1
|
L’intestin un organe endocrine : de la physiologie aux implications thérapeutiques en nutrition. NUTR CLIN METAB 2022. [DOI: 10.1016/j.nupar.2021.12.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
|
2
|
Nelson LR, Halpern-Felsher BL, Nagata JM, Carlson JL. Clinician practices assessing hypothalamic-pituitary-gonadal axis suppression in adolescents with an eating disorder. Int J Eat Disord 2021; 54:2218-2222. [PMID: 34611918 PMCID: PMC11378747 DOI: 10.1002/eat.23625] [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: 05/21/2021] [Revised: 09/27/2021] [Accepted: 09/27/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Although extensive literature exists on hypothalamic-pituitary-gonadal (HPG) axis suppression in females with an eating disorder, there are few studies in males. Our study aimed to determine clinician practices for the assessment of HPG axis suppression and to identify differences in practice based on the sex of the patient. METHOD Our 31-item survey queried clinicians about confidence level and practices for assessing HPG suppression in male compared to female patients. RESULTS Findings showed that clinicians (n = 104) were less likely to evaluate HPG suppression in males compared to females, including assessment of sexual maturity rating (p < .050), screening of decreased libido compared to amenorrhea (p < .001) and lab assessment (luteinizing hormone and follicular-stimulating hormone: p < .001; estradiol/testosterone: p < .010; TSH: p < .050). Participants also felt less confident evaluating male patients (p < .001) and requested better screening tools for males (p < .001). DISCUSSION Our data suggest that clinician practices differ based on patient sex and that clinicians request tools for HPG suppression assessment in males. This is the first study examining specific practices and comfort levels of clinicians when assessing HPG axis suppression. Findings suggest that more guidance on the management of male patients may be needed to standardize care and to prevent short and long-term sequela of malnutrition.
Collapse
Affiliation(s)
- Lance R Nelson
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Bonnie L Halpern-Felsher
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| | - Jason M Nagata
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of California, San Francisco, California, USA
| | - Jennifer L Carlson
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California, USA
| |
Collapse
|
3
|
Bulik CM, Carroll IM, Mehler P. Reframing anorexia nervosa as a metabo-psychiatric disorder. Trends Endocrinol Metab 2021; 32:752-761. [PMID: 34426039 PMCID: PMC8717872 DOI: 10.1016/j.tem.2021.07.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 07/27/2021] [Accepted: 07/30/2021] [Indexed: 02/07/2023]
Abstract
Anorexia nervosa (AN) is a serious and often fatal illness. Despite decades of research, investigators have failed to adequately advance our understanding of the biological aspects of AN that could inform the development of effective interventions. Genome-wide association studies are revealing the important role of metabolic factors in AN, and studies of the gastrointestinal tract are shedding light on disruptions in enteric microbial communities and anomalies in gut morphology. In this opinion piece, we review the state of the science through the lens of the clinical presentation of illness. We project how the integration of rigorous science in genomics and microbiology, in collaboration with experienced clinicians, has the potential to markedly enhance treatment outcome via precision interventions.
Collapse
Affiliation(s)
- Cynthia M Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Ian M Carroll
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Phil Mehler
- ACUTE at Denver Health, Denver, CO, USA; Eating Recovery Center, Denver, CO, USA; University of Colorado School of Medicine, Denver, CO, USA
| |
Collapse
|
4
|
Duriez P, Nilsson IAK, Le Thuc O, Alexandre D, Chartrel N, Rovere C, Chauveau C, Gorwood P, Tolle V, Viltart O. Exploring the Mechanisms of Recovery in Anorexia Nervosa through a Translational Approach: From Original Ecological Measurements in Human to Brain Tissue Analyses in Mice. Nutrients 2021; 13:nu13082786. [PMID: 34444945 PMCID: PMC8401511 DOI: 10.3390/nu13082786] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022] Open
Abstract
Anorexia nervosa (AN) is a severe eating disorder where caloric restriction, excessive physical activity and metabolic alterations lead to life-threatening situations. Despite weight restoration after treatment, a significant part of patients experience relapses. In this translational study, we combined clinical and preclinical approaches. We describe preliminary data about the effect of weight gain on the symptomatology of patients suffering from acute AN (n = 225) and partially recovered (n = 41). We measured more precisely physical activity with continuous cardiac monitoring in a sub-group (n = 68). Using a mouse model, we investigated whether a long-term food restriction followed by nutritional recovery associated or not with physical activity may differentially impact peripheral and central homeostatic regulation. We assessed the plasma concentration of acyl ghrelin, desacyl ghrelin and leptin and the mRNA expression of hypothalamic neuropeptides and their receptors. Our data show an effect of undernutrition history on the level of physical activity in AN. The preclinical model supports an important role of physical activity in the recovery process and points out the leptin system as one factor that can drive a reliable restoration of metabolic variables through the hypothalamic regulation of neuropeptides involved in feeding behavior.
