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Maunder K, Molloy E, Jenkins E, Hayden J, Adamis D, McNicholas F. Anorexia Nervosa in vivo cytokine production: a systematic review. Psychoneuroendocrinology 2023; 158:106390. [PMID: 37769539 DOI: 10.1016/j.psyneuen.2023.106390] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 08/17/2023] [Accepted: 09/12/2023] [Indexed: 10/03/2023]
Abstract
INTRODUCTION The underlying psychobiology that contributes to Anorexia Nervosa (AN) onset and disease progression remains unclear. New research is emerging suggesting a possible link between inflammation and a variety of mental illnesses. Alterations of cytokines may play a role in the pathogenesis of AN. Some studies have found differences in the cytokine profile of those with AN compared to healthy controls, but results are heterogeneous. The aim of this work was to systematically review existing studies investigating in-vivo cytokine production in those with AN before and after weight restoration compared to controls. METHODS A comprehensive literature search of four electronic databases (PubMed, PsychInfo, EMBASE and CINAH) was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines to identify human in-vivo studies investigating the relationship between AN and cytokine production. Data extracted from included studies related to population characteristics (e.g. age, gender, mean mBMI/%IBW), cytokine measurement and relevant findings. Confounding factors (e.g. smoking status, co-morbid mental illness, menstruation status) were also collected. RESULTS 36 studies were eligible for this systematic review of which the majority were conducted in Europe (77.8%) and involved female subjects (97.2%). Those with AN ranged in age from 13 to 47 years and had an illness duration of 3 months to 24 years. 15 candidate cytokines and 3 receptors were identified (TNF-alpha, IL-6, IL-1B, CRP, IL-2, IL-7, IL-10, IFN-γ, TNF-R2, IL-1 α, IL-15, TNF-R1, IL-17, IL-18, TGF-B1, IL-12, IL-6R and TGF-B2) exploring in-vivo levels in patients with AN and comparing to controls. TNF-alpha and IL-6 were the most extensively studied with IL-6 being significantly elevated in 4 out of 8 (50%) of longitudinal studies when comparing AN patients at baseline compared to post weight restoration. Following weight restoration, there was no difference in IL-6 levels when comparing to HC in 7 of 8 (87.5%) longitudinal studies examined. CONCLUSIONS The most promising cytokine potentially involved in the pathogenesis of AN appears to be IL-6, and possibly TNF-alpha pathways. The heterogeneity of clinical and methodology factors impedes the generalizability of results. Future studies may wish to address these methodological shortcomings as alterations in cytokine levels in AN could act as therapeutic targets assisting with weight restoration and psychopathology and may offer diagnostic potential.
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Affiliation(s)
- K Maunder
- University College Dublin, Ireland; Children's Health Ireland - Crumlin Hospital, Ireland; Lucena Clinic, St. John of God Community Services, Ireland.
| | - E Molloy
- Children's Health Ireland - Crumlin Hospital, Ireland; Children's Health Ireland - Tallaght Hospital, Ireland; Trinity College Dublin, Ireland
| | - E Jenkins
- Children's Health Ireland - Temple Street Hospital, Ireland
| | - J Hayden
- Royal College of Surgeons Ireland, Ireland
| | - D Adamis
- National University of Galway, Ireland
| | - F McNicholas
- University College Dublin, Ireland; Children's Health Ireland - Crumlin Hospital, Ireland; Lucena Clinic, St. John of God Community Services, Ireland
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Bou Khalil R, Sultan A, Seneque M, Richa S, Lefebvre P, Renard E, Courtet P, Maimoun L, Guillaume S. Clinical Correlates of Measured and Predicted Resting Energy Expenditure in Patients with Anorexia Nervosa: A Retrospective Cohort Study. Nutrients 2022; 14:2727. [PMID: 35807906 PMCID: PMC9269154 DOI: 10.3390/nu14132727] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/24/2022] Open
Abstract
Resting energy expenditure (REE; i.e., the calorie amount required for 24 h during a non-active period) is an important parameter in nutritional rehabilitation of patients with anorexia nervosa (AN). This study determined whether age, body mass index, AN duration/subtype/specific symptoms/clinical severity, cognitive function alterations, and psychiatric comorbidities influenced REE or the difference between the calculated and estimated REE. Patients with AN who were followed at a daycare treatment facility between May 2017 and January 2020 (n = 138) underwent a complete assessment that included the MINI, Eating Disorder Examination Questionnaire, d2 test of attention, body fat composition by bioelectrical impedance analysis (BIA) and REE measurement by indirect calorimetry (REEIC). AN subtype (N = 66 for restrictive subtype and N = 69 for non-restrictive subtype; p = 0.005), free-fat mass (<0.001), and fat mass (<0.001) were associated with REEIC. Age (p < 0.001), height (p = 0.003), and AN duration (N = 46 for <3 years and N = 82 for ≥3 years; p = 0.012) were associated with the difference between estimated REE (using the Schebendach equation) and measured REEIC. Therefore, the Schebendach equation was adjusted differently in the two patients’ subgroups (AN duration ≤ or >3 years). Overall, REE was higher in patients with restrictive than non-restrictive AN. In the absence of BIA measures, REE-estimating equations should take into account AN duration.
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Affiliation(s)
- Rami Bou Khalil
- Department of Psychiatry, Saint Joseph University-Hôtel Dieu de France Hospital, Mar Mikhael, Beirut 17-5208, Lebanon;
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.); (S.G.)
- UMR CNRS 5203, Institute of Functional Genomics, University of Montpellier, INSERM U1191, 34295 Montpellier, France;
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
| | - Ariane Sultan
- UMR CNRS 5203, Institute of Functional Genomics, University of Montpellier, INSERM U1191, 34295 Montpellier, France;
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
| | - Maude Seneque
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.); (S.G.)
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
| | - Sami Richa
- Department of Psychiatry, Saint Joseph University-Hôtel Dieu de France Hospital, Mar Mikhael, Beirut 17-5208, Lebanon;
| | - Patrick Lefebvre
- Department of Endocrinology, Diabetes and Nutrition, CHRU, 34295 Montpellier, France; (P.L.); (E.R.); (L.M.)
| | - Eric Renard
- Department of Endocrinology, Diabetes and Nutrition, CHRU, 34295 Montpellier, France; (P.L.); (E.R.); (L.M.)
- Institute of Functional Genomics, University of Montpellier, INSERM, CNRS, 34295 Montpellier, France
| | - Philippe Courtet
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.); (S.G.)
- UMR CNRS 5203, Institute of Functional Genomics, University of Montpellier, INSERM U1191, 34295 Montpellier, France;
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
| | - Laurent Maimoun
- Department of Endocrinology, Diabetes and Nutrition, CHRU, 34295 Montpellier, France; (P.L.); (E.R.); (L.M.)
- Département de Médecine Nucléaire, Hôpital Lapeyronie, Centre Hospitalier Régional Universitaire (CHRU) Montpellier, 34295 Montpellier, France
| | - Sebastien Guillaume
- PSNREC, University of Montpellier, INSERM, CHU de Montpellier, 34295 Montpellier, France; (M.S.); (P.C.); (S.G.)
- UMR CNRS 5203, Institute of Functional Genomics, University of Montpellier, INSERM U1191, 34295 Montpellier, France;
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295 Montpellier, France
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Ragu-Varman D, Macedo-Mendoza M, Labrada-Moncada FE, Reyes-Ortega P, Morales T, Martínez-Torres A, Reyes-Haro D. Anorexia increases microglial density and cytokine expression in the hippocampus of young female rats. Behav Brain Res 2019; 363:118-125. [PMID: 30690107 DOI: 10.1016/j.bbr.2019.01.042] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 01/07/2019] [Accepted: 01/25/2019] [Indexed: 12/26/2022]
Abstract
Anorexia by osmotic dehydration is an adaptive response to hypernatremia and hyperosmolaemia induced by ingestion of a hypertonic solution. Dehydration-induced anorexia (DIA) reproduces weight loss and avoidance of food, despite its availability. By using this model, we previously showed increased reactive astrocyte density in the rat dorsal hippocampus, suggesting a pro-inflammatory environment where microglia may play an important role. However, whether such anorexic condition increases a pro-inflammatory response is unknown. The aim of this study was to test if DIA increases microglial density in the dorsal hippocampus, as well as the expression of pro-inflammatory cytokines tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6) and interleukin 1 beta (IL-1β) in the hippocampus of young female rats. Our results showed that DIA significantly increased microglial density in CA2-CA3 and dentate gyrus (DG) but not in CA1. However, forced food restriction (FFR) only increased microglial density in the DG. Accordingly, the activated/resting microglia ratio was significantly increased in CA2-CA3 and DG, in DIA and FFR groups. Finally, western blot analysis showed increased expression of IBA1, TNF-α, IL-6 and IL-1β in the hippocampus of both experimental groups. We conclude that anorexia triggers increased reactive microglial density and expression of TNF-α, IL-6 and IL-1β; this environment may result in hippocampal neuroinflammation.
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Affiliation(s)
- Durairaj Ragu-Varman
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus Juriquilla, Boulevard Juriquilla 3001, Juriquilla, Querétaro, CP76230, Mexico
| | - Mayra Macedo-Mendoza
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus Juriquilla, Boulevard Juriquilla 3001, Juriquilla, Querétaro, CP76230, Mexico
| | - Francisco Emmanuel Labrada-Moncada
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus Juriquilla, Boulevard Juriquilla 3001, Juriquilla, Querétaro, CP76230, Mexico
| | - Pamela Reyes-Ortega
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus Juriquilla, Boulevard Juriquilla 3001, Juriquilla, Querétaro, CP76230, Mexico
| | - Teresa Morales
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus Juriquilla, Boulevard Juriquilla 3001, Juriquilla, Querétaro, CP76230, Mexico
| | - Ataúlfo Martínez-Torres
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus Juriquilla, Boulevard Juriquilla 3001, Juriquilla, Querétaro, CP76230, Mexico
| | - Daniel Reyes-Haro
- Departamento de Neurobiología Celular y Molecular, Instituto de Neurobiología, Universidad Nacional Autónoma de México, Campus Juriquilla, Boulevard Juriquilla 3001, Juriquilla, Querétaro, CP76230, Mexico.
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Dalton B, Bartholdy S, Robinson L, Solmi M, Ibrahim MAA, Breen G, Schmidt U, Himmerich H. A meta-analysis of cytokine concentrations in eating disorders. J Psychiatr Res 2018; 103:252-264. [PMID: 29906710 DOI: 10.1016/j.jpsychires.2018.06.002] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 05/16/2018] [Accepted: 06/01/2018] [Indexed: 01/02/2023]
Abstract
Cytokines are signalling molecules, which play an important role in both immune system function and brain development and function, and subsequently mental states and behaviour. Cytokines have been implicated in eating disorders (EDs) due to their role in psychological health, body weight and appetite regulation. This meta-analysis examined cross-sectional and longitudinal studies measuring concentrations of cytokines in individuals with EDs. Using PRISMA guidelines, we systematically reviewed relevant articles in PubMed, Web of Science, and MEDLINE. Random-effects meta-analyses were conducted for interleukin (IL)-1β, IL-6, transforming growth factor (TGF)-β, and tumor necrosis factor (TNF)-α, independently, firstly with all EDs combined and then stratified by ED diagnosis. Twenty-five studies were included: serum/plasma cytokine concentrations were measured in people with anorexia nervosa (AN) in 23 studies and bulimia nervosa (BN) in 4 studies. TNF-α and IL-6 were elevated in ED participants compared to healthy controls (HCs). Specifically, this pattern was seen only when comparing AN participants to HCs. Concentrations of these cytokines did not differ between people with BN and HCs. IL-1β and TGF-β did not differ between HCs and any ED group. Therefore, AN seems to be associated with elevated concentrations of TNF-α and IL-6. Considering the role of cytokines in appetite, mood regulation, and anxiety, these pro-inflammatory cytokines could be a potential future drug target to help people with AN, not only with weight gain, but also with various coexisting psychological problems. Future studies should consider confounding factors that affect cytokine concentrations and report ED-relevant clinical characteristics.
