S75. Maladaptive Food Choice and Neural Correlates Persist After Weight Restoration in Anorexia Nervosa

Background: Anorexia nervosa (AN) is a serious, multifactorial mental disorder affecting predominantly young females. This systematic review examines neuroimaging findings in adolescents and young adults up to 24 years old, in order to explore alterations associated with disease pathophysiology. Methods: Eligible studies on structural and functional brain neuroimaging were sought systematically in PubMed, CENTRAL and EMBASE databases up to 5 October 2020. Results: Thirty-three studies were included, investigating a total of 587 patients with a current diagnosis of AN and 663 healthy controls (HC). Global and regional grey matter (GM) volume reduction as well as white matter (WM) microstructure alterations were detected. The mainly affected regions were the prefrontal, parietal and temporal cortex, hippocampus, amygdala, insula, thalamus and cerebellum as well as various WM tracts such as corona radiata and superior longitudinal fasciculus (SLF). Regarding functional imaging, alterations were pointed out in large-scale brain networks, such as default mode network (DMN), executive control network (ECN) and salience network (SN). Most findings appear to reverse after weight restoration. Specific limitations of neuroimaging studies in still developing individuals are also discussed. Conclusions: Structural and functional alterations are present in the early course of the disease, most of them being partially or totally reversible. Nonetheless, neuroimaging findings have been open to many biological interpretations. Thus, more studies are needed to clarify their clinical significance.

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The neural correlates of a central coherence task in young women with anorexia nervosa

European Eating Disorders Review ◽

10.1002/erv.2852 ◽

2021 ◽

Author(s):

Monica Leslie ◽

Daniel Halls ◽

Jenni Leppanen ◽

Felicity Sedgewick ◽

Katie Lang ◽

...

Keyword(s):

Anorexia Nervosa ◽

Young Women ◽

Neural Correlates ◽

Central Coherence

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Managing anorexia from a dietitian's perspective

Proceedings of The Nutrition Society ◽

10.1017/s0029665109001281 ◽

2009 ◽

Vol 68 (3) ◽

pp. 281-288 ◽

Cited By ~ 18

Author(s):

Annette Cockfield ◽

Ursula Philpot

Keyword(s):

Eating Disorders ◽

Anorexia Nervosa ◽

Multidisciplinary Team ◽

Best Practice ◽

Tube Feeding ◽

Evidence Base ◽

Inpatient Setting ◽

Team Approach ◽

Normal Behaviour ◽

Weight Restoration

Anorexia nervosa has the highest mortality rate of any psychiatric condition and its management is complex and multi-faceted, requiring a multidisciplinary team approach. Dietitians are an important part of the multidisciplinary team, offering objective nutritional advice with the aim of helping the patient to develop an improved relationship with food. Refeeding patients with a low body weight requires careful management; nonetheless, refeeding the low-weight patient with anorexia presents many additional complications, largely of a psychological nature. Treatment plans need to consider psychological, physical, behavioural and psycho-social factors relating to anorexia nervosa. Currently, there is no consistent approach and a paucity of evidence to support best practice for weight restoration in this group of patients. Tube feeding is utilised at varying BMI in anorexia nervosa, mainly in an inpatient setting. However, its use should be seen as a last resort and limited to a life-saving intervention. Weight restoration is best managed by an experienced dietitian within a specialist eating disorders team, using normal foods. This approach is ideal for nutrition rehabilitation, promoting skills for eating and normal behaviour and providing a longer-term solution by challenging unhelpful coping strategies from the onset. Dietitians have a unique mix of skills and knowledge in numerous areas including nutrition, physiology, psychology, sociology and behaviour change, which can be applied to support patients with thoughts and behaviours around food, weight and appetite. Further research is required into the effectiveness of dietetic interventions in eating disorders in order to establish an evidence base for best practice.

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Data Processing Error in: Fluoxetine After Weight Restoration in Anorexia Nervosa: A Randomized Controlled Trial

JAMA ◽

10.1001/jama.298.17.2008 ◽

2007 ◽

Vol 298 (17) ◽

pp. 2008

Keyword(s):

Randomized Controlled Trial ◽

Anorexia Nervosa ◽

Data Processing ◽

Controlled Trial ◽

Randomized Controlled ◽

Processing Error ◽

Weight Restoration

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Insulin, glucose, and pancreatic polypeptide responses to a test meal in restricting type anorexia nervosa before and after weight restoration

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.00347.2006 ◽

2007 ◽

Vol 292 (5) ◽

pp. E1441-E1446 ◽

Cited By ~ 25

Author(s):

Kimberly P. Kinzig ◽

Janelle W. Coughlin ◽

Graham W. Redgrave ◽

Timothy H. Moran ◽

Angela S. Guarda

Keyword(s):

Anorexia Nervosa ◽

Pancreatic Polypeptide ◽

Test Meal ◽

Weight Status ◽

Endocrine Function ◽

Response Patterns ◽

Short Term ◽

Before And After ◽

Weight Restoration ◽

Relapse Rates

Prolonged malnutrition in individuals with anorexia nervosa (AN) has been associated with alterations in endocrine function that may play a sustaining role in the disorder. We hypothesized that abnormalities in endocrine responses to ingestion of a meal in AN are reversible and depend on weight restoration. We measured meal-induced endocrine responses in AN subjects at three time points during hospitalization: before refeeding ( n = 13, mean BMI 16.7 kg/m2), after 2 wk of refeeding (mean BMI 18.0 kg/m2), and in the weight-restored state (mean BMI 20.3 kg/m2). Control subjects ( n = 13, BMI 19–24.9 kg/m2) were tested once. Tests were 2.5-h sessions in which blood was drawn every 15 min before, during, and after a ∼650-kcal test breakfast. Relative to controls, peak levels of glucose were depressed and peak levels of insulin in response to ingestion of the test meal were delayed, with response patterns in the third trial most similar to controls. Pancreatic polypeptide (PP) levels were increased in AN relative to controls regardless of weight status. The delay in insulin release and elevated PP levels did not correct with short-term refeeding and may contribute to the high relapse rates and maintenance of AN.

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Neural Correlates of Theory of Mind Are Preserved in Young Women With Anorexia Nervosa

Frontiers in Psychology ◽

10.3389/fpsyg.2020.568073 ◽

2020 ◽

Vol 11 ◽

Author(s):

Monica Leslie ◽

Daniel Halls ◽

Jenni Leppanen ◽

Felicity Sedgewick ◽

Katherine Smith ◽

...

Keyword(s):

Anorexia Nervosa ◽

Prefrontal Cortex ◽

Theory Of Mind ◽

Social Interactions ◽

Young Women ◽

Inferior Frontal Gyrus ◽

Reliability And Validity ◽

Neural Correlates ◽

Neural Activation ◽

Neural Basis

People with anorexia nervosa (AN) commonly exhibit social difficulties, which may be related to problems with understanding the perspectives of others, commonly known as Theory of Mind (ToM) processing. However, there is a dearth of literature investigating the neural basis of these differences in ToM and at what age they emerge. This study aimed to test for differences in the neural correlates of ToM processes in young women with AN, and young women weight-restored (WR) from AN, as compared to healthy control participants (HC). