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Cartaud A, Duriez P, Querenghi J, Nandrino JL, Gorwood P, Viltart O, Coello Y. Body shape rather than facial emotion of others alters interpersonal distance in patients with anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2024; 32:917-929. [PMID: 38708578 DOI: 10.1002/erv.3098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 04/13/2024] [Accepted: 04/20/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE The study investigated interpersonal distance in patients with anorexia nervosa (AN), focussing on the role of other's facial expression and morphology, also assessing physiological and subjective responses. METHOD Twenty-nine patients with AN and 30 controls (CTL) were exposed to virtual characters either with an angry, neutral, or happy facial expression or with an overweight, normal-weight, or underweight morphology presented either in the near or far space while we recorded electrodermal activity. Participants had to judge their preferred interpersonal distance with the characters and rated them in terms of valence and arousal. RESULTS Unlike CTL, patients with AN exhibited heightened electrodermal activity for morphological stimuli only, when presented in the near space. They also preferred larger and smaller interpersonal distances with overweight and underweight characters respectively, although rating both negatively. Finally, and similar to CTL, they preferred larger interpersonal distance with angry than neutral or happy characters. DISCUSSION Although patients with AN exhibited behavioural response to emotional stimuli similar to CTL, they lacked corresponding physiological response, indicating emotional blunting towards emotional social stimuli. Moreover, they showed distinct behavioural and physiological adjustments in response to body shape, confirming the specific emotional significance attached to body shape.
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Affiliation(s)
- Alice Cartaud
- University of Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Villeneuve d'Ascq, France
| | - Philibert Duriez
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France
| | - Johanna Querenghi
- University of Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Villeneuve d'Ascq, France
| | - Jean-Louis Nandrino
- University of Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Villeneuve d'Ascq, France
| | - Philip Gorwood
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
- GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, CMME, Paris, France
| | - Odile Viltart
- University of Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Villeneuve d'Ascq, France
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, Paris, France
| | - Yann Coello
- University of Lille, CNRS, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Villeneuve d'Ascq, France
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2
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Schaumberg K, Pictor L, Frank M. Adaptive and Maladaptive Exercise in Eating Disorders. Curr Top Behav Neurosci 2024. [PMID: 39042250 DOI: 10.1007/7854_2024_499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/24/2024]
Abstract
While exercise is generally associated with positive health outcomes, in the context of eating disorders, exercise has high potential to become maladaptive. Maladaptive exercise is compelled or compulsive in nature for the purposes of weight and shape control or to obtain/avoid other eating disorder-relevant consequences. A transdiagnostic eating disorder feature with moderate-to-high prevalence across restrictive- and bulimic-spectrum eating disorders, maladaptive exercise is often associated with negative mental and physical health sequalae. Several proposed threat- and reward-related biobehavioral mechanisms may initiate or perpetuate maladaptive exercise. While exercise is generally contraindicated during periods of acute medical concern, adaptive forms of exercise are also present among those with eating disorders, and facilitation of adaptive exercise has potential to promote physical and mental health benefits during eating disorder recovery. Detailed assessment and targeted interventions are needed to address the clinical conundrum of how and when to integrate exercise into eating disorder treatment.
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Affiliation(s)
| | - Lauren Pictor
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
| | - Max Frank
- Department of Psychiatry, University of Wisconsin, Madison, WI, USA
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Davies HL, Peel AJ, Mundy J, Monssen D, Kakar S, Davies MR, Adey BN, Armour C, Kalsi G, Lin Y, Marsh I, Rogers HC, Walters JTR, Herle M, Glen K, Malouf CM, Kelly EJ, Eley TC, Treasure J, Breen G, Hübel C. The network structure of mania symptoms differs between people with and without binge eating. Bipolar Disord 2023; 25:592-607. [PMID: 37308319 PMCID: PMC10768381 DOI: 10.1111/bdi.13355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVES People with bipolar disorder who also report binge eating have increased psychopathology and greater impairment than those without binge eating. Whether this co-occurrence is related to binge eating as a symptom or presents differently across full-syndrome eating disorders with binge eating is unclear. METHODS We first compared networks of 13 lifetime mania symptoms in 34,226 participants from the United Kingdom's National Institute for Health and Care Research BioResource with (n = 12,104) and without (n = 22,122) lifetime binge eating. Second, in the subsample with binge eating, we compared networks of mania symptoms in participants with lifetime anorexia nervosa binge-eating/purging (n = 825), bulimia nervosa (n = 3737), and binge-eating disorder (n = 3648). RESULTS People with binge eating endorsed every mania symptom significantly more often than those without binge eating. Within the subsample, people with bulimia nervosa most often had the highest endorsement rate of each mania symptom. We found significant differences in network parameter statistics, including network structure (M = 0.25, p = 0.001) and global strength (S = 1.84, p = 0.002) when comparing the binge eating with no binge-eating participants. However, network structure differences were sensitive to reductions in sample size and the greater density of the latter network was explained by the large proportion of participants (34%) without mania symptoms. The structure of the anorexia nervosa binge-eating/purging network differed from the bulimia nervosa network (M = 0.66, p = 0.001), but the result was unstable. CONCLUSIONS Our results suggest that the presence and structure of mania symptoms may be more associated with binge eating as a symptom rather than any specific binge-type eating disorder. Further research with larger sample sizes is required to confirm our findings.
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Affiliation(s)
- Helena L. Davies
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
| | - Alicia J. Peel
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
| | - Jessica Mundy
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
- National Institute for Health and Social Care Research (NIHR) Biomedical Research Centre, South London and Maudsley HospitalLondonUK
| | - Dina Monssen
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
- National Institute for Health and Social Care Research (NIHR) Biomedical Research Centre, South London and Maudsley HospitalLondonUK
| | - Saakshi Kakar
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
- National Institute for Health and Social Care Research (NIHR) Biomedical Research Centre, South London and Maudsley HospitalLondonUK
| | - Molly R. Davies
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
- National Institute for Health and Social Care Research (NIHR) Biomedical Research Centre, South London and Maudsley HospitalLondonUK
| | - Brett N. Adey
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
- National Institute for Health and Social Care Research (NIHR) Biomedical Research Centre, South London and Maudsley HospitalLondonUK
| | - Chérie Armour
- Research Centre for Stress, Trauma and Related Conditions (STARC), School of PsychologyQueen's University Belfast (QUB)Belfast, Northern IrelandUK
| | - Gursharan Kalsi
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
- National Institute for Health and Social Care Research (NIHR) Biomedical Research Centre, South London and Maudsley HospitalLondonUK
| | - Yuhao Lin
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
- National Institute for Health and Social Care Research (NIHR) Biomedical Research Centre, South London and Maudsley HospitalLondonUK
| | - Ian Marsh
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
- National Institute for Health and Social Care Research (NIHR) Biomedical Research Centre, South London and Maudsley HospitalLondonUK
| | - Henry C. Rogers
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
- National Institute for Health and Social Care Research (NIHR) Biomedical Research Centre, South London and Maudsley HospitalLondonUK
| | - James T. R. Walters
- Division of Psychiatry and Clinical Neurosciences, National Centre for Mental Health and MRC Centre for Neuropsychiatric Genetics and GenomicsCardiff UniversityCardiffUK
| | - Moritz Herle
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
- Department of Biostatistics and Health InformaticsKing's College LondonLondonUK
| | - Kiran Glen
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
- National Institute for Health and Social Care Research (NIHR) Biomedical Research Centre, South London and Maudsley HospitalLondonUK
| | - Chelsea Mika Malouf
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
- National Institute for Health and Social Care Research (NIHR) Biomedical Research Centre, South London and Maudsley HospitalLondonUK
| | - Emily J. Kelly
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
- National Institute for Health and Social Care Research (NIHR) Biomedical Research Centre, South London and Maudsley HospitalLondonUK
| | - Thalia C. Eley
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
- National Institute for Health and Social Care Research (NIHR) Biomedical Research Centre, South London and Maudsley HospitalLondonUK
| | - Janet Treasure
- Section of Eating Disorders, Department of Psychological MedicineInstitute of Psychiatry, Psychology and Neuroscience, King's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustMaudsley HospitalLondonUK
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
- National Institute for Health and Social Care Research (NIHR) Biomedical Research Centre, South London and Maudsley HospitalLondonUK
| | - Christopher Hübel
- Social, Genetic and Developmental Psychiatry (SGDP) CentreInstitute of Psychiatry, Psychology, and Neuroscience, King's College LondonLondonUK
- National Institute for Health and Social Care Research (NIHR) Biomedical Research Centre, South London and Maudsley HospitalLondonUK
- National Centre for Register‐based Research, Aarhus Business and Social SciencesAarhus UniversityAarhusDenmark
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Amin L, Halbeisen G, Braks K, Huber TJ, Paslakis G. The State Urge to be Physically Active-Questionnaire (SUPA-Q): Development and validation of a state measure of activity urges in patients with eating disorders. Brain Behav 2023; 13:e3220. [PMID: 37559422 PMCID: PMC10570484 DOI: 10.1002/brb3.3220] [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] [Received: 05/06/2023] [Revised: 07/31/2023] [Accepted: 08/02/2023] [Indexed: 08/11/2023] Open
Abstract
OBJECTIVE Many people, including patients with eating disorders (EDs), experience an increased urge for physical activity. "Trait"-like activity in patients with EDs is assessed by existing questionnaires, but there are few clinically validated assessments of a "state" urge to be physically active. Here, we developed and validated the State Urge to be Physically Active-Questionnaire (SUPA-Q). METHODS After developing and piloting the items, N = 126 patients with EDs (mostly anorexia nervosa and bulimia nervosa) took part in our mixed-longitudinal validation study with one primary assessment for all patients and a secondary assessment for a subsample of patients. Cronbach's α and split-half-methods served as measures of consistency and reliability. Correlations with other questionnaires were used to determine convergent and divergent validity, and confirmatory factor analysis was used for investigating factorial validity. We used paired-samples t-tests for repeated assessments to investigate change sensitivity. RESULTS We found the SUPA-Q to be highly consistent, and reliable and to demonstrate convergent, divergent, and factorial validity. The comparison of SUPA-Q scores from repeated assessments within a subsample of patients demonstrated the questionnaire's change sensitivity, Cohen's d = 0.48. Moreover, an increase in SUPA-Q scores was associated with a less positive mood, more anxiety, more body dissatisfaction, more tenseness, less feelings of control, and more stress. DISCUSSION The newly developed SUPA-Q may help to accentuate the necessity to evaluate and address the acute urge to engage in physical activity in patients with EDs in clinical practice and ultimately support tailoring treatments to patients' unique symptom patterns. The questionnaire is available at https://doi.org/10.17605/OSF.IO/G2YBC.
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Affiliation(s)
- Lina Amin
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East‐WestphaliaRuhr‐University BochumLuebbeckeGermany
| | - Georg Halbeisen
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East‐WestphaliaRuhr‐University BochumLuebbeckeGermany
| | - Karsten Braks
- Centre for Eating DisordersKlinik am KorsoBad OeynhausenGermany
| | - Thomas J. Huber
- Centre for Eating DisordersKlinik am KorsoBad OeynhausenGermany
| | - Georgios Paslakis
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East‐WestphaliaRuhr‐University BochumLuebbeckeGermany
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Fricke C, Voderholzer U. Endocrinology of Underweight and Anorexia Nervosa. Nutrients 2023; 15:3509. [PMID: 37630700 PMCID: PMC10458831 DOI: 10.3390/nu15163509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
More than any other mental illness, the course, prognosis, and therapy of anorexia nervosa are shaped by the physical changes associated with being underweight. This article provides an overview of the endocrine changes associated with malnutrition and underweight. This overview serves as a basis for understanding the other articles in this special issue, which deal with the health risks associated with being underweight. In this context, the differences between underweight in anorexia nervosa and in constitutional thinness are of particular importance in assessing the impact of intentional weight loss. In this context, the regulation of hunger and satiety deserves special interest, as this is the area in which the intentional influence on body weight comes into play. Clinical consequences on, for example, fertility, bone metabolism, the homeostasis of, for example, serum glucose levels, or body temperature have been observed for a long time; nonetheless, the medical responses, apart from vitamin supplementations and advice to gain weight, are still limited. Therefore, emphasis was placed on the potential improvement of outcomes through the administration of central or peripheral hormones. Studies were identified on PubMed via a selection of relevant keywords; original texts that were cited in reviews were studied where it was advantageous. This review found some promising data on bone health and the administration of transdermal oestrogen, which is not yet widely used, as well as distinct hormonal markers to differentiate between CT and AN. We concluded that the continuous efforts to investigate the role of endocrinology in underweight and/or anorexia nervosa lead to outcome benefits and that more and higher-powered studies are needed.
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Affiliation(s)
| | - Ulrich Voderholzer
- Schoen Klinik Roseneck, 83209 Prien am Chiemsee, Germany;
- Klinik für Psychiatrie und Psychotherapie, Ludwig Maximilians Universität, 80336 Munich, Germany
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Tezenas du Montcel C, Cao J, Mattioni J, Hamelin H, Lebrun N, Ramoz N, Gorwood P, Tolle V, Viltart O. Chronic food restriction in mice and increased systemic ghrelin induce preference for running wheel activity. Psychoneuroendocrinology 2023; 155:106311. [PMID: 37295225 DOI: 10.1016/j.psyneuen.2023.106311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 05/25/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVES In eating disorders, particularly anorexia nervosa (AN), patients exhibit intense physical activity which is inappropriate regarding food restriction and chronic undernutrition, and exacerbates weight loss and energy deprivation. Rodent models of food restriction exhibit increased running wheel activity in the food anticipation period, also known as Food Anticipatory Activity (FAA). FAA probably has various physiological and/or neurobiological origins. Plasma concentrations of the orexigenic hormone ghrelin are, for example, increased during FAA. We hypothesize that the drive for physical activity in chronic food restriction is triggered by metabolic factors but also relies on motivational aspects that we aim to decipher in this study. METHODS Young female C57Bl6/J mice were exposed to a paradigm based on a progressive 50% quantitative food restriction alone (FR) or associated with running wheel activity (Food Restriction Wheel: FRW) in their home-cage during 15 days. We measured preference for running wheel in a three-chamber apparatus in which animals could choose to explore either a known running wheel or a novel object. Testing took place either during resting or during FAA. We calculated the time spent in each compartment and the activity in running wheels. After progressive refeeding over 10 days, mice were tested again when refed. Plasma levels of both ghrelin isoforms were measured with selective immunoassays. RESULTS When tested during FAA period, food restricted mice displayed increased preference for the running wheel compared to ad libitum fed controls. Both FR and FRW mice exhibited increased running time and distance in the wheel and running distance was correlated with ghrelin levels. Similar preference and behavior were found when testing took place during the resting period. Animals housed without an active wheel also exhibited active running. Progressive refeeding resulted in body weight restoration, a decrease in FAA and completely abolished preference for the running wheel. Refed animals displayed similar behavior as ad libitum fed controls. CONCLUSIONS These data provide evidence that food restriction-induced physical activity is closely correlated with metabolic adaptations to nutritional status implicating ghrelin in the quantity of physical activity.
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Affiliation(s)
- Chloé Tezenas du Montcel
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR-S 1266, F-75014 Paris, France; GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte Anne, F-75014 Paris, France
| | - Jingxian Cao
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR-S 1266, F-75014 Paris, France
| | - Julia Mattioni
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR-S 1266, F-75014 Paris, France
| | - Héloïse Hamelin
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR-S 1266, F-75014 Paris, France
| | - Nicolas Lebrun
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR-S 1266, F-75014 Paris, France
| | - Nicolas Ramoz
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR-S 1266, F-75014 Paris, France; GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte Anne, F-75014 Paris, France
| | - Philip Gorwood
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR-S 1266, F-75014 Paris, France; GHU Paris Psychiatrie et Neurosciences, CMME, Hôpital Sainte Anne, F-75014 Paris, France
| | - Virginie Tolle
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR-S 1266, F-75014 Paris, France
| | - Odile Viltart
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM UMR-S 1266, F-75014 Paris, France; Université de Lille, SCALab laboratory, UMR CNRS 9193, PsySEF Faculty, F-59650 Villeneuve d'Ascq, France.
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7
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Giunti E, Collu R, Dedoni S, Castelli MP, Fratta W, Scherma M, Fadda P. Food restriction and hyperactivity induce changes in corticolimbic brain dopamine and serotonin levels in female rats. Behav Brain Res 2023; 444:114374. [PMID: 36863461 DOI: 10.1016/j.bbr.2023.114374] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/27/2023] [Accepted: 02/27/2023] [Indexed: 03/04/2023]
Abstract
Compelling data support altered dopamine (DA) and serotonin (5-HT) signaling in anorexia nervosa (AN). However, their exact role in the etiopathogenesis of AN has yet to be elucidated. Here, we evaluated the corticolimbic brain levels of DA and 5-HT in the induction and recovery phases of the activity-based anorexia (ABA) model of AN. We exposed female rats to the ABA paradigm and measured the levels of DA, 5-HT, the metabolites 3,4-dihydroxyphenylacetic acid (DOPAC), homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA), and the dopaminergic type 2 (D2) receptors density in feeding- and reward-implicated brain regions (i.e., cerebral cortex, Cx; prefrontal cortex, PFC; caudate putamen, CPu; nucleus accumbens, NAcc; amygdala, Amy; hypothalamus, Hyp; hippocampus, Hipp). DA levels were significantly increased in the Cx, PFC and NAcc, while 5-HT was significantly enhanced in the NAcc and Hipp of ABA rats. Following recovery, DA was still elevated in the NAcc, while 5-HT was increased in the Hyp of recovered ABA rats. DA and 5-HT turnover were impaired at both ABA induction and recovery. D2 receptors density was increased in the NAcc shell. These results provide further proof of the impairment of the dopaminergic and serotoninergic systems in the brain of ABA rats and support the knowledge of the involvement of these two important neurotransmitter systems in the development and progression of AN. Thus, providing new insights on the corticolimbic regions involved in the monoamine dysregulations in the ABA model of AN.
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Affiliation(s)
- Elisa Giunti
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Roberto Collu
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Simona Dedoni
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - M Paola Castelli
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | | | - Maria Scherma
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy.
| | - Paola Fadda
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy; CNR Institute of Neuroscience, Cagliari, National Research Council, Cagliari, Italy
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8
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Johnson JS, Cote AC, Dobbyn A, Sloofman LG, Xu J, Cotter L, Charney AW, Birgegård A, Jordan J, Kennedy M, Landén M, Maguire SL, Martin NG, Mortensen PB, Thornton LM, Bulik CM, Huckins LM. Mapping anorexia nervosa genes to clinical phenotypes. Psychol Med 2023; 53:2619-2633. [PMID: 35379376 PMCID: PMC10123844 DOI: 10.1017/s0033291721004554] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/23/2021] [Accepted: 10/20/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) is a psychiatric disorder with complex etiology, with a significant portion of disease risk imparted by genetics. Traditional genome-wide association studies (GWAS) produce principal evidence for the association of genetic variants with disease. Transcriptomic imputation (TI) allows for the translation of those variants into regulatory mechanisms, which can then be used to assess the functional outcome of genetically regulated gene expression (GReX) in a broader setting through the use of phenome-wide association studies (pheWASs) in large and diverse clinical biobank populations with electronic health record phenotypes. METHODS Here, we applied TI using S-PrediXcan to translate the most recent PGC-ED AN GWAS findings into AN-GReX. For significant genes, we imputed AN-GReX in the Mount Sinai BioMe™ Biobank and performed pheWASs on over 2000 outcomes to test the clinical consequences of aberrant expression of these genes. We performed a secondary analysis to assess the impact of body mass index (BMI) and sex on AN-GReX clinical associations. RESULTS Our S-PrediXcan analysis identified 53 genes associated with AN, including what is, to our knowledge, the first-genetic association of AN with the major histocompatibility complex. AN-GReX was associated with autoimmune, metabolic, and gastrointestinal diagnoses in our biobank cohort, as well as measures of cholesterol, medications, substance use, and pain. Additionally, our analyses showed moderation of AN-GReX associations with measures of cholesterol and substance use by BMI, and moderation of AN-GReX associations with celiac disease by sex. CONCLUSIONS Our BMI-stratified results provide potential avenues of functional mechanism for AN-genes to investigate further.
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Affiliation(s)
- Jessica S. Johnson
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alanna C. Cote
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Amanda Dobbyn
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Laura G. Sloofman
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jiayi Xu
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Liam Cotter
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Alexander W. Charney
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- James J. Peters Department of Veterans Affairs Medical Center, Mental Illness Research, Education and Clinical Centers, Bronx, NY 14068, USA
| | | | - Andreas Birgegård
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Jennifer Jordan
- Department of Psychological Medicine, Christchurch School of Medicine & Health Sciences, University of Otago, 2 Riccarton Avenue, PO Box 4345, 8140 Christchurch, New Zealand
| | - Martin Kennedy
- Department of Psychological Medicine, Christchurch School of Medicine & Health Sciences, University of Otago, 2 Riccarton Avenue, PO Box 4345, 8140 Christchurch, New Zealand
| | - Mikaél Landén
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Institute of Neuroscience and Physiology, Sahlgrenska Academy at Gothenburg University, SE-413 45 Gothenburg, Sweden
| | - Sarah L. Maguire
- InsideOut Institute, University of Sydney, New South Wales 2006, Australia
| | - Nicholas G. Martin
- QIMR Berghofer Medical Research Institute, Locked Bag 2000, Royal Brisbane Hospital, Herston, QLD 4029, Australia
| | - Preben Bo Mortensen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research, Aarhus, Denmark
- National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark
| | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27517, 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, NC 27517, USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27517, USA
| | - Laura M. Huckins
- Pamela Sklar Division of Psychiatric Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Genetics and Genomics, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Icahn Institute for Genomics and Multiscale Biology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- James J. Peters Department of Veterans Affairs Medical Center, Mental Illness Research, Education and Clinical Centers, Bronx, NY 14068, USA
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9
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Sutton Hickey AK, Duane SC, Mickelsen LE, Karolczak EO, Shamma AM, Skillings A, Li C, Krashes MJ. AgRP neurons coordinate the mitigation of activity-based anorexia. Mol Psychiatry 2023; 28:1622-1635. [PMID: 36577844 PMCID: PMC10782560 DOI: 10.1038/s41380-022-01932-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 12/29/2022]
Abstract
Anorexia nervosa (AN) is a debilitating and deadly disease characterized by low body mass index due to diminished food intake, and oftentimes concurrent hyperactivity. A high percentage of AN behavioral and metabolic phenotypes can be replicated in rodents given access to a voluntary running wheel and subject to food restriction, termed activity-based anorexia (ABA). Despite the well-documented bodyweight loss observed in AN human patients and ABA rodents, much less is understood regarding the neurobiological underpinnings of these maladaptive behaviors. Hunger-promoting hypothalamic agouti-related peptide (AgRP) neurons have been well characterized in their ability to regulate appetite, yet much less is known regarding their activity and function in the mediation of food intake during ABA. Here, feeding microstructure analysis revealed ABA mice decreased food intake due to increased interpellet interval retrieval and diminished meal number. Longitudinal activity recordings of AgRP neurons in ABA animals exhibited a maladaptive inhibitory response to food, independent of basal activity changes. We then demonstrated that ABA development or progression can be mitigated by chemogenetic AgRP activation through the reprioritization of food intake (increased meal number) over hyperactivity, but only during periods of food availability. These results elucidate a potential neural target for the amelioration of behavioral maladaptations present in AN patients.
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Affiliation(s)
- Ames K Sutton Hickey
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA.
| | - Sean C Duane
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA
| | - Laura E Mickelsen
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA
| | - Eva O Karolczak
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA
| | - Ahmed M Shamma
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA
| | - Anna Skillings
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA
| | - Chia Li
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA
| | - Michael J Krashes
- Diabetes, Endocrinology, and Obesity Branch, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health, Bethesda, MD, USA.
- National Institute on Drug Abuse (NIDA), National Institutes of Health, Baltimore, MD, USA.
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10
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Yamashita M, Kawai K, Toda K, Aso C, Suematsu T, Yokoyama H, Hata T, Takakura S, Sudo N. Cardiopulmonary exercise testing for patients with anorexia nervosa: a case-control study. Eat Weight Disord 2022; 27:3553-3560. [PMID: 36271269 DOI: 10.1007/s40519-022-01492-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 10/11/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE Patients with anorexia nervosa (AN) require appropriate nutrient therapy and physical activity management. Eating disorder treatment guidelines do not include safe, evidence-based intensity criteria for exercise. This study used cardiopulmonary exercise testing (CPX) to evaluate the exercise tolerance of patients with AN. METHODS CPX was performed with 14 female patients with AN admitted to a specialized eating disorder unit between 2015 and 2019. Their anaerobic threshold (AT) was determined by assessing their exercise tolerance using CPX and compared with 14 healthy controls (HC). The metabolic equivalents (AT-METS) were compared when AT was reached. We examined factors related to AT (AN-AT) in the AN group, including age, body mass index (BMI), previous lowest weight, minimum BMI, past duration of BMI < 15, exercise history, and ΔHR (heart rate at the AT-resting heart rate). RESULTS The AT of the AN group (BMI: 15.7 [Mean] ± 1.8 standard deviation [SD]) was significantly lower than that of the HC group (BMI: 19.7 ± 1.8) (AN: 10.0 ± 1.8 vs. HC: 15.2 ± 3.0 ml/kg/min, P < 0.001). AT-METS was also significantly lower in the AN group than in the HC group (AN: 2.9 ± 0.52 vs. HC: 4.4 ± 0.91, P < 0.001). AN-AT was highly influenced by ΔHR. CONCLUSIONS This study showed that AT and AT-METS were lower in patients with AN than in HC. Patients with AN should be prescribed light-intensity aerobic exercise, and the current findings may help develop future physical management guidelines for patients with AN. LEVEL OF EVIDENCE III: Evidence obtained from case-control analytic studies.
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Affiliation(s)
- Makoto Yamashita
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Keisuke Kawai
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan.
- Department of Psychosomatic Medicine, Kohnodai Hospital, National Center for Global Health Medicine, Chiba, Japan.
| | - Kenta Toda
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Chie Aso
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takafumi Suematsu
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroaki Yokoyama
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomokazu Hata
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Shu Takakura
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Kyushu University Hospital, Fukuoka, Japan
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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11
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Minano-Garrido EJ, Catalan-Matamoros D, Gómez-Conesa A. Physical Therapy Interventions in Patients with Anorexia Nervosa: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13921. [PMID: 36360815 PMCID: PMC9653588 DOI: 10.3390/ijerph192113921] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Assess the effectiveness of physical therapy, including supervised physical exercise for body mass index (BMI) restoration; improving muscle strength and the psychological, behavioural, cognitive symptoms and quality of life in patients with anorexia nervosa (AN). METHODS A Systematic Review (SR) was conducted in the following scientific databases: Medline, PubMed, PEDro, PsychInfo, Cochrane Library plus, Nursing and Allied Health database, Scopus and Web of Science databases, from inception until November 2021. An assessment of the risk of bias and the certainty of evidence across studies was conducted. Articles were eligible if they followed randomized and non-randomized control trial designs with treatments based on physical therapy or exercise or physical activity in AN patients. RESULTS 496 records were screened, and after eligibility assessment, 6 studies from 8 articles were finally analysed. The studies, involving 176 AN patient (85.02% of patients), reported improvements in muscle strength, eating behaviour, eating attitude, mood and quality of life. Three studies included nutritional co-interventions and four studies included psychological therapy. None of the studies reported adverse effects. CONCLUSIONS In two of the RCTs included in this SR, strength training and high intensity resistance improved the muscle strength of patients with AN. In addition, in two RCTs, improvements were observed in patients' attitudes towards their bodies after basic body awareness therapy or after full body massage and instruction to relax. In addition, quality of life improved in two studies, with stretching, isometrics, endurance cardiovascular and muscular exercising.
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Affiliation(s)
| | - Daniel Catalan-Matamoros
- Department of Nursing, Physiotherapy and Medicine, and Health Research Centre, University of Almería, 04120 Almería, Spain
- Institute for Culture and Technology, Madrid University Carlos III, 28903 Madrid, Spain
| | - Antonia Gómez-Conesa
- Research Group Research Methods and Evaluation in Social Sciences, Mare Nostrum Campus of International Excellence, University of Murcia, 30100 Murcia, Spain
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12
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Circulating Spexin Is Associated with Body Mass Index and Fat Mass but Not with Physical Activity and Psychological Parameters in Women across a Broad Body Weight Spectrum. J Clin Med 2022; 11:jcm11175107. [PMID: 36079049 PMCID: PMC9457358 DOI: 10.3390/jcm11175107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 08/19/2022] [Accepted: 08/27/2022] [Indexed: 11/24/2022] Open
Abstract
Spexin (SPX) is a novel, widely expressed peptide, with anorexigenic effects demonstrated in animal models and negatively correlated with body mass index (BMI) in humans. It increases locomotor activity in rodents and is elevated in human plasma following exercise. Studies have also shown an effect of stress and anxiety on SPX’s expression in different brain structures in animals. The relationships between plasma SPX and physical activity, body composition, and patient-reported outcomes such as perceived stress, depressiveness, anxiety, and eating behaviors are unknown and were examined in this study over a wide BMI range. A total of 219 female (n = 68 with anorexia nervosa; n = 79 with obesity; n = 72 with normal weight) inpatients were enrolled. Perceived stress (PSQ 20), anxiety (GAD 7), depressiveness (PHQ 9), and eating disorder pathology (EDI 2), as well as BMI, bioimpedance analysis, and accelerometry, were measured cross-sectionally at the beginning of treatment and correlated with plasma SPX levels (measured by ELISA) obtained at the same time. Plasma SPX levels were negatively associated with BMI (r = −0.149, p = 0.027) and body fat mass (r = −0.149, p = 0.04), but did not correlate with perceived stress, anxiety, depressiveness, eating behavior, energy expenditure, and physical activity (p > 0.05). The results replicate the negative correlation of SPX with BMI and fat mass, but do not support the hypothesis that peripheral SPX plays a role in the regulation of stress, depressiveness, anxiety, eating behavior, or physical activity.
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13
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Hung C, Muñoz M, Shibli-Rahhal A. Anorexia Nervosa and Osteoporosis. Calcif Tissue Int 2022; 110:562-575. [PMID: 33666707 DOI: 10.1007/s00223-021-00826-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 02/14/2021] [Indexed: 12/12/2022]
Abstract
Patients with anorexia nervosa (AN) often experience low bone mineral density (BMD) and increased fracture risk, with low body weight and decreased gonadal function being the strongest predictors of the observed bone mineral deficit and fractures. Other metabolic disturbances have also been linked to bone loss in this group of patients, including growth hormone resistance, low insulin-like growth factor-1 (IGF-1) concentrations, low leptin concentrations, and hypercortisolemia. However, these correlations lack definitive evidence of causality. Weight restoration and resumption of menstrual function have the strongest impact on increasing BMD. Other potential treatment options include bisphosphonates and teriparatide, supported by data from small clinical trials, but these agents are not approved for the treatment of low BMD in adolescents or premenopausal women with AN.
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Affiliation(s)
- Chermaine Hung
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Marcus Muñoz
- Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Amal Shibli-Rahhal
- Division of Endocrinology, Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.
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14
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Duriez P, Guy-Rubin A, Kaya Lefèvre H, Gorwood P. Morphing analysis of facial emotion recognition in anorexia nervosa: association with physical activity. Eat Weight Disord 2022; 27:1053-1061. [PMID: 34213746 DOI: 10.1007/s40519-021-01254-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/17/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Anorexia Nervosa (AN) has been linked to emotion processing inefficiencies, social cognition difficulties and emotion dysregulation, but data on Facial Emotion Recognition (FER) are heterogenous and inconclusive. This study aims to explore FER in patients with AN using a dynamic and ecological evaluation, and its relationship with Physical Activity (PA), an important aspect of AN that could impact emotional processing. METHODS Sixty-six participants (33 patients with AN and 33 healthy controls) performed a morphed facial emotional recognition task and 49 of them wore an accelerometer during seven days to assess PA. Axis-I disorders and depressive symptoms have been assessed. RESULTS No difference was found regarding time to recognize facial emotions. However, patients with AN correctly recognize emotions more frequently than controls. This was specific to disgust, although there was also a tendency for sadness. Among patients, higher depressive scores are associated with a faster and more accurate recognition of disgust, while a higher level of PA is associated to decreased accuracy in recognizing sadness. CONCLUSION Patients with AN are capable of recognizing facial emotions as accurately as controls, but could have a higher sensitivity in recognizing negative emotions, especially disgust and sadness. PA has opposite effects and, thus, could be considered as an emotional regulation strategy against negative affect. LEVEL OF EVIDENCE II Controlled trial without randomization.
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Affiliation(s)
- Philibert Duriez
- GHU Paris Psychiatrie Et Neurosciences, Hôpital Sainte-Anne, CMME, 1 rue Cabanis, 75014, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM U1266, 75014, Paris, France
| | - Aurore Guy-Rubin
- GHU Paris Psychiatrie Et Neurosciences, Hôpital Sainte-Anne, CMME, 1 rue Cabanis, 75014, Paris, France
| | - Héline Kaya Lefèvre
- GHU Paris Psychiatrie Et Neurosciences, Hôpital Sainte-Anne, CMME, 1 rue Cabanis, 75014, Paris, France. .,Université de Paris, LPPS, 92100, Boulogne-Billancourt, France.
| | - Philip Gorwood
- GHU Paris Psychiatrie Et Neurosciences, Hôpital Sainte-Anne, CMME, 1 rue Cabanis, 75014, Paris, France.,Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM U1266, 75014, Paris, France
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15
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Wyssen A, Munsch S. [Physical Activity in the Prevention and Treatment of Eating Disorders]. PRAXIS 2022; 111:327-332. [PMID: 35473329 DOI: 10.1024/1661-8157/a003840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Physical Activity in the Prevention and Treatment of Eating Disorders Abstract. On the one hand, excessive or insufficient physical activity is a phenomenological feature and an important etiological factor in eating disorders. On the other hand, healthy and adaptive physical activity has the potential to support the effectiveness of preventive and therapeutic interventions for eating disorders. Research findings confirm the usefulness of interventions focusing on physical activity as an add-on to psychotherapy. Professionally planned and accompanied interventions of this kind are not counterproductive or dangerous but can have a positive effect on the treatment outcome. The current state of research allows a preliminary formulation of guidelines to embed physical activity interventions into evidence-based treatment approaches. The focus of such interventions lies on the reduction of unhealthy, excessive physical activity and the promotion of flexible physical activity.
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Affiliation(s)
- Andrea Wyssen
- Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Bern, Schweiz
| | - Simone Munsch
- Klinische Psychologie und Psychotherapie, Departement für Psychologie, Universität Fribourg, Fribourg, Schweiz
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16
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Agne A, Quesnel DA, Larumbe-Zabala E, Olmedillas H, Graell-Berna M, Perez M, Fernandez-del-Valle M. Progressive resistance exercise as complementary therapy improves quality of life and body composition in anorexia nervosa: A randomized controlled trial. Complement Ther Clin Pract 2022; 48:101576. [DOI: 10.1016/j.ctcp.2022.101576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 11/03/2022]
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17
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Agne A, Olmedillas H, Pérez Ruiz M, del Valle Soto M, Fernandez-del-Valle M. Physical Fitness-Not Physical Activity Levels-Influence Quality of Life in Anorexia Nervosa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2678. [PMID: 35270370 PMCID: PMC8910610 DOI: 10.3390/ijerph19052678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 02/15/2022] [Accepted: 02/23/2022] [Indexed: 02/04/2023]
Abstract
Background: Incorporating physical activity (PA) has been a challenge for health care professionals working with anorexia nervosa (AN) patients. This has contributed to partial physical fitness (PFit) recovery that persists after weight restoration. Objective: This cross-sectional study aimed to examine the relationships between PA, sedentary behaviors, PFit, and quality of life (QoL) in a group of adolescents after hospitalization. Methods: QoL, PA, and sedentary behaviors were measured using the Health-Questionnaire Short-Form 36 (SF-36) and accelerometers, while PFit was assessed through cardiorespiratory fitness, body composition (anthropometry), and strength (six repetition maximum) tests in a total of 63 patients. Results: Light-PA (LPA), moderate-PA (MPA), moderate-to-vigorous-PA (MVPA), and relative sedentary time (%ST) did not meet the recommendations (p < 0.001). Only 22% of the patients met MVPA criteria, and ~82% exceeded %ST. SF-36 scores were lower than normative values except the physical component scale. Absolute cardiorespiratory fitness was reduced (p < 0.001) in 84% of the patients, and was positively associated to body weight, body mass index (BMI), circumferences, and muscle areas. Additional positive significant relationships were found between QoL, muscular strength, and body composition, and negative associations between vigorous-to-very vigorous PA and BMI, skinfolds, and percent body fat. Regression analyses revealed lower body strength as an explanatory factor for improved QoL (OR 1.03, 95%CI 1.00−1.07). Conclusions: PFit and QoL scores are poor after hospitalization. LPA, MPA, and MVPA do not meet recommendations. PFit management—with emphasis on improving muscular fitness—may be a valuable strategy for QoL improvement in AN after hospitalization.
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Affiliation(s)
- Alexa Agne
- Department of Applied Health, Southern Illinois University Edwardsville, Edwardsville, IL 62026, USA;
| | - Hugo Olmedillas
- Department of Functional Biology, Campus del Crito B, University of Oviedo, 33006 Oviedo, Spain;
- Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain;
| | - Margarita Pérez Ruiz
- Grupo de Investigación de Investigación en Nutrición, Ejercicio y Estilo de Vida Saludable (ImFINE), Departamento de Salud y Rendimiento, Facultad de Ciencias de la Actividad Física y del Deporte–Instituto Nacional de Educación Física (INEF), Universidad Politécnica de Madrid, 28040 Madrid, Spain;
| | - Miguel del Valle Soto
- Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain;
- Department of Morphology and Cellular Biology, Anatomy, Campus del Crito B, University of Oviedo, 33006 Oviedo, Spain
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18
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Toutain M, Gauthier A, Leconte P. Exercise therapy in the treatment of anorexia nervosa: Its effects depending on the type of physical exercise-A systematic review. Front Psychiatry 2022; 13:939856. [PMID: 36339831 PMCID: PMC9627498 DOI: 10.3389/fpsyt.2022.939856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/12/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND AND PURPOSE Clinical research focusing on the effectiveness of exercise therapy (ET) in patients with anorexia nervosa (AN) shows increasing interest in the last decade. The aim of this systematic review was to provide an overview of quantitative studies that have examined the impact of ET in AN patients and to examine its specific effects on physical and mental health according to the type of physical exercise (PE) practiced. METHODS The review was carried out based on the PRISMA 2020. Electronic databases PubMed, Web of Science, Embase, and Wiley were searched from inception to December 2021. Quantitative studies assessing the effects of ET interventions on AN patients were included and study quality was assessed using the PEDro scale. RESULTS A total of 27 studies were selected, including 13 randomized controlled trials. Regarding outcomes measured, results showed that aerobic and resistance exercise improved muscle strength, that mind-body PE decreased main symptoms of AN and mental health, and that combined PE reduced dysfunctional exercise and improved weight gain. CONCLUSION The findings suggest that ET intervention can induce benefits and has no deleterious effects on patients. In addition, specific effects on anorexia symptoms and physical and mental health have been observed according to the type of PE. However, this review reported several methodological weaknesses, including a lack of control group or randomization and statistical misconduct. Finally, ET intervention parameters were heterogeneous, and ET intervention generally lacked details, making reproducibility and comparability difficult. All these limitations underscore the need for a more rigorous methodology for further research.
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Affiliation(s)
- Marc Toutain
- UNICAEN, INSERM, COMETE, GIP CYCERON, Normandie University, Caen, France
| | - Antoine Gauthier
- UNICAEN, INSERM, COMETE, GIP CYCERON, Normandie University, Caen, France
| | - Pascale Leconte
- UNICAEN, INSERM, COMETE, GIP CYCERON, Normandie University, Caen, France
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19
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Tavolacci MP, Ladner J, Dechelotte P. COVID-19 Pandemic and Eating Disorders among University Students. Nutrients 2021; 13:4294. [PMID: 34959846 PMCID: PMC8707255 DOI: 10.3390/nu13124294] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/19/2021] [Accepted: 11/25/2021] [Indexed: 01/02/2023] Open
Abstract
An online cross-sectional study was conducted in May 2021 to identify factors, such as changes in food choices, lifestyle, risk and protective behavior, mental health, and social demographics, on eating disorders (ED) among students of a French university. Students were invited to fill out an online questionnaire. ED were identified using the French version of the five-item "Sick, Control, One stone, Fat, Food" (SCOFF) questionnaire. The Expali™-validated algorithmic tool, combining SCOFF and body mass index, was used to screen EDs into four diagnostic categories: bulimic ED, hyperphagic ED, restrictive ED and other ED. A total of 3508 students filled the online questionnaire, 67.3% female, mean age 20.7 years (SD = 2.3). The prevalence of ED was 51.6% in women and 31.9% in men (p < 0.0001). Lower food security scores were associated with a higher risk for all ED categories. Depression and academic stress due to COVID-19 were associated with ED regardless of category. Regarding health behaviors, a high adherence to the National nutrition recommendation was a protective factor for the risk of bulimic ED, hyperphagic ED and restrictive ED. A lower frequency of moderate and vigorous physical activity was associated with a higher risk of hyperphagic ED. Our study has shown a high screening of ED among the students of a French university fourteen months after the beginning of the COVID-19 pandemic. By disrupting academic learning, jobs and social life, the COVID-19 pandemic could have exacerbated existing ED or contributed to the onset of new ED.
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Affiliation(s)
- Marie-Pierre Tavolacci
- Clinical Investigation Center 1404, CHU Rouen, U 1073, Normandie University, UNIROUEN, F 76000 Rouen, France
| | - Joel Ladner
- Department of Epidemiology and Health Promotion, CHU Rouen, U 1073, Normandie University, UNIROUEN, F 76000 Rouen, France;
| | - Pierre Dechelotte
- Department of Nutrition, CHU Rouen, U 1073, Normandie University, UNIROUEN, F 76000 Rouen, France;
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20
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Spadini S, Ferro M, Lamanna J, Malgaroli A. Activity-based anorexia animal model: a review of the main neurobiological findings. J Eat Disord 2021; 9:123. [PMID: 34600568 PMCID: PMC8487535 DOI: 10.1186/s40337-021-00481-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The genesis of anorexia nervosa (AN), a severe eating disorder with a pervasive effect on many brain functions such as attention, emotions, reward processing, cognition and motor control, has not yet been understood. Since our current knowledge of the genetic aspects of AN is limited, we are left with a large and diversified number of biological, psychological and environmental risk factors, called into question as potential triggers of this chronic condition with a high relapse rate. One of the most valid and used animal models for AN is the activity-based anorexia (ABA), which recapitulates important features of the human condition. This model is generated from naïve rodents by a self-motivated caloric restriction, where a fixed schedule food delivery induces spontaneous increased physical activity. AIM In this review, we sought to provide a summary of the experimental research conducted using the ABA model in the pursuit of potential neurobiological mechanism(s) underlying AN. METHOD The experimental work presented here includes evidence for neuroanatomical and neurophysiological changes in several brain regions as well as for the dysregulation of specific neurochemical synaptic and neurohormonal pathways. RESULTS The most likely hypothesis for the mechanism behind the development of the ABA phenotype relates to an imbalance of the neural circuitry that mediates reward processing. Evidence collected here suggests that ABA animals show a large set of alterations, involving regions whose functions extend way beyond the control of reward mechanisms and eating habits. Hence, we cannot exclude a primary role of these alterations from a mechanistic theory of ABA induction. CONCLUSIONS These findings are not sufficient to solve such a major enigma in neuroscience, still they could be used to design ad hoc further experimental investigation. The prospect is that, since treatment of AN is still challenging, the ABA model could be more effectively used to shed light on the complex AN neurobiological framework, thus supporting the future development of therapeutic strategies but also the identification of biomarkers and diagnostic tools. Anorexia Nervosa (AN) is a severe eating disorder with a dramatic effect on many functions of our brain, such as attention, emotions, cognition and motion control. Since our current knowledge of the genetic aspects behind the development of AN is still limited, many biological, psychological and environmental factors must be taken into account as potential triggers of this condition. One of the most valid animal models for studying AN is the activity-based anorexia (ABA). In this model, rodents spontaneously limit food intake and start performing increased physical activity on a running wheel, a result of the imposition of a fixed time schedule for food delivery. In this review, we provide a detailed summary of the experimental research conducted using the ABA model, which includes extended evidence for changes in the anatomy and function of the brain of ABA rodents. The hope is that such integrated view will support the design of future experiments that will shed light on the complex brain mechanisms behind AN. Such advanced knowledge is crucial to find new, effective strategies for both the early diagnosis of AN and for its treatment.
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Affiliation(s)
- Sara Spadini
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
| | - Mattia Ferro
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
- Department of Psychology, Sigmund Freud University, Milan, Italy
| | - Jacopo Lamanna
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Malgaroli
- Center for Behavioral Neuroscience and Communication (BNC), Vita-Salute San Raffaele University, Via Olgettina 58, 20132, Milan, Italy.
- Faculty of Psychology, Vita-Salute San Raffaele University, Milan, Italy.
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Gorrell S, Flatt RE, Bulik CM, Le Grange D. Psychosocial etiology of maladaptive exercise and its role in eating disorders: A systematic review. Int J Eat Disord 2021; 54:1358-1376. [PMID: 33942917 PMCID: PMC8811798 DOI: 10.1002/eat.23524] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/13/2021] [Accepted: 04/13/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Although maladaptive exercise (ME) is widely recognized as a clinical feature in transdiagnostic eating disorders, less is known about psychosocial factors that give rise to and perpetuate this behavior. This systematic review aimed to examine the empirical status of this association. METHOD We reviewed 46 full text articles examining longitudinal associations between psychosocial variables and ME. RESULTS Eighteen studies met full inclusion criteria. Based on our qualitative synthesis, evidence suggests reasonably consistent associations between early concern with weight and shape, and negative affect on later development of ME. DISCUSSION Inconsistent and insufficient assessment of ME across a majority of studies underscores caution in interpretation of results, but guides important discussion for future clinical and research efforts.
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Affiliation(s)
- Sasha Gorrell
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California
| | - Rachael E. Flatt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Cynthia M. Bulik
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, San Francisco, California,Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, Illinois
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Michels N, De Backer F, Dimakopoulou M, Mane K, Indave I, Huybrechts I. Eating disorders and the risk of developing cancer: a systematic review. Eat Weight Disord 2021; 26:1021-1035. [PMID: 33025526 DOI: 10.1007/s40519-020-01020-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/11/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Evidence concerning eating disorders as risk toward developing cancer is sparse. Energy restriction might be cancer protective, while malnutrition, vomiting, laxative and substance use might stimulate cancer development. We examined whether individuals with an eating disorder (not restricted to anorexia nervosa) had a different risk of developing cancer. METHODS A systematic search on Medline and Embase until 28th April 2020 identified relevant human original research publications, including all populations and all cancer types. RESULTS From 990 records, 6 case reports and 9 cohorts were included. Some cohorts found a decreased breast (3/5 studies) or cervical (1/2) cancer risk, while an increased esophageal (2/3), liver (1/1), brain (1/1 in men) and respiratory (2/4) cancer risk, but other cancer risks were non-significant, and an increased mortality overall (1/2), from breast (1/1), female genital (1/1) and skin (1/1) cancer in eating disorder patients. The case reports further described esophageal cancer and leukemia. No clear statistical differences in cancer risk were found depending on eating disorder type, perhaps due to the small sample size (n = 1783 for other than anorexia nervosa). CONCLUSIONS The literature on eating disorders and cancer risk is sparse with many gaps. Hormonal changes, sexual activity, nutritional status, vomiting and concomitant tobacco/alcohol abuse may explain increased/decreased cancer risk. Future large studies (now 1-366 cancer cases) that also include men (now 4.7%), bulimia nervosa (now 3.8%) and several cancer sites (now mainly breast cancer) are needed and should foresee longer follow-up time (now 5.4-15.2 years) and extensive confounder adjustment (now only age and sex). LEVEL OF EVIDENCE Level I, systematic review.
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Affiliation(s)
- Nathalie Michels
- Department of Public Health and Primary Care, Ghent University, 4K3, Corneel Heymanslaan 10, 9000, Gent, Belgium.
| | - Fien De Backer
- Department of Public Health and Primary Care, Ghent University, 4K3, Corneel Heymanslaan 10, 9000, Gent, Belgium
| | | | - Katerina Mane
- International Agency for Research on Cancer, Lyon, France
| | - Iciar Indave
- International Agency for Research on Cancer, Lyon, France
| | - Inge Huybrechts
- Department of Public Health and Primary Care, Ghent University, 4K3, Corneel Heymanslaan 10, 9000, Gent, Belgium
- International Agency for Research on Cancer, Lyon, France
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23
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Popiołek-Kalisz J, Teter M, Kozak G, Powrózek T, Mlak R, Sobieszek G, Karakuła-Juchnowicz H, Małecka-Massalska T. Potential bioelectrical impedance analysis (BIA) parameters in prediction muscle strength in women with anorexia nervosa. World J Biol Psychiatry 2021; 22:203-213. [PMID: 32462960 DOI: 10.1080/15622975.2020.1774652] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The role of physical activity in anorexia nervosa (AN) treatment has been investigated. Muscle strength (MS) reflects physical condition and can predict AN patients' response to this novel treatment approach. This study was intended to find bioelectrical impedance analysis (BIA) parameters that predict AN patients' MS. METHODS The study included 42 AN patients and 42 healthy ones in the control group. BIA parameters that predict MS were assessed by dividing AN patients into groups by their hand grip strength test score (higher/lower than 22.5 kg). RESULTS The highest accuracy for distinguishing AN subjects from the control group was achieved by cell membrane capacitance (AUC = 0.916), impedance at 200 kHz and 5 kHz ratio (AUC = 0.924), phase angle (PA) 5 kHz (AUC = 0.906) and PA 50 kHz (AUC = 0.919). The low MS group had significantly lower values of PA 50 kHz (mean: 4.03 ± 0.80° vs. 4.58 ± 0.65°; p = 0.032) and fat-free mass index (mean: 12.22 ± 1.41 kg/m2 vs. 13.14 ± 0.94 kg/m2; p = 0.026). In the univariate model, PA 50 kHz ≥4.037° was associated with the lowest chance of muscle weakness (OR = 0.230; p = 0.005). In the multivariate analysis, PA 50 kHz was the only significant factor of MS (OR = 0.01; p = 0.027). CONCLUSIONS PA 50 kHz is the best BIA parameter to predict MS in AN patients. It could be useful for assessment before physical activity treatment application.
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Affiliation(s)
| | - Mariusz Teter
- Department of Human Physiology, Medical University of Lublin, Lublin, Poland
| | - Gustaw Kozak
- Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Lublin, Poland
| | - Tomasz Powrózek
- Department of Human Physiology, Medical University of Lublin, Lublin, Poland
| | - Radosław Mlak
- Department of Human Physiology, Medical University of Lublin, Lublin, Poland
| | - Grzegorz Sobieszek
- Clinic of Cardiology and Internal Medicine, Department of Cardiology, Military Hospital, Lublin, Poland
| | - Hanna Karakuła-Juchnowicz
- Department of Psychiatry, Psychotherapy and Early Intervention, Medical University of Lublin, Lublin, Poland
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Coëffier M, Gâté M, Rimbert A, Petit A, Folope V, Grigioni S, Déchelotte P, Achamrah N. Validity of Bioimpedance Equations to Evaluate Fat-Free Mass and Muscle Mass in Severely Malnourished Anorectic Patients. J Clin Med 2020; 9:jcm9113664. [PMID: 33202580 PMCID: PMC7698304 DOI: 10.3390/jcm9113664] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/30/2020] [Accepted: 11/08/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Bioelectrical impedance analysis (BIA) is a simple and rapid technique to measure body composition (BC). Validity of BIA in patients with low body mass index (BMI) remains controversial. We assessed the validity of several BIA equations to evaluate fat-free mass (FFM), fat mass (FM) and muscle mass in patients with anorexia nervosa (AN) by using dual X ray absorptiometry (DXA) as reference. METHODS Sixteen BIA equations developed for FFM and appendicular lean mass (ALM) were applied on electrical data measured by BIA in AN patients with BMI <16 kg/m². BIA and DXA were done the same day after overnight fasting. Results were compared with the Bland-Altman method, Pearson correlation and a Lin concordance test. RESULTS Data from 115 female AN patients (14.6 ± 1.2 kg/m²; 32.3 ± 14.5 years) were included. FM and FFM assessed by DXA were, respectively, 4.2 ± 2.4 kg and 35.5 ± 3.8 kg. The best results were obtained with Sun's equation: respectively for FM and FFM, Bland Altman bias at 0.548 and 0.706 kg, Pearson correlation r at 0.86 and 0.86 and Lin concordance coefficient at 0.81 and 0.84. However, confidence intervals (CI) at 95% were high (-2.73-3.83 kg for FM; -4.55-3.13 kg for FFM). Other equations also showed high 95% CI. Accuracy was acceptable for Sun and Bedogni equations for FFM (approximately 66%) but very low for FM prediction considering all equations (<15%). Concerning ALM evaluated at 14.88 ± 2.04 kg by DXA, only Scafoglieri and Yoshida equations showed acceptable values: bias (-0.2 and 2.8%), Pearson r (0.89 and 0.86), Lin concordance coefficient (0.82 and 0.82) and accuracy (83.5 and 82.6%). Confidence intervals at 95% were high for both equations (-2.1-2.0 for Scafoglieri equation and -1.6-2.4 for Yoshida equation). CONCLUSION In AN patients with BMI < 16 kg/m², no BIA equation tested was adapted to evaluate BC at the individual level.
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Affiliation(s)
- Moise Coëffier
- Nutrition Department, Rouen University Hospital Center, 76000 Rouen, France; (M.C.); (M.G.); (A.R.); (A.P.); (V.F.); (S.G.); (P.D.)
- Nutrition, Inflammation et Dysfonction de l’axe Intestin-Cerveau, Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, INSERM UMR 1073, 76000 Rouen, France
- Clinical Investigation Centre CIC 1404, INSERM and Rouen University Hospital, 76000 Rouen, France
| | - Mathilde Gâté
- Nutrition Department, Rouen University Hospital Center, 76000 Rouen, France; (M.C.); (M.G.); (A.R.); (A.P.); (V.F.); (S.G.); (P.D.)
| | - Agnès Rimbert
- Nutrition Department, Rouen University Hospital Center, 76000 Rouen, France; (M.C.); (M.G.); (A.R.); (A.P.); (V.F.); (S.G.); (P.D.)
- Nutrition, Inflammation et Dysfonction de l’axe Intestin-Cerveau, Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, INSERM UMR 1073, 76000 Rouen, France
| | - André Petit
- Nutrition Department, Rouen University Hospital Center, 76000 Rouen, France; (M.C.); (M.G.); (A.R.); (A.P.); (V.F.); (S.G.); (P.D.)
- Nutrition, Inflammation et Dysfonction de l’axe Intestin-Cerveau, Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, INSERM UMR 1073, 76000 Rouen, France
| | - Vanessa Folope
- Nutrition Department, Rouen University Hospital Center, 76000 Rouen, France; (M.C.); (M.G.); (A.R.); (A.P.); (V.F.); (S.G.); (P.D.)
- Nutrition, Inflammation et Dysfonction de l’axe Intestin-Cerveau, Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, INSERM UMR 1073, 76000 Rouen, France
| | - Sébastien Grigioni
- Nutrition Department, Rouen University Hospital Center, 76000 Rouen, France; (M.C.); (M.G.); (A.R.); (A.P.); (V.F.); (S.G.); (P.D.)
- Nutrition, Inflammation et Dysfonction de l’axe Intestin-Cerveau, Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, INSERM UMR 1073, 76000 Rouen, France
| | - Pierre Déchelotte
- Nutrition Department, Rouen University Hospital Center, 76000 Rouen, France; (M.C.); (M.G.); (A.R.); (A.P.); (V.F.); (S.G.); (P.D.)
- Nutrition, Inflammation et Dysfonction de l’axe Intestin-Cerveau, Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, INSERM UMR 1073, 76000 Rouen, France
- Clinical Investigation Centre CIC 1404, INSERM and Rouen University Hospital, 76000 Rouen, France
| | - Najate Achamrah
- Nutrition Department, Rouen University Hospital Center, 76000 Rouen, France; (M.C.); (M.G.); (A.R.); (A.P.); (V.F.); (S.G.); (P.D.)
- Nutrition, Inflammation et Dysfonction de l’axe Intestin-Cerveau, Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, INSERM UMR 1073, 76000 Rouen, France
- Clinical Investigation Centre CIC 1404, INSERM and Rouen University Hospital, 76000 Rouen, France
- Correspondence:
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Influence of Glutamine and Branched-Chain Amino Acids Supplementation during Refeeding in Activity-Based Anorectic Mice. Nutrients 2020; 12:nu12113510. [PMID: 33202638 PMCID: PMC7696484 DOI: 10.3390/nu12113510] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/03/2020] [Accepted: 11/12/2020] [Indexed: 01/20/2023] Open
Abstract
Background: Optimizing the refeeding of patients with anorexia nervosa remains important to limit somatic complications of malnutrition, as well as to avoid disease relapses by targeting persistent mood and intestinal disorders. We aimed to evaluate the effects of glutamine (Gln) and branched-chain amino acids (BCAA) supplementation during refeeding in activity-based anorectic (ABA) mice. Method: Male C57Bl/6 mice were randomized in control and ABA groups. Once ABA-induced malnutrition was established, mice were progressively refed or not. Refed mice had free access to drinking water supplemented or not with 1% Gln or 2.5% BCAA for 10 days. Results: A progressive refeeding was associated with a partial restoration of body weight and lean mass, while a fat mass rebound was observed. In addition, refeeding restored glucose and leptin. Gln did not affect these parameters, while BCAA tended to increase body weight, fat mass, and glycaemia. In the colon, refeeding improved total protein synthesis and restored the LC3II/LC3I ratio, a marker of autophagy. Gln supplementation enhanced colonic protein synthesis, which was associated with an increased p-p70S6kinase/p70S6kinase ratio, whereas these effects were blunted by BCCA supplementation. Conclusions: In ABA mice, Gln and BCAA supplementations during a progressive refeeding fail to restore body weight and lean mass. However, Gln supplementation improves total colonic protein synthesis conversely to BCAA. Further studies are needed to decipher the underlying mechanisms involved in these opposite results.
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Skowron K, Kurnik-Łucka M, Dadański E, Bętkowska-Korpała B, Gil K. Backstage of Eating Disorder-About the Biological Mechanisms behind the Symptoms of Anorexia Nervosa. Nutrients 2020; 12:E2604. [PMID: 32867089 PMCID: PMC7551451 DOI: 10.3390/nu12092604] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/23/2020] [Accepted: 08/25/2020] [Indexed: 12/12/2022] Open
Abstract
Anorexia nervosa (AN) represents a disorder with the highest mortality rate among all psychiatric diseases, yet our understanding of its pathophysiological components continues to be fragmentary. This article reviews the current concepts regarding AN pathomechanisms that focus on the main biological aspects involving central and peripheral neurohormonal pathways, endocrine function, as well as the microbiome-gut-brain axis. It emerged from the unique complexity of constantly accumulating new discoveries, which hamper the ability to look at the disease in a more comprehensive way. The emphasis is placed on the mechanisms underlying the main symptoms and potential new directions that require further investigation in clinical settings.
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Affiliation(s)
- Kamil Skowron
- Department of Pathophysiology, Jagiellonian University Medical College, Czysta St 18, 31-121 Krakow, Poland; (K.S.); (M.K.-Ł.); (E.D.)
| | - Magdalena Kurnik-Łucka
- Department of Pathophysiology, Jagiellonian University Medical College, Czysta St 18, 31-121 Krakow, Poland; (K.S.); (M.K.-Ł.); (E.D.)
| | - Emil Dadański
- Department of Pathophysiology, Jagiellonian University Medical College, Czysta St 18, 31-121 Krakow, Poland; (K.S.); (M.K.-Ł.); (E.D.)
| | - Barbara Bętkowska-Korpała
- Department of Psychiatry, Jagiellonian University Medical College, Institute of Medical Psychology, Jakubowskiego St 2, 30-688 Krakow, Poland;
| | - Krzysztof Gil
- Department of Pathophysiology, Jagiellonian University Medical College, Czysta St 18, 31-121 Krakow, Poland; (K.S.); (M.K.-Ł.); (E.D.)
