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Riedlinger C, Mazurak N, Schäffeler N, Stengel A, Giel KE, Zipfel S, Enck P, Mack I. Gastrointestinal complaints in patients with anorexia nervosa in the timecourse of inpatient treatment. Front Psychiatry 2022; 13:962837. [PMID: 36061281 PMCID: PMC9436028 DOI: 10.3389/fpsyt.2022.962837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 07/25/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND In patients with anorexia nervosa (AN), gastrointestinal (GI) symptoms are common and usually improve during or after nutritional rehabilitation. It is unclear when exactly GI symptoms change in the timecourse of treatment and to which extent. In this study, we analyzed the timecourse of GI symptoms and their relation to disease-specific, demographic, anthropometric, and psychological factors in inpatients with AN. METHODS In weekly intervals, the Gastrointestinal Symptom Rating Scale (GSRS) was completed, and body weight was measured over a mean of 9.5 weeks in inpatients with AN. A total of four self-report questionnaires assessing psychological factors were completed before and after inpatient treatment. Data from 38 inpatients with AN were analyzed using mixed linear models. RESULTS Abdominal pain and constipation improved significantly in the timecourse with 0.085 (p = 0.002) and 0.101 (p = 0.004) points per week on the GSRS and were predicted to normalize after 13 (p = 0.002) and 17 (p = 0.004) weeks, respectively. Total GI symptoms tended to normalize after 25 weeks (p = 0.079). Indigestion (borborygmus, abdominal distension, eructation, flatulence) was the most severely pathological symptom at admission and did not improve significantly (p = 0.197). Diarrhea and reflux were, on average, not pathological at admission and remained stable during treatment. In addition to treatment time, the strongest predictors were ED pathology at admission for the development of abdominal pain, constipation, reflux, and total GI symptoms; stress for the development of constipation and total GI symptoms; and depression for constipation. CONCLUSIONS Informing patients with AN about the course of GI symptoms and their improvement during weight rehabilitation may help support compliance during treatment.
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Affiliation(s)
- Caroline Riedlinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Nazar Mazurak
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Norbert Schäffeler
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany.,Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Centre of Excellence for Eating Disorders (KOMET), Tübingen, Germany
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Marques CG, Dos Santos Quaresma MVL, Nakamoto FP, Magalhães ACO, Lucin GA, Thomatieli-Santos RV. Does Modern Lifestyle Favor Neuroimmunometabolic Changes? A Path to Obesity. Front Nutr 2021; 8:705545. [PMID: 34621773 PMCID: PMC8490681 DOI: 10.3389/fnut.2021.705545] [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] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/27/2021] [Indexed: 12/19/2022] Open
Abstract
Factors linked to modern lifestyles, such as physical inactivity, Western diet, and poor sleep quality have been identified as key contributors to the positive energy balance (PEB). PEB rises adipose tissue hypertrophy and dysfunction over the years, affecting cells and tissues that are metabolically critical for energy homeostasis regulation, especially skeletal muscle, hypothalamic-pituitary-adrenal axis, and gut microbiota. It is known that the interaction among lifestyle factors and tissue metabolic dysfunction increases low-grade chronic systemic inflammation, leading to insulin resistance and other adverse metabolic disorders. Although immunometabolic mechanisms are widely discussed in obesity, neuroimmunoendocrine pathways have gained notoriety, as a link to neuroinflammation and central nervous system disorders. Hypothalamic inflammation has been associated with food intake dysregulation, which comprises homeostatic and non-homeostatic mechanisms, promoting eating behavior changes related to the obesity prevalence. The purpose of this review is to provide an updated and integrated perspective on the effects of Western diet, sleep debt, and physical exercise on the regulation of energy homeostasis and low-grade chronic systemic inflammation. Subsequently, we discuss the intersection between systemic inflammation and neuroinflammation and how it can contribute to energy imbalance, favoring obesity. Finally, we propose a model of interactions between systemic inflammation and neuroinflammation, providing new insights into preventive and therapeutic targets for obesity.