Collapse
Affiliation(s)
- Philibert Duriez
- Institute of Psychiatry and Neuroscience of Paris (IPNP), University of Paris, INSERM UMR-S 1266, F-75014 Paris, France; (P.D.); (P.G.); (V.T.)
- GHU Paris Psychiatry and Neurosciences, Hospital Sainte-Anne, F-75014 Paris, France
| | - Ida A. K. Nilsson
- Department of Molecular Medicine & Surgery, Karolinska Institutet, Centre for Eating Disorders Innovation (CEDI), Medical University, Karolinska Institutet, S-17176 Stockholm, Sweden;
| | - Ophelia Le Thuc
- CNRS UMR 7275, Institute of Molecular and Cellular Pharmacology (IPMC), University of Nice-Sophia Antipolis, F-06560 Valbonne, France; (O.L.T.); (C.R.)
| | - David Alexandre
- INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, University of Normandie, UNIROUEN, F-76821 Mont-Saint-Aignan, France; (D.A.); (N.C.)
| | - Nicolas Chartrel
- INSERM U1239, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, University of Normandie, UNIROUEN, F-76821 Mont-Saint-Aignan, France; (D.A.); (N.C.)
| | - Carole Rovere
- CNRS UMR 7275, Institute of Molecular and Cellular Pharmacology (IPMC), University of Nice-Sophia Antipolis, F-06560 Valbonne, France; (O.L.T.); (C.R.)
| | - Christophe Chauveau
- Marrow Adiposity and Bone Laboratory (MABLab), University of Littoral Côté d’Opale, CHRU Lille, F-62327 Boulogne sur Mer, France;
- Faculty of Sciences and Technologies, University of Lille, F-59650 Villeneuve d’Ascq, France
| | - Philip Gorwood
- Institute of Psychiatry and Neuroscience of Paris (IPNP), University of Paris, INSERM UMR-S 1266, F-75014 Paris, France; (P.D.); (P.G.); (V.T.)
- GHU Paris Psychiatry and Neurosciences, Hospital Sainte-Anne, F-75014 Paris, France
| | - Virginie Tolle
- Institute of Psychiatry and Neuroscience of Paris (IPNP), University of Paris, INSERM UMR-S 1266, F-75014 Paris, France; (P.D.); (P.G.); (V.T.)
| | - Odile Viltart
- Institute of Psychiatry and Neuroscience of Paris (IPNP), University of Paris, INSERM UMR-S 1266, F-75014 Paris, France; (P.D.); (P.G.); (V.T.)
- Faculty of Sciences and Technologies, University of Lille, F-59650 Villeneuve d’Ascq, France
- Correspondence: ; Tel.: +33-6-76-88-05-06
| |
Collapse
|
5
|
Puckett L, Grayeb D, Khatri V, Cass K, Mehler P. A Comprehensive Review of Complications and New Findings Associated with Anorexia Nervosa. J Clin Med 2021; 10:jcm10122555. [PMID: 34207744 PMCID: PMC8226688 DOI: 10.3390/jcm10122555] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/02/2021] [Accepted: 06/06/2021] [Indexed: 02/08/2023] Open
Abstract
Anorexia nervosa is a complex and deadly psychiatric disorder. It is characterized by a significant degree of both co-occurring psychiatric diseases and widespread physiological changes which affect nearly every organ system. It is important for clinicians to be aware of the varied consequences of this disorder. Given the high rate of mortality due to AN, there is a need for early recognition so that patients can be referred for appropriate medical and psychiatric care early in the course of the disorder. In this study, we present a comprehensive review of the recent literature describing medical findings commonly encountered in patients with AN. The varied and overlapping complications of AN affect pregnancy, psychological well-being, as well as bone, endocrine, gastrointestinal, cardiovascular, and pulmonary systems.
Collapse
Affiliation(s)
- Leah Puckett
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Daniela Grayeb
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Vishnupriya Khatri
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Kamila Cass
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
| | - Philip Mehler
- ACUTE Center for Eating Disorders, Denver, CO 80204, USA; (L.P.); (D.G.); (V.K.); (K.C.)