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Affiliation(s)
- Bethan Dalton
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK.
| | - Savani Bartholdy
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Lauren Robinson
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Marco Solmi
- Department of Neurosciences, Psychiatry Unit, University of Padua, Padua, Italy; Cognitive Neuroscience Center, University of Padua, Padua, Italy; University Hospital Padua, Padua, Italy
| | - Mohammad A A Ibrahim
- Department of Immunological Medicine and Allergy, King's Health Partners, King's College Hospital, London SE5 9RS, UK
| | - Gerome Breen
- MRC Social, Genetic, and Developmental Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Hubertus Himmerich
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Messaoudi I, Handu M, Rais M, Sureshchandra S, Park BS, Fei SS, Wright H, White AE, Jain R, Cameron JL, Winters-Stone KM, Varlamov O. Long-lasting effect of obesity on skeletal muscle transcriptome. BMC Genomics 2017; 18:411. [PMID: 28545403 PMCID: PMC5445270 DOI: 10.1186/s12864-017-3799-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/16/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Reduced physical activity and increased intake of calorically-dense diets are the main risk factors for obesity, glucose intolerance, and type 2 diabetes. Chronic overnutrition and hyperglycemia can alter gene expression, contributing to long-term obesity complications. While caloric restriction can reduce obesity and glucose intolerance, it is currently unknown whether it can effectively reprogram transcriptome to a pre-obesity level. The present study addressed this question by the preliminary examination of the transcriptional dynamics in skeletal muscle after exposure to overnutrition and following caloric restriction. RESULTS Six male rhesus macaques of 12-13 years of age consumed a high-fat western-style diet for 6 months and then were calorically restricted for 4 months without exercise. Skeletal muscle biopsies were subjected to longitudinal gene expression analysis using next-generation whole-genome RNA sequencing. In spite of significant weight loss and normalized insulin sensitivity, the majority of WSD-induced (n = 457) and WSD-suppressed (n = 47) genes remained significantly dysregulated after caloric restriction (FDR ≤0.05). The MetacoreTM pathway analysis reveals that western-style diet induced the sustained activation of the transforming growth factor-β gene network, associated with extracellular matrix remodeling, and the downregulation of genes involved in muscle structure development and nutritional processes. CONCLUSIONS Western-style diet, in the absence of exercise, induced skeletal muscle transcriptional programing, which persisted even after insulin resistance and glucose intolerance were completely reversed with caloric restriction.
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Affiliation(s)
- Ilhem Messaoudi
- School of Biological Sciences, University of California, Irvine, Irvine, CA, 92697, USA
| | - Mithila Handu
- Division of Cardiometabolic Health, Oregon National Primate Research Center, L584 505 NW 185th Ave., Beaverton, OR, 97006, USA
| | - Maham Rais
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, Riverside, CA, 92521, USA
| | - Suhas Sureshchandra
- School of Biological Sciences, University of California, Irvine, Irvine, CA, 92697, USA
| | - Byung S Park
- Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Suzanne S Fei
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, 97006, USA
| | - Hollis Wright
- Division of Neuroscience, Oregon National Primate Research Center, Beaverton, OR, 97006, USA
| | - Ashley E White
- Division of Cardiometabolic Health, Oregon National Primate Research Center, L584 505 NW 185th Ave., Beaverton, OR, 97006, USA
| | - Ruhee Jain
- Department of Neuroscience and Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Judy L Cameron
- Department of Neuroscience and Psychiatry, University of Pittsburgh, Pittsburgh, PA, 15260, USA
| | - Kerri M Winters-Stone
- Department of School of Nursing, Oregon Health and Science University, Portland, OR, 97239, USA
| | - Oleg Varlamov
- Division of Cardiometabolic Health, Oregon National Primate Research Center, L584 505 NW 185th Ave., Beaverton, OR, 97006, USA.