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Breton J, Giallourou N, Nobis S, Morin A, Achamrah N, Goichon A, Belmonte L, Dechelotte P, Rego JLD, Coëffier M, Swann J. Characterizing the metabolic perturbations induced by activity-based anorexia in the C57Bl/6 mouse using 1H NMR spectroscopy. Clin Nutr 2020; 39:2428-2434. [DOI: 10.1016/j.clnu.2019.10.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/25/2019] [Indexed: 12/17/2022]
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Duriez P, Eddarkaoui S, Blum D, Dickson SL, Gorwood P, Tolle V, Viltart O. Does physical activity associated with chronic food restriction alleviate anxiety like behaviour, in female mice? Horm Behav 2020; 124:104807. [PMID: 32544401 DOI: 10.1016/j.yhbeh.2020.104807] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 06/09/2020] [Accepted: 06/10/2020] [Indexed: 12/17/2022]
Abstract
Anorexia nervosa (AN) is an eating disorder characterized by excessive weight loss, persistent food restriction and inappropriate physical activity relative to declining energy balance. The comorbidity with depression and/or anxiety disorders might contribute to the "chronicization" of the disease. We aimed here to question first the link between physical activity and anxiety from a clinical investigation of AN patients (n = 206). Then, using a rodent model mimicking numerous physiological and metabolic alterations commonly seen in AN patients, we examined whether 1) chronic food restriction increased anxiety-like behaviour and 2) physical activity plays a role in regulating anxiety levels. To this end, we exposed young female mice to a chronic food restriction (FR, n = 8) paradigm combined or not with access to a running wheel (FRW, n = 8) for two weeks. The mice were compared to a group of mice fed ad libitum without (AL, n = 6) or with running wheel access (ALW, n = 8). We explored anxiety-like behaviour of all mice in the following tests: hyponeophagia, marble burying, elevated plus maze, open field, and the light and dark box. On the last day, we used a restraint test of 30 min duration and measured their stress reactivity by assaying plasma corticosterone. In the open field and the elevated plus-maze, we found that FRW mice behaved similarly to AL and ALW mice whereas FR mice did not express anxiety-like behaviour. The FRW mice displayed the lowest latency to reach the food in the hyponeophagia test. Regarding stress reactivity, FRW mice exhibited corticosterone reactivity after acute stress that was similar to the control mice, while FR mice did not fully return to basal corticosterone at one hour after the restraint stress. Taken together, these data demonstrate a differential reactivity to acute stress in FR conditions and a beneficial effect of running wheel activity in ALW and FRW conditions. Moreover, we report the absence of a typical anxiety-like behaviour associated with the food restriction (FR and FRW groups). We conclude that this model (FR and FRW mice) did not express typical anxiety-like behaviour, but that physical activity linked to food restriction improved coping strategies in an anxiogenic context.
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Affiliation(s)
- Philibert Duriez
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP) INSERM U1266, "Vulnerability of Psychiatric and Addictive Disorders", F-75014 Paris, France; GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, F-75014 Paris, France
| | - Sabiha Eddarkaoui
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France; Alzheimer & Tauopathies, LabEx DISTALZ, LiCEND, F-59000 Lille, France
| | - David Blum
- Univ. Lille, Inserm, CHU Lille, U1172 - LilNCog - Lille Neuroscience & Cognition, F-59000 Lille, France; Alzheimer & Tauopathies, LabEx DISTALZ, LiCEND, F-59000 Lille, France
| | - Suzanne L Dickson
- Department of Physiology/Endocrine, Institute of Neuroscience and Physiology, The Sahlgrenska Academy at the University of Gothenburg, SE-405 30 Gothenburg, Sweden
| | - Philip Gorwood
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP) INSERM U1266, "Vulnerability of Psychiatric and Addictive Disorders", F-75014 Paris, France; GHU Paris Psychiatrie et Neurosciences, Hôpital Sainte-Anne, F-75014 Paris, France
| | - Virginie Tolle
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP) INSERM U1266, "Vulnerability of Psychiatric and Addictive Disorders", F-75014 Paris, France
| | - Odile Viltart
- Université de Paris, Institute of Psychiatry and Neuroscience of Paris (IPNP) INSERM U1266, "Vulnerability of Psychiatric and Addictive Disorders", F-75014 Paris, France; Université de Lille, F-59650 Villeneuve d'Ascq, France.
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D'Addario C, Zaplatic E, Giunti E, Pucci M, Micioni Di Bonaventura MV, Scherma M, Dainese E, Maccarrone M, Nilsson IA, Cifani C, Fadda P. Epigenetic regulation of the cannabinoid receptor CB1 in an activity-based rat model of anorexia nervosa. Int J Eat Disord 2020; 53:432-446. [PMID: 32275093 DOI: 10.1002/eat.23271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/16/2020] [Accepted: 03/16/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Both environmental and genetic factors are known to contribute to the development of anorexia nervosa (AN), but the exact etiology remains poorly understood. Herein, we studied the transcriptional regulation of the endocannabinoid system, an interesting target for body weight maintenance and the control of food intake and energy balance. METHOD We used two well-characterized animal models of AN: (a) the activity-based anorexia (ABA) model in which rats, housed with running wheels and subjected to daily food restriction, show reductions in body weight and increase in physical activity; (b) the genetic anx/anx mouse displaying the core features of AN: low food intake and emaciation. RESULTS Among the evaluated endocannabinoid system components, we observed a selective and significant down-regulation of the gene encoding for the type 1 cannabinoid receptor (Cnr1) in ABA rats' hypothalamus and nucleus accumbens and, in the latter area, a consistent, significant and correlated increase in DNA methylation at the gene promoter. No changes were evident in the anx/anx mice except for a down-regulation of Cnr1, in the prefrontal cortex. DISCUSSION Our findings support a possible role for Cnr1 in the ABA animal model of AN. In particular, its regulation in the nucleus accumbens appears to be triggered by environmental cues due to the consistent epigenetic modulation of the promoter. These data warrant further studies on Cnr1 regulation as a possible target for treatment of AN.
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Affiliation(s)
- Claudio D'Addario
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Elizabeta Zaplatic
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - Elisa Giunti
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Mariangela Pucci
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | | | - Maria Scherma
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Enrico Dainese
- Faculty of Bioscience and Technology for Food, Agriculture and Environment, University of Teramo, Teramo, Italy
| | - Mauro Maccarrone
- Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy.,Lipid Neurochemistry Unit, Santa Lucia Foundation IRCCS, Rome, Italy
| | - Ida A Nilsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Center for Molecular Medicine, Karolinska Hospital, Stockholm, Sweden
| | - Carlo Cifani
- School of Pharmacy, Pharmacology Unit, University of Camerino, Camerino, Italy
| | - Paola Fadda
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Cagliari, Italy.,CNR Institute of Neuroscience - Cagliari, National Research Council, Cagliari, Italy
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Kemmer M, Correll CU, Hofmann T, Stengel A, Grosser J, Haas V. Assessment of Physical Activity Patterns in Adolescent Patients with Anorexia Nervosa and Their Effect on Weight Gain. J Clin Med 2020; 9:E727. [PMID: 32156088 PMCID: PMC7141193 DOI: 10.3390/jcm9030727] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 02/24/2020] [Accepted: 03/04/2020] [Indexed: 01/04/2023] Open
Abstract
(1) Background: Altered physical activity (PA) affects weight recovery in anorexia nervosa (AN) patients. The study aimed to objectively characterize PA patterns and their effect on weight trajectory in adolescent AN patients. (2) Methods: PA was assessed in 47 patients on admission to inpatient treatment, in n = 25 of these patients again 4 weeks after discharge (follow-up, FU), as well as in 20 adolescent healthy controls using the Sense Wear™ armband. The following PA categories were defined by metabolic equivalent (MET) ranges: sedentary behavior (SB), light (LPA), moderate (MPA), vigorous (VPA), and high-level PA (HLPA= MPA + VPA). (3) Results: LPA on admission was significantly higher in AN patients than in controls (103 vs. 55 min/d, p < 0.001), and LPA in AN decreased over time to 90 min/d (p = 0.006). Patients with higher admission LPA (n = 12) still had elevated LPA at FU (p = 0.003). High admission LPA was associated with a higher inpatient BMI percentage gain (ΔBMI%; 18.2% ± 10.0% vs. 12.0% ± 9.7%, p = 0.037) but with a loss of ΔBMI% at FU (-2.3% ± 3.6% vs. 0.8% ± 3.6%, p = 0.045). HLPA at baseline was associated with a lower inpatient ΔBMI% (p = 0.045). (4) Conclusion: Elevated LPA in AN patients decreased after inpatient treatment, and PA patterns had an impact on weight trajectory.
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Affiliation(s)
- Miriam Kemmer
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (M.K.); (C.U.C.); (J.G.)
| | - Christoph U. Correll
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (M.K.); (C.U.C.); (J.G.)
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, USA
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY 11004, USA
| | - Tobias Hofmann
- Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin, 12200 Berlin, Germany; (T.H.); (A.S.)
| | - Andreas Stengel
- Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin, 12200 Berlin, Germany; (T.H.); (A.S.)
- Department of Psychosomatic Medicine and Psychotherapy, Medical University Hospital Tübingen, 72076 Tübingen, Germany
| | - Julia Grosser
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (M.K.); (C.U.C.); (J.G.)
| | - Verena Haas
- Department of Child and Adolescent Psychiatry, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany; (M.K.); (C.U.C.); (J.G.)
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31
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Di Lodovico L, Gorwood P. The relationship between moderate to vigorous physical activity and cognitive rigidity in anorexia nervosa. Psychiatry Res 2020; 284:112703. [PMID: 31813596 DOI: 10.1016/j.psychres.2019.112703] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/22/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022]
Abstract
A drive for physical activity despite underweight is a core feature of anorexia nervosa. This pilot study detects which aspect of physical activity, if any, could be related to cognitive rigidity in anorexia nervosa. Twenty-eight outpatients with anorexia nervosa and 24 healthy participants were assessed for cognitive flexibility with the Trail Making Test (TMT) and for multiple dimensions of physical activity by subjective and objective assessments. Correlation analysis was conducted to disentangle the relationship between cognitive rigidity and the different aspects of physical activity, then, the moderating effect of anorexia nervosa on this relationship was assessed. A principal component analysis was performed to incorporate all variables of physical activity in (a) global factor(s) reflecting the multidimensional nature of this construct. Cognitive rigidity (TMT b - a score) was significantly correlated to the amount of objectively assessed physical activity estimated, only in the sample of patients with anorexia nervosa. The principal component analysis confirms the correlation between a single construct of "physical activity" and cognitive rigidity in anorexia nervosa only. This pilot study suggests a relationship between cognitive rigidity and physical activity that could help explain the persistence of the latter despite ongoing malnutrition in patients with anorexia nervosa.
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Affiliation(s)
- Laura Di Lodovico
- Clinique des Maladies Mentales et de l'Encéphale (CMME), Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, 1 Rue Cabanis, Paris 75014, France; INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Université de Paris Descartes, PRES Sorbonne Paris Cité, Paris, France.
| | - Philip Gorwood
- Clinique des Maladies Mentales et de l'Encéphale (CMME), Hôpital Sainte-Anne, GHU Paris Psychiatrie et Neurosciences, 1 Rue Cabanis, Paris 75014, France; INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Université de Paris Descartes, PRES Sorbonne Paris Cité, Paris, France
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32
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MARTÍNEZ-SÁNCHEZ SM, MARTÍNEZ-GARCÍA TE, MUNGUÍA-IZQUIERDO D. Physical fitness and nutritional status in female adolescents with anorexia nervosa. REV NUTR 2020. [DOI: 10.1590/1678-9865202033e190154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective This study aimed to determine whether physical fitness is related to nutritional status in a sample of female adolescents with anorexia nervosa, to contrast the nourished and undernourished patients, and to compare the physical fitness in these patients with normative data of healthy subjects stratified by age and gender. Methods Nutritional status was determined using the body mass index Z-score, fat mass, fat-free mass (bioelectrical impedance analysis), and the Controlling Nutritional Status score in 15 anorexic adolescents with 14.3±1.6 years. Physical fitness was assessed using the ALPHA-Fitness Battery (handgrip strength, standing broad jump, 4x10m shuttle run, and 20m shuttle run tests). Results Handgrip strength was significantly associated with all variables of nutritional status, except with the three blood components of the Controlling Nutritional Status score. The undernourished anorexic patients showed significantly worse physical fitness than the nourished anorexic patients in all tests, except in the standing broad jump and the 4x10m shuttle run tests. The physical fitness tests of the female anorexic adolescents showed scores significantly worse than those of the normative European female adolescent population. Conclusion The observation of female adolescents with anorexia nervosa showed associations between higher physical fitness levels and better nutritional statuses. Handgrip strength and 20m shuttle run tests may be options of additional indicators of undernutrition in anorexic female adolescents. The undernourished anorexic patients showed worse physical fitness than the nourished ones. According to normative data for healthy sex- and agematched adolescents, physical fitness is severely impaired in anorexic female adolescents.
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Scharmer C, Gorrell S, Schaumberg K, Anderson D. Compulsive exercise or exercise dependence? Clarifying conceptualizations of exercise in the context of eating disorder pathology. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2020; 46:101586. [PMID: 34093941 PMCID: PMC8174529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Maladaptive exercise relates to eating disorder (ED) pathology and impairment in clinical and non-clinical populations. At present, two different conceptualizations of maladaptive exercise are often studied in relation to ED pathology: compulsive exercise and exercise dependence. Compulsive exercise functions to avoid negative affect (e.g., guilt and anxiety) associated with not exercising, whereas exercise dependence is associated with tolerance to exercise benefits and avoidance of exercise withdrawal. At present, clinicians and researchers struggle to determine the most appropriate term for describing problematic exercise in individuals with ED pathology. This study aimed to directly compare these conceptualizations of maladaptive exercise in relation to severity of ED pathology. DESIGN This study examined cross-sectional data. METHOD Undergraduate participants (N =235, 78% female) with elevated ED pathology completed the Eating Disorder Examination Questionnaire (EDE-Q), Compulsive Exercise Test (CET), and Exercise Dependence Scale (EDS). Multiple linear regression analyses evaluated associations between EDE-Q and CET and EDS scores and dominance analysis determined which qualities of exercise were uniquely associated with EDE-Q scores. RESULTS Results suggest that compulsive qualities of exercise, including exercise to control shape and weight and to avoid negative affect are more strongly associated with severity of ED pathology than qualities of exercise dependence. CONCLUSIONS Clinicians and researchers working with ED populations can benefit from prioritizing assessments that capture compulsive qualities of exercise. Additionally, these results suggest that interventions that effectively target other compulsive behaviors (e.g., exposure and response prevention) may be promising treatment options for problematic exercise in the context of EDs.