- Department of Medicine, School of Medicine, University of Colorado, Aurora, CO 80045, USA
- Eating Recovery Center, Denver, CO 80230, USA
- Correspondence: ; Tel.: +1-(303)-602-4972
| |
Collapse
|
6
|
Dumitrașcu MC, Șandru F, Carsote M, Petca RC, Gheorghisan-Galateanu AA, Petca A, Valea A. Anorexia nervosa: COVID-19 pandemic period (Review). Exp Ther Med 2021; 22:804. [PMID: 34093760 DOI: 10.3892/etm.2021.10236] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/16/2021] [Indexed: 12/14/2022] Open
Abstract
Anorexia nervosa is an eating disorder characterized by restrictive eating and an intense fear of gaining weight. It is a disease with an increasing incidence during the last few decades, and represents a complex psychiatric condition which includes secondary amenorrhea, nutritional and metabolic damage, and impaired endocrine panel up to bone loss as well as cardiac, gastrointestinal and hematological complications. This is a narrative review which includes an update on this eating disorder from the perspective of an endocrine panel of anomalies, especially of the skeleton, considering the pressure of the recent global COVID-19 pandemic changes. Practically affecting every organ, anorexia nervosa needs to be taken into consideration during the pandemic period because of the higher risk of relapse due to new living conditions, social distancing, self-isolation, changes in food access, more intense use of social media platforms, disruption of daily habits, and more difficult access to healthcare practitioners. The lack of physical activity in addition to vitamin D deficiency related to low sun exposure or to the use of facial masks may also be connected to further bone damage related to this disease.
Collapse
Affiliation(s)
- Mihai Cristian Dumitrașcu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, Emergency University Hospital Bucharest, 050098 Bucharest, Romania
| | - Florica Șandru
- Department of Dermatology, 'Elias' Emergency University Hospital, 011461 Bucharest, Romania.,Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, 'C. I. Parhon' National Institute of Endocrinology, 011863 Bucharest, Romania.,Department of Endocrinology 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Razvan Cosmin Petca
- Department of Urology, 'Prof. Dr. Th. Burghele' Clinical Hospital, 050659 Bucharest, Romania.,Department of Urology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Ancuta Augustina Gheorghisan-Galateanu
- Department of Endocrinology, 'C. I. Parhon' National Institute of Endocrinology, 011863 Bucharest, Romania.,Department of Molecular and Cellular Biology, and Histology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Aida Petca
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Elias' Emergency University Hospital, 011461 Bucharest, Romania
| | - Ana Valea
- Department of Endocrinology, Clinical County Hospital, 400000 Cluj-Napoca, Romania.,Department of Endocrinology, 'I. Hatieganu' University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| |
Collapse
|
7
|
Comparison between inpatients with anorexia nervosa with and without major depressive disorder: Clinical characteristics and outcome. Psychiatry Res 2021; 297:113734. [PMID: 33486276 DOI: 10.1016/j.psychres.2021.113734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/14/2021] [Indexed: 11/22/2022]
Abstract
Anorexia Nervosa (AN) and Major Depressive Disorder (MDD) are frequent comorbid conditions. It is unclear how MDD affects intensive emergency treatment and outcome. Eighty-seven AN inpatients were analyzed, twenty-two suffered also from MDD. Individuals with AN and MDD at admission had no remarkable differences in psychopathology, but a full diagnosis of MDD - and not just the presence of depressive symptoms - was associated with longer length of stay and worse clinical outcome (weight restoration, increase of caloric intake). Health care policies might consider that MDD comorbidity, regardless of AN clinical severity, affects the efficacy and timing of acute treatments.
Collapse
|
8
|
Unexpected Association of Desacyl-Ghrelin with Physical Activity and Chronic Food Restriction: A Translational Study on Anorexia Nervosa. J Clin Med 2020; 9:jcm9092782. [PMID: 32872151 PMCID: PMC7565884 DOI: 10.3390/jcm9092782] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 08/19/2020] [Accepted: 08/22/2020] [Indexed: 01/20/2023] Open
Abstract
Anorexia nervosa (AN) is a severe metabopsychiatric disorder characterised by caloric intake restriction and often excessive physical exercise. Our aim is to assess in female AN patients and in a rodent model, the co-evolution of physical activity and potential dysregulation of acyl—(AG) and desacyl—(DAG) ghrelin plasma concentrations during denutrition and weight recovery. AN inpatients were evaluated at inclusion (T0, n = 29), half—(T1) and total (T2) weight recovery, and one month after discharge (T3, n = 13). C57/Bl6 mice with access to a running wheel, were fed ad libitum or submitted to short—(15 days) or long—(50 days) term quantitative food restriction, followed by refeeding (20 days). In AN patients, AG and DAG rapidly decreased during weight recovery (T0 to T2), AG increased significantly one-month post discharge (T3), but only DAG plasma concentrations at T3 correlated negatively with BMI and positively with physical activity. In mice, AG and DAG both increased during short- and long-term food restriction. After 20 days of ad libitum feeding, DAG was associated to persistence of exercise alteration. The positive association of DAG with physical activity during caloric restriction and after weight recovery questions its role in the adaptation mechanisms to energy deprivation that need to be considered in recovery process in AN.
Collapse
|