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Hugo M, Pierreisnard A, Mehsen-Cetre N, Gin H, Schaeverbeke T, Rigalleau V. Action of tocilizumab on energy expenditure in rheumatoid arthritis: A prospective study using calorimetry and actimetry. Joint Bone Spine 2016; 84:751-752. [PMID: 28017819 DOI: 10.1016/j.jbspin.2016.11.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/23/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Marie Hugo
- Nutrition-Diabetology department, CHU Bordeaux, avenue Magellan, 33600 Pessac, France.
| | - Audrey Pierreisnard
- Rheumatology department, CHU Bordeaux, avenue Magellan, 33600 Pessac, France
| | - Nadia Mehsen-Cetre
- Rheumatology department, CHU Bordeaux, avenue Magellan, 33600 Pessac, France
| | - Henri Gin
- Nutrition-Diabetology department, CHU Bordeaux, avenue Magellan, 33600 Pessac, France
| | | | - Vincent Rigalleau
- Nutrition-Diabetology department, CHU Bordeaux, avenue Magellan, 33600 Pessac, France
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Solmi M, Veronese N, Favaro A, Santonastaso P, Manzato E, Sergi G, Correll CU. Inflammatory cytokines and anorexia nervosa: A meta-analysis of cross-sectional and longitudinal studies. Psychoneuroendocrinology 2015; 51:237-52. [PMID: 25462897 DOI: 10.1016/j.psyneuen.2014.09.031] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 09/17/2014] [Accepted: 09/30/2014] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Although inflammation is increasingly implicated in psychiatric disorders, less is known about its role in anorexia nervosa (AN), an illness with low body mass index (BMI). METHODS We performed a systematic PubMed literature search until 12/31/2013 and meta-analyzed cross-sectional and longitudinal studies comparing circulating pro- and anti-inflammatory cytokines between patients with anorexia nervosa (AN) and healthy controls (HCs) (1) before and (2) after weight gain, and (3) within AN patients before and after weight gain. Standardized mean differences (SMDs)± 95% confidence intervals (CIs) for results from ≥ 2 studies were calculated. RESULTS Of 999 initial hits, 22 studies with 924 participants (AN=512, HCs=412) were eligible. Compared to HCs, tumor necrosis factor (TNF)-alpha (SMD=0.35, 95%CI=0.09-0.61, p=0.008), interleukin (IL)1-beta (SMD=0.51, 95%CI=0.18-0.84, p=0.003), IL-6 (SMD=0.43, 95%CI=0.11-0.76, p=0.009), and TNF-receptor-II (SMD=0.42, 95%CI:0.07-0.78, p=0.02) were significantly elevated in AN, while C-reactive protein (SMD=-0.53, 95%CI=-.77, -0.28, p<0.0001) and IL-6 receptor (SMD=-0.85, 95%CI=-1.33, -0.36, p=0.0006) were significantly decreased. No differences were found for TNF-receptor I and TGF-β. Across a subset of eight longitudinal studies (AN=152, HCs=129), significant weight gain (baseline BMI=15.4 ± 1.5, endpoint BMI=18.2 ± 1.6, p<0.0001) was not associated with significant changes in TNF-α, IL-6 and IL1-β. However, after weight gain, IL-6 was not different anymore compared to HCs (SMD=0.06, 95%CI=-0.32, 0.45, p=0.75). In meta-regression, shorter illness duration (p=0.0008), but not younger age (p=0.71) significantly moderated greater IL-6 levels. CONCLUSION Despite abnormally low BMI, AN seems to be associated with increased inflammatory cytokines. Whether specific elevated cytokines represent trait or state markers of AN, and whether they could be treatment targets requires further study.
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Affiliation(s)
- Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Nicola Veronese
- Department of Medicine-DIMED, Geriatrics Section, University of Padova, Padova, Italy
| | - Angela Favaro
- Department of Neurosciences, University of Padova, Padova, Italy
| | | | - Enzo Manzato
- Department of Medicine-DIMED, Geriatrics Section, University of Padova, Padova, Italy
| | - Giuseppe Sergi
- Department of Medicine-DIMED, Geriatrics Section, University of Padova, Padova, Italy
| | - Christoph U Correll
- The Zucker Hillside Hospital, Psychiatry Research, NorthShore-Long Island Jewish Health System, Glen Oaks, NY, USA; Hofstra North Shore LIJ School of Medicine, Hempstead, NY, USA; The Feinstein Institute for Medical Research, Manhasset, NY, USA; Albert Einstein College of Medicine, Bronx, NY, USA.
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