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Affiliation(s)
- Camila Guazzelli Marques
- Programa de Pós-graduação em Psicobiologia, Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | - Ana Carolina Oumatu Magalhães
- Programa de Pós-graduação em Psicobiologia, Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.,Departamento de Nutrição, Centro Universitário São Camilo, São Paulo, Brazil
| | | | - Ronaldo Vagner Thomatieli-Santos
- Programa de Pós-graduação em Psicobiologia, Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil.,Departamento de Biociências, Universidade Federal de São Paulo, Santos, Brazil
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Wiklund CA, Rania M, Kuja-Halkola R, Thornton LM, Bulik CM. Evaluating disorders of gut-brain interaction in eating disorders. Int J Eat Disord 2021; 54:925-935. [PMID: 33955041 PMCID: PMC10751984 DOI: 10.1002/eat.23527] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/18/2021] [Accepted: 04/10/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Eating disorders commonly co-occur with gastrointestinal problems. This case-control study aimed to (a) document the prevalence of disorders of gut-brain interaction (DGBI) in eating disorders, (b) examine the specific impact of disordered eating behaviors on the risk of DGBI, and (c) explore the impact of current eating disorder psychopathology on DGBI. METHOD We included 765 cases with eating disorders and 1,240 controls. DGBI were assessed via the ROME III questionnaire. Prevalences of DGBI were calculated across eating disorder diagnoses (anorexia nervosa, bulimia nervosa, and multiple eating disorders) and in controls. The association between disordered eating behaviors and DGBI was examined using logistic regression models. Lastly, we compared the total number of DGBI in individuals with high versus low current eating disorder symptoms. RESULTS A large majority (88.2-95.5%) of individuals with eating disorders reported at least one DGBI and 34.8-48.7% reported three or more DGBI. Of the DGBI categories, functional bowel disorders were the most commonly endorsed category, and of the individual DGBI, irritable bowel syndrome was the most frequently reported (43.9-58.8%). All investigated disordered eating behaviors showed a positive association with most DGBI categories. Finally, individuals reporting high current eating disorder symptoms reported higher mean number of DGBI (3.03-3.34) than those with low current symptoms (1.60-1.84). DISCUSSION The directionality and mechanisms underlying the nature of the relationship between gastrointestinal and eating disorder symptoms is worthy of further study and clinicians should adopt an integrated approach by attending to both gastrointestinal and eating disorder symptoms in their patients.
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Affiliation(s)
- Camilla A Wiklund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Marianna Rania
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Outpatient Unit for Clinical Research and Treatment of Eating Disorders, Mater Domini University Hospital, Catanzaro, Italy
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laura M Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Bardone-Cone AM, Higgins MK, St George SM, Rosenzweig I, Schaefer LM, Fitzsimmons-Craft EE, Henning TM, Preston BF. Behavioral and psychological aspects of exercise across stages of eating disorder recovery. Eat Disord 2016; 24:424-39. [PMID: 27463591 PMCID: PMC5055812 DOI: 10.1080/10640266.2016.1207452] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined the relationship between behavioral and psychological aspects of exercise and eating disorder recovery. Participants were categorized as having an eating disorder (n = 53), partially recovered (n = 15), fully recovered (n = 20), or non-eating disorder controls (n = 67). Groups did not differ significantly in time spent exercising, but did differ in exercise intensity, guilt-related exercise, obsessive exercise cognitions, and appearance/weight management and stress/mood management motivations for exercise. Results support the importance of measuring psychological aspects of exercise in particular across the course of an eating disorder.
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Affiliation(s)
- Anna M Bardone-Cone
- a Department of Psychology and Neuroscience , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - M K Higgins
- a Department of Psychology and Neuroscience , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Sara M St George
- b Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Ilyssa Rosenzweig
- a Department of Psychology and Neuroscience , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Lauren M Schaefer
- c Department of Psychology , University of South Florida , Tampa , Florida , USA
| | | | - Taylor M Henning
- a Department of Psychology and Neuroscience , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Brittany F Preston
- e Department of Psychological Sciences , University of Missouri-St. Louis , St. Louis , Missouri , USA
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Wang X, Luscombe GM, Boyd C, Kellow J, Abraham S. Functional gastrointestinal disorders in eating disorder patients: Altered distribution and predictors using ROME III compared to ROME II criteria. World J Gastroenterol 2014; 20:16293-16299. [PMID: 25473186 PMCID: PMC4239520 DOI: 10.3748/wjg.v20.i43.16293] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 05/23/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the prevalence of Functional gastrointestinal disorders (FGIDs) using ROME III and ROME II and to describe predictors of FGIDs among eating disorder (ED) patients.
