showed a significant reduced performance in the inhibition response measured with the Stroop test (F(5.11); p<.001) compared with both AN and HC. Conclusions These findings suggest that EWC subjects (namely AN and OB) have similar dysfunctional executive profile that may play a role in the development and maintenance of such disorders.
Collapse
Affiliation(s)
- Ana B. Fagundo
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
| | - Rafael de la Torre
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Human Pharmacology and Clinical Neurosciences Research Group, Neuroscience Research Program, IMIM-Hospital del Mar Research Institute, Parc de Salut Mar, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain
| | - Zaida Agüera
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
| | - Roser Granero
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Laboratori d’Estadística Aplicada, Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Spain
| | - Salomé Tárrega
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Laboratori d’Estadística Aplicada, Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Spain
| | - Cristina Botella
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Department of Basic Psychology, Clinic and Psychobiology, University Jaume I, Castellón, Spain
| | - Rosa Baños
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Department of Pyschological, Personality, Evaluation and Treatment, University of Valencia, Spain
| | - Jose M. Fernández-Real
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Service of Diabetes, Endocrinology and Nutrition, Institut d’Investigació Biomèdica de Girona (IdlBGi) Hospital Dr Josep Trueta, Girona, Spain
| | - Roser Rodríguez
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Service of Diabetes, Endocrinology and Nutrition, Institut d’Investigació Biomèdica de Girona (IdlBGi) Hospital Dr Josep Trueta, Girona, Spain
| | - Laura Forcano
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
| | - Gema Frühbeck
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Department of Endocrinology, University of Navarra, Pamplona, Spain
| | - Javier Gómez-Ambrosi
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Department of Endocrinology, University of Navarra, Pamplona, Spain
| | - Francisco J. Tinahones
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Service of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria, Málaga, Spain
| | - Jose C. Fernández-García
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Service of Diabetes, Endocrinology and Nutrition, Hospital Clínico Universitario Virgen de Victoria, Málaga, Spain
| | - Felipe F. Casanueva
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Endocrine Division, Complejo Hospitalario U. de Santiago, Santiago de Compostela University, Spain
| | - Fernando Fernández-Aranda
- Department of Psychiatry, University Hospital of Bellvitge-IDIBELL, Barcelona, Spain
- CIBER Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Spain
- Department of Clinical Sciences, School of Medicine, University of Barcelona, Spain
- * E-mail:
| |
Collapse
|