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Affiliation(s)
- Christina Scharmer
- University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA
| | - Sasha Gorrell
- University of California, 401 Parnassus Avenue, San Francisco, CA, 94143, USA
| | | | - Drew Anderson
- University at Albany, State University of New York, 1400 Washington Avenue, Albany, NY, 12222, USA
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34
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New therapeutic approaches to target gut-brain axis dysfunction during anorexia nervosa. CLINICAL NUTRITION EXPERIMENTAL 2019. [DOI: 10.1016/j.yclnex.2019.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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35
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Collu R, Scherma M, Piscitelli F, Giunti E, Satta V, Castelli MP, Verde R, Fratta W, Bisogno T, Fadda P. Impaired brain endocannabinoid tone in the activity-based model of anorexia nervosa. Int J Eat Disord 2019; 52:1251-1262. [PMID: 31456239 DOI: 10.1002/eat.23157] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/25/2019] [Accepted: 08/13/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Despite the growing knowledge on the functional relationship between an altered endocannabinoid (eCB) system and development of anorexia nervosa (AN), to date no studies have investigated the central eCB tone in the activity-based anorexia (ABA) model that reproduces key aspects of human AN. METHOD We measured levels of two major eCBs, anandamide (AEA) and 2-arachidonoylglycerol (2-AG), those of two eCB-related lipids, oleoylethanolamide (OEA) and palmitoylethanolamide (PEA), and the cannabinoid type-1 receptor (CB1R) density in the brain of female ABA rats, focusing on areas involved in homeostatic and rewarding-related regulation of feeding behavior (i.e., prefrontal cortex, nucleus accumbens, caudato putamen, amygdala, hippocampus and hypothalamus). Analysis was carried out also at the end of recovery from the ABA condition. RESULTS At the end of the ABA induction phase, 2-AG was significantly decreased in ABA rats in different brain areas but not in the caudato putamen. No changes were detected in AEA levels in any region, whereas the levels of OEA and PEA were decreased exclusively in the hippocampus and hypothalamus. Furthermore, CB1R density was decreased in the dentate gyrus of hippocampus and in the lateral hypothalamus. After recovery, both 2-AG levels and CB1R density were partially normalized in some areas. In contrast, AEA levels became markedly reduced in all the analyzed areas. DISCUSSION These data demonstrate an altered brain eCB tone in ABA rats, further supporting the involvement of an impaired eCB system in AN pathophysiology that may contribute to the maintenance of some symptomatic aspects of the disease.
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Affiliation(s)
- Roberto Collu
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Italy
| | - Maria Scherma
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Italy
| | - Fabiana Piscitelli
- Endocannabinoid Research Group, Institute of Biomolecular Chemistry, Consiglio Nazionale delle Ricerche, Pozzuoli, Italy
| | - Elisa Giunti
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Italy
| | - Valentina Satta
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Italy
| | - M Paola Castelli
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Italy
| | - Roberta Verde
- Endocannabinoid Research Group, Institute of Biomolecular Chemistry, Consiglio Nazionale delle Ricerche, Pozzuoli, Italy
| | - Walter Fratta
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Italy.,Centre of Excellence "Neurobiology of Addiction", University of Cagliari, Cagliari, Italy
| | - Tiziana Bisogno
- Endocannabinoid Research Group, Institute of Traslational Pharmacology, Consiglio Nazionale delle Ricerche, Rome, Italy
| | - Paola Fadda
- Department of Biomedical Sciences, Division of Neuroscience and Clinical Pharmacology, University of Cagliari, Italy.,Centre of Excellence "Neurobiology of Addiction", University of Cagliari, Cagliari, Italy.,CNR Institute of Neuroscience - Cagliari, National Research Council, Cagliari.,National Institute of Neuroscience (INN), Turin, Italy
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36
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Nagata JM, Carlson JL, Golden NH, Murray SB, Long J, Leonard MB, Peebles R. Associations between exercise, bone mineral density, and body composition in adolescents with anorexia nervosa. Eat Weight Disord 2019; 24:939-945. [PMID: 29949128 PMCID: PMC6286679 DOI: 10.1007/s40519-018-0521-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/28/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE To identify the effect of duration of weight-bearing exercise and team sports participation on bone mineral density (BMD) and body composition among adolescents with anorexia nervosa (AN). METHOD We retrospectively reviewed electronic medical records of all patients 9-20 years old with a DSM-5 diagnosis of AN evaluated by the Stanford Eating Disorders Program (1997-2011) who underwent dual-energy X-ray absorptiometry. RESULTS A total of 188 adolescents with AN were included (178 females and 10 males). Using multivariate linear regression, duration of weight-bearing exercise (B = 0.15, p = 0.005) and participation in team sports (B = 0.53, p = 0.001) were associated with higher BMD at the hip and team sports (B = 0.39, p = 0.006) were associated with higher whole body BMC, controlling for covariates. Participation in team sports (B = - 1.06, p = 0.007) was associated with greater deficits in FMI Z-score. LBMI Z-score was positively associated with duration of weight-bearing exercise (B = 0.10, p = 0.018) and may explain the relationship between exercise and bone outcomes. CONCLUSION Duration of weight-bearing exercise and team sports participation may be protective of BMD at the hip and whole body BMC, while participation in team sports was associated with greater FMI deficits among adolescents with AN. LEVEL OF EVIDENCE Level V, descriptive retrospective study.
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Affiliation(s)
- Jason M Nagata
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA. .,Department of Pediatrics, University of California, San Francisco, 3333 California Street, Suite 245, Box 0503, San Francisco, CA, 94143, USA.
| | - Jennifer L Carlson
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Neville H Golden
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Stuart B Murray
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA
| | - Jin Long
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Mary B Leonard
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Rebecka Peebles
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Hübel C, Gaspar HA, Coleman JRI, Finucane H, Purves KL, Hanscombe KB, Prokopenko I, Graff M, Ngwa JS, Workalemahu T, O'Reilly PF, Bulik CM, Breen G. Genomics of body fat percentage may contribute to sex bias in anorexia nervosa. Am J Med Genet B Neuropsychiatr Genet 2019; 180:428-438. [PMID: 30593698 PMCID: PMC6751355 DOI: 10.1002/ajmg.b.32709] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/25/2018] [Accepted: 11/26/2018] [Indexed: 12/14/2022]
Abstract
Anorexia nervosa (AN) occurs nine times more often in females than in males. Although environmental factors likely play a role, the reasons for this imbalanced sex ratio remain unresolved. AN displays high genetic correlations with anthropometric and metabolic traits. Given sex differences in body composition, we investigated the possible metabolic underpinnings of female propensity for AN. We conducted sex-specific GWAS in a healthy and medication-free subsample of the UK Biobank (n = 155,961), identifying 77 genome-wide significant loci associated with body fat percentage (BF%) and 174 with fat-free mass (FFM). Partitioned heritability analysis showed an enrichment for central nervous tissue-associated genes for BF%, which was more prominent in females than males. Genetic correlations of BF% and FFM with the largest GWAS of AN by the Psychiatric Genomics Consortium were estimated to explore shared genomics. The genetic correlations of BF%male and BF%female with AN differed significantly from each other (p < .0001, δ = -0.17), suggesting that the female preponderance in AN may, in part, be explained by sex-specific anthropometric and metabolic genetic factors increasing liability to AN.
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Affiliation(s)
- Christopher Hübel
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUnited Kingdom
- UK National Institute for Health Research (NIHR) Biomedical Research CentreSouth London and Maudsley HospitalLondonUnited Kingdom
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
| | - Héléna A. Gaspar
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUnited Kingdom
- UK National Institute for Health Research (NIHR) Biomedical Research CentreSouth London and Maudsley HospitalLondonUnited Kingdom
| | - Jonathan R. I. Coleman
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUnited Kingdom
- UK National Institute for Health Research (NIHR) Biomedical Research CentreSouth London and Maudsley HospitalLondonUnited Kingdom
| | - Hilary Finucane
- Schmidt Fellows ProgramBroad Institute of MIT and HarvardCambridgeMassachusetts
| | - Kirstin L. Purves
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUnited Kingdom
| | - Ken B. Hanscombe
- Department of Medical and Molecular GeneticsKing's College London, Guy's HospitalLondonUnited Kingdom
| | - Inga Prokopenko
- Section of Genomics of Common Disease, Department of MedicineImperial College LondonLondonUnited Kingdom
| | | | - Mariaelisa Graff
- Department of EpidemiologyUniversity of North CarolinaChapel HillNorth Carolina
| | - Julius S. Ngwa
- Department of BiostatisticsJohns Hopkins Bloomberg School of Public HealthBaltimoreMaryland
- Department of BiostatisticsBoston University School of Public HealthBostonMassachusetts
| | - Tsegaselassie Workalemahu
- Epidemiology Branch, Division of Intramural Population Health ResearchEunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of HealthBethesdaMaryland
| | | | | | | | | | - Paul F. O'Reilly
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUnited Kingdom
| | - Cynthia M. Bulik
- Department of Medical Epidemiology and BiostatisticsKarolinska InstitutetStockholmSweden
- Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
- Department of NutritionUniversity of North Carolina at Chapel HillChapel HillNorth Carolina
| | - Gerome Breen
- Social, Genetic & Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & Neuroscience, King's College LondonLondonUnited Kingdom
- UK National Institute for Health Research (NIHR) Biomedical Research CentreSouth London and Maudsley HospitalLondonUnited Kingdom
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Steinman J, Shibli-Rahhal A. Anorexia Nervosa and Osteoporosis: Pathophysiology and Treatment. J Bone Metab 2019; 26:133-143. [PMID: 31555610 PMCID: PMC6746661 DOI: 10.11005/jbm.2019.26.3.133] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/06/2019] [Accepted: 07/21/2019] [Indexed: 01/18/2023] Open
Abstract
Anorexia nervosa (AN) affects 2.9 million people, many of whom experience bone loss and increased fracture risk. In this article, we review data on the underlying pathophysiology of AN-related osteoporosis and possible approaches to disease management. Available research suggests that low body weight and decreased gonadal function are the strongest predictors of bone loss and fractures in patients with AN. Additionally, other metabolic disturbances have been linked to bone loss, including growth hormone resistance, low leptin concentrations, and hypercortisolemia, but those correlations are less consistent and lack evidence of causality. In terms of treatment of AN-related bone disease, weight gain has the most robust impact on bone mineral density (BMD). Restoration of gonadal function seems to augment this effect and may independently improve BMD. Bisphosphonates, insulin-like growth factor 1 supplementation, and teriparatide may also be reasonable considerations, however need long-term efficacy and safety data.
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Affiliation(s)
- Jeremy Steinman
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Amal Shibli-Rahhal
- Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Autonomic Nervous System Response during Light Physical Activity in Adolescents with Anorexia Nervosa Measured by Wearable Devices. SENSORS 2019; 19:s19122820. [PMID: 31238575 PMCID: PMC6630965 DOI: 10.3390/s19122820] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/17/2019] [Accepted: 06/21/2019] [Indexed: 12/12/2022]
Abstract
Anorexia nervosa (AN) is associated with a wide range of disturbances of the autonomic nervous system. The aim of the present study was to monitor the heart rate (HR) and the heart rate variability (HRV) during light physical activity in a group of adolescent girls with AN and in age-matched controls using a wearable, minimally obtrusive device. For the study, we enrolled a sample of 23 adolescents with AN and 17 controls. After performing a 12-lead electrocardiogram and echocardiography, we used a wearable device to record a one-lead electrocardiogram for 5 min at baseline for 5 min during light physical exercise (Task) and for 5 min during recovery. From the recording, we extracted HR and HRV indices. Among subjects with AN, the HR increased at task and decreased at recovery, whereas among controls it did not change between the test phases. HRV features showed a different trend between the two groups, with an increased low-to-high frequency ratio (LF/HF) in the AN group due to increased LF and decreased HF, differently from controls that, otherwise, slightly increased their standard deviation of NN intervals (SDNN) and the root mean square of successive differences (RMSSD). The response in the AN group during the task as compared to that of healthy adolescents suggests a possible sympathetic activation or parasympathetic withdrawal, differently from controls. This result could be related to the low energy availability associated to the excessive loss of fat and lean mass in subjects with AN, that could drive to autonomic imbalance even during light physical activity.
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L'Huillier C, Jarbeau M, Achamrah N, Belmonte L, Amamou A, Nobis S, Goichon A, Salameh E, Bahlouli W, do Rego JL, Déchelotte P, Coëffier M. Glutamine, but not Branched-Chain Amino Acids, Restores Intestinal Barrier Function during Activity-Based Anorexia. Nutrients 2019; 11:nu11061348. [PMID: 31208031 PMCID: PMC6628073 DOI: 10.3390/nu11061348] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 12/21/2022] Open
Abstract
Background: During activity-based anorexia (ABA) in mice, enhanced paracellular permeability and reduced protein synthesis have been shown in the colon while the gut–brain axis has received increasing attention in the regulation of intestinal and mood disorders that frequently occur during anorexia nervosa, a severe eating disorder for which there is no specific treatment. In the present study, we assessed the effects of oral glutamine (Gln) or branched-chain amino acids (BCAA) supplementation during ABA to target intestinal functions, body composition and feeding behavior. Methods: C57BL/6 male mice were randomized in Control (CTRL) and ABA groups. After ABA induction, mice received, or not, either 1% Gln or 2.5% BCAA (Leu, Ile, Val) for one week in drinking water. Results: Neither Gln nor BCAA supplementation affected body weight and body composition, while only Gln supplementation slightly increased food intake. ABA mice exhibited increased paracellular permeability and reduced protein synthesis in the colonic mucosa. Oral Gln restored colonic paracellular permeability and protein synthesis and increased the mucin-2 mRNA level, whereas BCAA did not affect colonic parameters. Conclusion: In conclusion, oral Gln specifically improves colonic response during ABA. These data should be further confirmed in AN patients.
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Affiliation(s)
- Clément L'Huillier
- UNIROUEN, INSERM UMR 1073 "Nutrition, Inflammation and Gut-Brain Axis", Normandie University, 76183 Rouen, France.
- Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, 76183 Rouen, France.
| | - Marine Jarbeau
- UNIROUEN, INSERM UMR 1073 "Nutrition, Inflammation and Gut-Brain Axis", Normandie University, 76183 Rouen, France.
- Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, 76183 Rouen, France.
| | - Najate Achamrah
- UNIROUEN, INSERM UMR 1073 "Nutrition, Inflammation and Gut-Brain Axis", Normandie University, 76183 Rouen, France.
- Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, 76183 Rouen, France.
- Department of Nutrition, Rouen University Hospital, 76183 Rouen, France.
| | - Liliana Belmonte
- UNIROUEN, INSERM UMR 1073 "Nutrition, Inflammation and Gut-Brain Axis", Normandie University, 76183 Rouen, France.
- Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, 76183 Rouen, France.
- Department of Nutrition, Rouen University Hospital, 76183 Rouen, France.
| | - Asma Amamou
- UNIROUEN, INSERM UMR 1073 "Nutrition, Inflammation and Gut-Brain Axis", Normandie University, 76183 Rouen, France.
- Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, 76183 Rouen, France.
| | - Séverine Nobis
- UNIROUEN, INSERM UMR 1073 "Nutrition, Inflammation and Gut-Brain Axis", Normandie University, 76183 Rouen, France.
- Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, 76183 Rouen, France.
| | - Alexis Goichon
- UNIROUEN, INSERM UMR 1073 "Nutrition, Inflammation and Gut-Brain Axis", Normandie University, 76183 Rouen, France.
- Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, 76183 Rouen, France.
| | - Emmeline Salameh
- UNIROUEN, INSERM UMR 1073 "Nutrition, Inflammation and Gut-Brain Axis", Normandie University, 76183 Rouen, France.
- Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, 76183 Rouen, France.
| | - Wafa Bahlouli
- UNIROUEN, INSERM UMR 1073 "Nutrition, Inflammation and Gut-Brain Axis", Normandie University, 76183 Rouen, France.
- Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, 76183 Rouen, France.
| | - Jean-Luc do Rego
- Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, 76183 Rouen, France.
- Animal Behavior Facility, SCAC, UNIROUEN, 76183 Rouen, France.
| | - Pierre Déchelotte
- UNIROUEN, INSERM UMR 1073 "Nutrition, Inflammation and Gut-Brain Axis", Normandie University, 76183 Rouen, France.
- Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, 76183 Rouen, France.
- Department of Nutrition, Rouen University Hospital, 76183 Rouen, France.
| | - Moïse Coëffier
- UNIROUEN, INSERM UMR 1073 "Nutrition, Inflammation and Gut-Brain Axis", Normandie University, 76183 Rouen, France.
- Institute of Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, 76183 Rouen, France.
- Department of Nutrition, Rouen University Hospital, 76183 Rouen, France.
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Hebebrand J, Milos G, Wabitsch M, Teufel M, Führer D, Bühlmeier J, Libuda L, Ludwig C, Antel J. Clinical Trials Required to Assess Potential Benefits and Side Effects of Treatment of Patients With Anorexia Nervosa With Recombinant Human Leptin. Front Psychol 2019; 10:769. [PMID: 31156489 PMCID: PMC6533856 DOI: 10.3389/fpsyg.2019.00769] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 03/20/2019] [Indexed: 12/16/2022] Open
Abstract
The core phenotype of anorexia nervosa (AN) comprises the age and stage dependent intertwining of both its primary and secondary (i.e., starvation induced) somatic and mental symptoms. Hypoleptinemia acts as a key trigger for the adaptation to starvation by affecting diverse brain regions including the reward system and by induction of alterations of the hypothalamus-pituitary-“target-organ” axes, e.g., resulting in amenorrhea as a characteristic symptom of AN. Particularly, the rat model activity-based anorexia (ABA) convincingly demonstrates the pivotal role of hypoleptinemia in the development of starvation-induced hyperactivity. STAT3 signaling in dopaminergic neurons in the ventral tegmental area (VTA) plays a crucial role in the transmission of the leptin signal in ABA. In patients with AN, an inverted U-shaped relationship has been observed between their serum leptin levels and physical activity. Albeit obese and therewith of a very different phenotype, humans diagnosed with rare congenital leptin deficiency have starvation like symptoms including hypothalamic amenorrhea in females. Over the past 20 years, such patients have been successfully treated with recombinant human (rh) leptin (metreleptin) within a compassionate use program. The extreme hunger of these patients subsides within hours upon initiation of treatment; substantial weight loss and menarche in females ensue after medium term treatment. In contrast, metreleptin had little effect in patients with multifactorial obesity. Small clinical trials have been conducted for hypothalamic amenorrhea and to increase bone mineral density, in which metreleptin proved beneficial. Up to now, metreleptin has not yet been used to treat patients with AN. Metreleptin has been approved by the FDA under strict regulations solely for the treatment of generalized lipodystrophy. The recent approval by the EMA may offer, for the first time, the possibility to treat extremely hyperactive patients with AN off-label. Furthermore, a potential dissection of hypoleptinemia-induced AN symptoms from the primary cognitions and behaviors of these patients could ensue. Accordingly, the aim of this article is to review the current state of the art of leptin in relation to AN to provide the theoretical basis for the initiation of clinical trials for treatment of this eating disorder.
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Affiliation(s)
- Johannes Hebebrand
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Gabriella Milos
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital of Zürich, Zurich, Switzerland
| | - Martin Wabitsch
- Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics and Adolescent Medicine, Ulm University Hospital, Ulm, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Dagmar Führer
- Department of Endocrinology and Metabolism, Medical Center and Central Laboratory, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Judith Bühlmeier
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Lars Libuda
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Christine Ludwig
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Jochen Antel
- Department of Child and Adolescent Psychiatry, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Ibrahim A, Cutinha D, Ayton A. What is the evidence for using bed rest as part of hospital treatment of severe anorexia nervosa? EVIDENCE-BASED MENTAL HEALTH 2019; 22:77-82. [PMID: 31003978 PMCID: PMC10270425 DOI: 10.1136/ebmental-2018-300064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 02/18/2019] [Accepted: 02/25/2019] [Indexed: 11/04/2022]
Abstract
Bed rest is commonly used on medical and paediatric wards as part of nursing management of the physically compromised patient with severe anorexia nervosa. The aim of this study was to review the evidence base of bed rest as an intervention in the management of severe anorexia nervosa. We searched MEDLINE, PubMed, Embase, PsychInfo, CINAHL, HMIC, AMED, HBE, BNI and guidelines written in English until April 2018 using the following terms: bed rest and anorexia nervosa. After exclusion of duplicates, three guidelines and eight articles were included. The papers were methodologically heterogeneous, and therefore, quantitative summary was not possible. There have been no randomised controlled trials to compare the benefits and harms of bed rest as the focus of intervention in the treatment of anorexia nervosa. Several papers showed that patients have a strong preference for less restrictive approaches. These are also less intensive in nursing time. Negative physical consequences were described in a number of studies: these included lower heart rate, impaired bone turn over and increased risk of infection. We found no evidence to support bed rest in hospital treatment of anorexia nervosa. The risks associated with bed rest are significant and include both physical and psychological harm, and these can be avoided by early mobilisation. Given the established complications of bed rest in other critically ill patient populations, it is difficult to recommend the enforcement of bed rest for patients with anorexia nervosa. Future research should focus on safe early mobilisation, which would reduce complications and improve patient satisfaction.
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Affiliation(s)
- Ali Ibrahim
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, London, UK
| | - Darren Cutinha
- Maudsley Centre for Child and Adolescent Eating Disorders, South London and Maudsley NHS Foundation Trust, London, London, UK
| | - Agnes Ayton
- Cotswold House, Oxford Health NHS Foundation Trust Adult Mental Health Services, Oxford, Oxfordshire, UK
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Lackner S, Mörkl S, Müller W, Fürhapter-Rieger A, Oberascher A, Lehofer M, Bieberger C, Wonisch W, Amouzadeh-Ghadikolai O, Moser M, Mangge H, Zelzer S, Holasek SJ. Novel approaches for the assessment of relative body weight and body fat in diagnosis and treatment of anorexia nervosa: A cross-sectional study. Clin Nutr 2019; 38:2913-2921. [PMID: 30670293 DOI: 10.1016/j.clnu.2018.12.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 10/26/2018] [Accepted: 12/21/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Anorexia nervosa (AN) is a severe psychosomatic disease that seriously affects nutritional status. Therapeutic approaches primarily aim for rapid weight restoration by high caloric diets and activity restriction. This often promotes abdominal body fat gain, which potentially negatively influences the patient's compliance and increases the risk of relapse. This study focused on the evaluation of body weight and subcutaneous adipose tissue (SAT) in AN patients by novel approaches. METHODS The SAT of AN patients (n = 18, body mass index (BMI) 15.3 ± 1.3 kg/m2) was determined by a highly accurate and reliable ultrasound method. The sum of SAT thicknesses of eight sites (DINCL) was calculated. Individual metabolic profiles were analyzed. The mass index (MI), which considers body proportions, was used in addition to BMI. Additional to the standard laboratory diagnostics, dermal carotenoids measured by resonance Raman spectroscopy, leptin, and oxidative stress indicators were determined. RESULTS The mean MI was 15.7 ± 1.4 kg/m2. The DINCL considerably differed between individuals with the same BMI. Half of the patients (Group 1) had low DINCL: 1.3-28.4 mm, and Group 2 showed values up to 58.2 mm (corresponding to approximately 6 kg SAT mass). The two group means differed by more than 300% (P < 0.001). Accordingly, leptin levels significantly differed (P < 0.001). Mean SAT thicknesses were significantly higher in Group 2 at all eight sites. The groups also significantly differed in two oxidative stress parameters: total antioxidative capacity, malondialdehyde-modified low density lipoprotein immunoglobulin M (MDA-LDL IgM), and in the carotenoid level. CONCLUSION Half of the patients had sufficiently high fat mass, despite very low BMI. Consequently, their muscle (and other organ) masses must have been extremely low. Diagnostic criteria and treatment protocols for AN should consider each patient's body composition. In addition to dietary treatments, muscle training at low energy turnover rates may be essential for avoiding unnecessary body fat gain, better treatment results, and long-term recovery.
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Affiliation(s)
- Sonja Lackner
- Department of Immunology and Pathophysiology, Medical University of Graz, Otto Loewi Research Center, Heinrichstraße, Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz, Graz, Austria
| | - Wolfram Müller
- Department of Biophysics, Medical University of Graz, Gottfried Schatz Research Center, Neue Stiftingtalstraße, Graz, Austria.
| | - Alfred Fürhapter-Rieger
- Department of Biophysics, Medical University of Graz, Gottfried Schatz Research Center, Neue Stiftingtalstraße, Graz, Austria
| | - Andreas Oberascher
- Department of Immunology and Pathophysiology, Medical University of Graz, Otto Loewi Research Center, Heinrichstraße, Graz, Austria
| | - Michael Lehofer
- State Hospital Graz South-West, Location South, Wagner Jauregg Platz, Graz, Austria
| | - Claudia Bieberger
- State Hospital Graz South-West, Location South, Wagner Jauregg Platz, Graz, Austria
| | - Willibald Wonisch
- Department of Physiological Chemistry, Medical University of Graz, Otto Loewi Research Center, Neue Stiftingtalstraße, Graz, Austria
| | | | - Maximilian Moser
- Department of Physiology, Medical University of Graz, Otto Loewi Research Center, Neue Stiftingtalstraße, Graz, Austria; Human Research Institute, Franz-Pichler-Straße, Weiz, Austria
| | - Harald Mangge
- Clinical Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Auenbruggerplatz, Graz, Austria
| | - Sieglinde Zelzer
- Clinical Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Auenbruggerplatz, Graz, Austria
| | - Sandra Johanna Holasek
- Department of Immunology and Pathophysiology, Medical University of Graz, Otto Loewi Research Center, Heinrichstraße, Graz, Austria
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44
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The gut microbiome in anorexia nervosa: relevance for nutritional rehabilitation. Psychopharmacology (Berl) 2019; 236:1545-1558. [PMID: 30612189 PMCID: PMC6598943 DOI: 10.1007/s00213-018-5159-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/21/2018] [Indexed: 02/07/2023]
Abstract
Rapidly accumulating evidence supports the important role of gut microbiome in the regulation of mood, behaviour, appetite, gastrointestinal symptomology, and nutrient metabolism. These are all core features frequently altered in individuals with anorexia nervosa (AN). Current treatment recommendations for AN support the use of high-calorie diets as an essential part of nutritional rehabilitation, commonly achieved by elevating the fat content of the diet. However, in contrast to this approach, there is accumulating evidence suggesting the importance of balanced, high-fibre diets on the gut microbiome. Studies have demonstrated profound differences in the microbial composition of underweight people with AN and those of normal- or overweight individuals. Specific alterations vary widely between studies. It is thus far unclear to what extent the observed differences are brought on by iatrogenic effects of nutritional rehabilitation or the disorder itself. To date, only two studies have investigated the changes in the intestinal microbiota during nutritional rehabilitation and corresponding weight restoration. These studies suggest that the gut microbiome of AN patients was different to healthy controls both prior and following nutritional rehabilitation, though it is noted that these states were associated with lower and higher nutritional intakes, respectively. There is a clear need for further investigation regarding the effects of nutritional rehabilitation on the gut microbiome. Such research would provide insights into the potential role of gut microbiome in modulating the pathophysiology of AN and inform future treatment strategies.
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45
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Manuelli M, Blundell JE, Biino G, Cena H. Body composition and resting energy expenditure in women with anorexia nervosa: Is hyperactivity a protecting factor? Clin Nutr ESPEN 2018; 29:160-164. [PMID: 30661682 DOI: 10.1016/j.clnesp.2018.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/25/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND In subjects with anorexia nervosa (AN) physical exercise may cause or even prevent weight loss, body composition alterations and adaptive thermogenesis. To investigate the influence of behavioral patterns on body composition and energy expenditure in women with AN, we conducted a retrospective analysis in 62 patients with AN referring to our outpatients' clinic. MATERIALS AND METHODS We assessed anthropometric measurement of weight, height, and BMI; body composition was assessed by bioelectrical impedance analysis; resting energy expenditure was measured through indirect calorimetry. Patients' characteristics were assessed at the time of first evaluation. RESULTS The subjects were both restricting type (ANR, n = 39) and binge-eating/purging type (ANBP, n = 23) according to DSM-5. We observed a lower reactance (58.63 (11.9) vs. 66.5 (15.5) Ohm, p < 0.05) and higher total body water in ANR subjects. No differences were found in phase angle, fat mass or fat-free mass, nor in REE measures. Within ANR subgroup, we identified two behavioral patterns, with or without physical hyperactivity. Compared to dieting and fasting subjects, hyperactive subjects showed higher phase angle [5.6 (0.7) vs. 4.8 (0.8), p < 0.05], lower fat-free mass [82.5 (6.8) vs. 89.9 (7.5)%, p < 0.05], greater proportion of fat mass [17.5 (6.8) vs. 10.1 (7.5)%, p < 0.05] and body cell mass [46.6 (5.1) vs. 42.5 (5.5)%, p < 0.05]. Finally, hyperactive subjects had greater BMI than dieting or fasting subjects [18.2 (1.7) vs. 15.8 (1.7), p < 0.005]. CONCLUSION With limitations due to the small sample size, hyperactive subjects show body composition and energy metabolism features that seem protective in terms of prognosis.
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Affiliation(s)
- Matteo Manuelli
- Department of Public Health, Experimental and Forensic Medicine, Unit of Human Nutrition, University of Pavia, Via Bassi 21, 27100, Pavia, Italy.
| | - John E Blundell
- School of Psycology, University of Leeds, Leeds, LS2 9JT, UK
| | - Ginevra Biino
- Institute of Molecular Genetics, National Research Council of Italy, Pavia, Italy
| | - Hellas Cena
- Department of Public Health, Experimental and Forensic Medicine, Unit of Human Nutrition, University of Pavia, Via Bassi 21, 27100, Pavia, Italy
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46
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Nobis S, Achamrah N, Goichon A, L'Huillier C, Morin A, Guérin C, Chan P, do Rego JL, do Rego JC, Vaudry D, Déchelotte P, Belmonte L, Coëffier M. Colonic Mucosal Proteome Signature Reveals Reduced Energy Metabolism and Protein Synthesis but Activated Autophagy during Anorexia-Induced Malnutrition in Mice. Proteomics 2018; 18:e1700395. [PMID: 29938906 DOI: 10.1002/pmic.201700395] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 06/12/2018] [Indexed: 12/18/2022]
Abstract
Anorexia nervosa is an eating disorder often associated with intestinal disorders. To explore the underlying mechanisms of these disorders, the colonic proteome was evaluated during activity-based anorexia. Female C57Bl/6 mice were randomized into three groups: Control, Limited Food Access (LFA) and Activity-Based Anorexia (ABA). LFA and ABA mice had a progressive limited access to food but only ABA mice had access to an activity wheel. On colonic mucosal protein extracts, a 2D PAGE-based comparative proteomic analysis was then performed and differentially expressed proteins were identified by LC-ESI-MS/MS. Twenty-seven nonredundant proteins that were differentially expressed between Control, LFA, and ABA groups were identified. ABA mice exhibited alteration of several mitochondrial proteins involved in energy metabolism such as dihydrolipoyl dehydrogenase and 3-mercaptopyruvate sulfurtransferase. In addition, a downregulation of mammalian target of rapamycin (mTOR) pathway was observed leading, on the one hand, to the inhibition of protein synthesis, evaluated by puromycin incorporation and mediated by the increased phosphorylation of eukaryotic elongation factor 2, and on the other hand, to the activation of autophagy, assessed by the increase of the marker of autophagy, form LC3-phosphatidylethanolamine conjugate/Cytosolic form of Microtubule-associated protein 1A/1B light chain 3 (LC3II/LC3I) ratio. Colonic mucosal proteome is altered during ABA suggesting a downregulation of energy metabolism. A decrease of protein synthesis and an activation of autophagy were also observed mediated by mTOR pathway.
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Affiliation(s)
- Séverine Nobis
- INSERM Unit 1073, UNIROUEN, Normandie University, 76000, Rouen, France.,Institute for Research and Innovation in Biomedicine, UNIROUEN, Normandie University, 76000, Rouen, France
| | - Najate Achamrah
- INSERM Unit 1073, UNIROUEN, Normandie University, 76000, Rouen, France.,Institute for Research and Innovation in Biomedicine, UNIROUEN, Normandie University, 76000, Rouen, France.,Nutrition Department, Rouen University Hospital, 76000, Rouen, France
| | - Alexis Goichon
- INSERM Unit 1073, UNIROUEN, Normandie University, 76000, Rouen, France.,Institute for Research and Innovation in Biomedicine, UNIROUEN, Normandie University, 76000, Rouen, France
| | - Clément L'Huillier
- INSERM Unit 1073, UNIROUEN, Normandie University, 76000, Rouen, France.,Institute for Research and Innovation in Biomedicine, UNIROUEN, Normandie University, 76000, Rouen, France
| | - Aline Morin
- INSERM Unit 1073, UNIROUEN, Normandie University, 76000, Rouen, France.,Institute for Research and Innovation in Biomedicine, UNIROUEN, Normandie University, 76000, Rouen, France
| | - Charlène Guérin
- INSERM Unit 1073, UNIROUEN, Normandie University, 76000, Rouen, France.,Institute for Research and Innovation in Biomedicine, UNIROUEN, Normandie University, 76000, Rouen, France
| | - Philippe Chan
- Institute for Research and Innovation in Biomedicine, UNIROUEN, Normandie University, 76000, Rouen, France.,Platform in proteomics PISSARO, UNIROUEN, Normandie University, 76000, Rouen, France
| | - Jean Luc do Rego
- Institute for Research and Innovation in Biomedicine, UNIROUEN, Normandie University, 76000, Rouen, France.,Animal Behaviour Platform SCAC, UNIROUEN, Normandie University, 76000, Rouen, France
| | - Jean Claude do Rego
- Institute for Research and Innovation in Biomedicine, UNIROUEN, Normandie University, 76000, Rouen, France.,Animal Behaviour Platform SCAC, UNIROUEN, Normandie University, 76000, Rouen, France
| | - David Vaudry
- Institute for Research and Innovation in Biomedicine, UNIROUEN, Normandie University, 76000, Rouen, France.,Platform in proteomics PISSARO, UNIROUEN, Normandie University, 76000, Rouen, France.,INSERM Unit 1239, UNIROUEN, Normandie University, 76000, Rouen, France
| | - Pierre Déchelotte
- INSERM Unit 1073, UNIROUEN, Normandie University, 76000, Rouen, France.,Institute for Research and Innovation in Biomedicine, UNIROUEN, Normandie University, 76000, Rouen, France.,Nutrition Department, Rouen University Hospital, 76000, Rouen, France
| | - Liliana Belmonte
- INSERM Unit 1073, UNIROUEN, Normandie University, 76000, Rouen, France.,Institute for Research and Innovation in Biomedicine, UNIROUEN, Normandie University, 76000, Rouen, France.,Nutrition Department, Rouen University Hospital, 76000, Rouen, France
| | - Moïse Coëffier
- INSERM Unit 1073, UNIROUEN, Normandie University, 76000, Rouen, France.,Institute for Research and Innovation in Biomedicine, UNIROUEN, Normandie University, 76000, Rouen, France.,Nutrition Department, Rouen University Hospital, 76000, Rouen, France
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47
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Nobis S, Morin A, Achamrah N, Belmonte L, Legrand R, Chan P, do Rego JL, Vaudry D, Gourcerol G, Déchelotte P, Goichon A, Coëffier M. Delayed gastric emptying and altered antrum protein metabolism during activity-based anorexia. Neurogastroenterol Motil 2018; 30:e13305. [PMID: 29411462 DOI: 10.1111/nmo.13305] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 01/05/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND Anorexia nervosa, a restrictive eating disorder, is often associated with gastrointestinal disorders, particularly a delayed gastric emptying. However, the mechanisms remained poorly documented. Thus, we aimed to evaluate gastric emptying and antrum protein metabolism in the Activity-Based Anorexia model (ABA). METHODS Females C57Bl/6 mice were randomized into 3 groups: Control, ABA, and Limited Food Access (LFA). Food access has been progressively limited from 6 h/day at day 6 to 3 h/day at day 9 and until day 17. ABA mice had free access to an activity wheel. Gastric emptying was assessed. On gastric extracts, a proteomic analysis was performed, as well as an evaluation of protein synthesis and protein oxidation. KEY RESULTS Both LFA and ABA mice exhibited a delayed gastric emptying compared with Controls (P < .05). Proteomic approach revealed 15 proteins that were differentially expressed. Among these proteins, we identified 2 clusters of interest contributing to (i) the organization of muscle fiber with ACTA2, VCL, KRT19, KRT8, and DES proteins and (ii) "heat shock proteins" with STIP1, HSPD1, and HSPA8 proteins. ABA mice specifically exhibited an increased rate of gastric oxidized proteins. CONCLUSIONS AND INFERENCES Delayed gastric emptying observed in anorectic conditions appears to be secondary to malnutrition. However, an oxidative stress is specifically present in the stomach of ABA mice. Its role remains to be further studied.
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Affiliation(s)
- S Nobis
- INSERM Unit 1073, UNIROUEN, Normandie University, Rouen, France.,Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, Rouen, France
| | - A Morin
- INSERM Unit 1073, UNIROUEN, Normandie University, Rouen, France.,Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, Rouen, France
| | - N Achamrah
- INSERM Unit 1073, UNIROUEN, Normandie University, Rouen, France.,Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, Rouen, France.,Nutrition Department, Rouen University Hospital, Rouen, France
| | - L Belmonte
- INSERM Unit 1073, UNIROUEN, Normandie University, Rouen, France.,Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, Rouen, France.,Nutrition Department, Rouen University Hospital, Rouen, France
| | - R Legrand
- INSERM Unit 1073, UNIROUEN, Normandie University, Rouen, France.,Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, Rouen, France
| | - P Chan
- Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, Rouen, France.,Platform in proteomics PISSARO, UNIROUEN, Normandie University, Rouen, France
| | - J-L do Rego
- Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, Rouen, France.,Animal Behaviour Platform SCAC, UNIROUEN, Normandie University, Rouen, France
| | - D Vaudry
- Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, Rouen, France.,Platform in proteomics PISSARO, UNIROUEN, Normandie University, Rouen, France.,INSERM Unit 1239, UNIROUEN, Normandie University, Rouen, France
| | - G Gourcerol
- INSERM Unit 1073, UNIROUEN, Normandie University, Rouen, France.,Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, Rouen, France.,Physiology Department, Rouen University Hospital, Rouen, France
| | - P Déchelotte
- INSERM Unit 1073, UNIROUEN, Normandie University, Rouen, France.,Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, Rouen, France.,Nutrition Department, Rouen University Hospital, Rouen, France
| | - A Goichon
- INSERM Unit 1073, UNIROUEN, Normandie University, Rouen, France.,Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, Rouen, France
| | - M Coëffier
- INSERM Unit 1073, UNIROUEN, Normandie University, Rouen, France.,Institute for Research and Innovation in Biomedicine (IRIB), UNIROUEN, Normandie University, Rouen, France.,Nutrition Department, Rouen University Hospital, Rouen, France
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Nobis S, Goichon A, Achamrah N, Guérin C, Azhar S, Chan P, Morin A, Bôle-Feysot C, do Rego JC, Vaudry D, Déchelotte P, Belmonte L, Coëffier M. Alterations of proteome, mitochondrial dynamic and autophagy in the hypothalamus during activity-based anorexia. Sci Rep 2018; 8:7233. [PMID: 29740148 PMCID: PMC5940678 DOI: 10.1038/s41598-018-25548-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 04/24/2018] [Indexed: 12/20/2022] Open
Abstract
Restrictive anorexia nervosa is associated with reduced eating and severe body weight loss leading to a cachectic state. Hypothalamus plays a major role in the regulation of food intake and energy homeostasis. In the present study, alterations of hypothalamic proteome and particularly of proteins involved in energy and mitochondrial metabolism have been observed in female activity-based anorexia (ABA) mice that exhibited a reduced food intake and a severe weight loss. In the hypothalamus, mitochondrial dynamic was also modified during ABA with an increase of fission without modification of fusion. In addition, increased dynamin-1, and LC3II/LC3I ratio signed an activation of autophagy while protein synthesis was increased. In conclusion, proteomic analysis revealed an adaptive hypothalamic protein response in ABA female mice with both altered mitochondrial response and activated autophagy.
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Affiliation(s)
- Séverine Nobis
- Normandie University, UNIROUEN, INSERM Unit 1073, Rouen, France.,Normandie University, UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France
| | - Alexis Goichon
- Normandie University, UNIROUEN, INSERM Unit 1073, Rouen, France.,Normandie University, UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France
| | - Najate Achamrah
- Normandie University, UNIROUEN, INSERM Unit 1073, Rouen, France.,Normandie University, UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France.,Rouen University Hospital, Nutrition Department, Rouen, France
| | - Charlène Guérin
- Normandie University, UNIROUEN, INSERM Unit 1073, Rouen, France.,Normandie University, UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France
| | - Saida Azhar
- Normandie University, UNIROUEN, INSERM Unit 1073, Rouen, France.,Normandie University, UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France
| | - Philippe Chan
- Normandie University, UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France.,Normandie University, UNIROUEN, Platform in proteomics PISSARO, Rouen, France
| | - Aline Morin
- Normandie University, UNIROUEN, INSERM Unit 1073, Rouen, France.,Normandie University, UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France
| | - Christine Bôle-Feysot
- Normandie University, UNIROUEN, INSERM Unit 1073, Rouen, France.,Normandie University, UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France
| | - Jean Claude do Rego
- Normandie University, UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France.,Normandie University, UNIROUEN, Animal Behaviour Platform SCAC, Rouen, France
| | - David Vaudry
- Normandie University, UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France.,Normandie University, UNIROUEN, Platform in proteomics PISSARO, Rouen, France.,Normandie University, UNIROUEN, INSERM Unit 1239, Mont-Saint-Aignan, France
| | - Pierre Déchelotte
- Normandie University, UNIROUEN, INSERM Unit 1073, Rouen, France.,Normandie University, UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France.,Rouen University Hospital, Nutrition Department, Rouen, France
| | - Liliana Belmonte
- Normandie University, UNIROUEN, INSERM Unit 1073, Rouen, France.,Normandie University, UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France.,Rouen University Hospital, Nutrition Department, Rouen, France
| | - Moïse Coëffier
- Normandie University, UNIROUEN, INSERM Unit 1073, Rouen, France. .,Normandie University, UNIROUEN, Institute for Research and Innovation in Biomedicine (IRIB), Rouen, France. .,Rouen University Hospital, Nutrition Department, Rouen, France.
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Viltart O, Duriez P, Tolle V. Metabolic and neuroendocrine adaptations to undernutrition in anorexia nervosa: from a clinical to a basic research point of view. Horm Mol Biol Clin Investig 2018; 36:hmbci-2018-0010. [PMID: 29804101 DOI: 10.1515/hmbci-2018-0010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 03/13/2018] [Indexed: 02/07/2023]
Abstract
The exact mechanisms linking metabolic and neuroendocrine adaptations to undernutrition and the pathophysiology of anorexia nervosa (AN) are not fully understood. AN is a psychiatric disorder of complex etiology characterized by extreme starvation while the disease is progressing into a chronic state. Metabolic and endocrine alterations associated to this disorder are part of a powerful response to maintain whole body energy homeostasis. But these modifications may also contribute to associated neuropsychiatric symptoms (reward abnormalities, anxiety, depression) and thus participate to sustain the disease. The current review presents data with both a clinical and basic research point of view on the role of nutritional and energy sensors with neuroendocrine actions in the pathophysiology of the disease, as they modulate metabolic responses, reproductive functions, stress responses as well as physical activity. While clinical data present a full description of changes occurring in AN, animal models that integrate either spontaneous genetic mutations or experimentally-induced food restriction with hyperactivity and/or social stress recapitulate the main metabolic and endocrine alterations of AN and provide mechanistic information between undernutrition state and symptoms of the disease. Further progress on the central and peripheral mechanism involved in the pathophysiology of eating disorders partly relies on the development and/or refinement of existing animal models to include recently identified genetic traits and better mimic the complex and multifactorial dimensions of the disease.
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Affiliation(s)
- Odile Viltart
- Centre de Psychiatrie et Neurosciences, INSERM UMR 894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Université de Lille (Sciences et technologies), Lille, France
| | - Philibert Duriez
- Centre de Psychiatrie et Neurosciences, INSERM UMR 894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Clinique des Maladies Mentales et de l'Encéphale (CMME), Hôpital Sainte-Anne, Paris, France
| | - Virginie Tolle
- Centre de Psychiatrie et Neurosciences, INSERM UMR 894, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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50
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Worse survival after breast cancer in women with anorexia nervosa. Breast Cancer Res Treat 2017; 168:495-500. [PMID: 29235044 DOI: 10.1007/s10549-017-4618-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 12/07/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE A history of anorexia nervosa has been associated with a reduced risk of developing breast cancer. We investigated survival after breast cancer among women with a prior anorexia nervosa diagnosis compared with women in a population comparison group. METHODS This register-based study included combined data from Sweden, Denmark and Finland. A total of 76 and 1462 breast cancer cases identified among 22,654 women with anorexia nervosa and 224,619 women in a population comparison group, respectively, were included in the study. Hazard ratios (HR) for overall and breast cancer-specific mortality after breast cancer diagnosis were estimated using Cox regression. Cause of death was available only for Swedish and Danish women; therefore, the analysis on breast cancer-specific mortality was restricted to these women. RESULTS We observed 23 deaths after breast cancer among anorexia nervosa patients and 247 among population comparisons. The overall mortality after the breast cancer diagnosis was increased in women with a history of anorexia nervosa compared with population comparisons (HR 2.5, 95% CI 1.6-3.9) after adjustment for age, period and extent of disease. Results were similar for overall (HR 2.3, 95% CI 1.4-3.6) and breast cancer-specific mortality (HR 2.1, 95% CI 1.3-3.6) among Swedish and Danish women. CONCLUSIONS We found that female breast cancer patients with a prior diagnosis of anorexia nervosa have a worse survival compared with other breast cancer patients.
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