METHODS: Two similar cohorts of female ED inpatients, aged 17-50 years, with no organic gastrointestinal or systemic disorders, completed either the ROME III (n = 100) or the ROME II (n = 160) questionnaire on admission for ED treatment. The two ROME cohorts were compared on continuous demographic variables (e.g., age, BMI) using Student’s t-tests, and on categorical variables (e.g., ED diagnosis) using χ2-tests. The relationship between ED diagnostic subtypes and FGID categories was explored using χ2-tests. Age, BMI, and psychological and behavioural predictors of the common (prevalence greater than 20%) ROME III FGIDs were tested using logistic regression analyses.
RESULTS: The criteria for at least one FGID were fulfilled by 83% of the ROME III cohort, and 94% of the ROME II cohort. There were no significant differences in age, BMI, lowest ever BMI, ED diagnostic subtypes or ED-related quality of life (QOL) scores between ROME II and ROME III cohorts. The most prevalent FGIDs using ROME III were postprandial distress syndrome (PDS) (45%) and irritable bowel syndrome (IBS) (41%), followed by unspecified functional bowel disorders (U-FBD) (24%), and functional heartburn (FH) (22%). There was a 29% or 46% increase (depending on presence or absence of cyclic vomiting) in functional gastroduodenal disorders because of the introduction of PDS in ROME III compared to ROME II. There was a 35% decrease in functional bowel disorders (FBD) in Rome III (excluding U-FBD) compared to ROME II. The most significant predictor of PDS was starvation (P = 0.008). The predictor of FH (P = 0.021) and U-FBD (P = 0.007) was somatisation, and of IBS laxative use (P = 0.025). Age and BMI were not significant predictors. The addition of the 6-mo duration of symptoms requirement for a diagnosis in ROME III added precision to many FGIDs.
CONCLUSION: ROME III confers higher precision in diagnosing FGIDs but self-induced vomiting should be excluded from the diagnosis of cyclic vomiting. Psychological factors appear to be more influential in ROME II than ROME III.
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Russell J. What is an eating disorder? - the importance of nourishment controlling behaviours in the service of self-worth. Aust N Z J Psychiatry 2013; 47:581-2. [PMID: 23719738 DOI: 10.1177/0004867412464064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abraham SF, von Lojewski A, Anderson G, Clarke S, Russell J. Feelings: what questions best discriminate women with and without eating disorders? Eat Weight Disord 2009; 14:e6-10. [PMID: 19367134 DOI: 10.1007/bf03354621] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
This study explored feelings that discriminate between eating disorder and community groups of women. Responses to 25 questions about body image (9), eating (8) self-esteem (3) general psychology (5) were collected in 2002-2003 (N=268) and 2005-2006 (N=472). Wilk's lambda was used to test discrimination. The most discriminating psychological questions were: 'feeling unhappy and unable to cope as well as usual', 'unease attending social functions', 'fearing loss of control over emotions'; and for eating questions were: 'feeling uneasy if other people saw you eating', 'feeling preoccupied with food/eating', 'fearing loss of control over eating'. For body image only 'feeling preoccupied with body weight/shape' and 'fearing loss of control over your body' discriminated. Questions relating to weight and shape for self-esteem ('feeling fat', 'fearing weight gain' and 'wanting to lose weight') discriminated poorly. Results for both cohorts were consistent. Preoccupation with thoughts of eating or body image and fear of loss of control of these would be useful additions to eating disorders criteria. Psychological impairment should also be present.
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Affiliation(s)
- S F Abraham
- Department of Psychological Medicine, University of Sydney, The Northside Clinic, Greenwich, NSW, Australia.
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Abstract
OBJECTIVE To describe the use of crystal methamphetamine hydrochloride "ice," a powerful, synthetic stimulant drug associated with rapid weight loss. METHOD We report the first three cases of young women "ice" users requiring admission to a specialized eating disorders unit. RESULTS Case one had no prior history of an eating disorder and became emaciated following regular use of "ice"; she regarded weight gain positively. Case 2 had polysubstance abuse since early adolescence and commenced binge eating and vomiting in response to weight gain when not using "ice"; she learned to maintain her weight without weight losing behaviors. Case 3 developed anorexia nervosa in early adolescence, required numerous inpatient admissions and commenced using stimulant drugs for weight loss in her late teens; she discharged prematurely. All patients had features of personality disorder on interview and drug abuse had impaired their work and social adjustment. DISCUSSION "Ice" use may be associated with the onset of disordered eating or used as an efficient weight losing behavior in an established eating disorder.
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Affiliation(s)
- Alice Neale
- Department of Psychological Medicine, University of Sydney, New South Wales, Australia
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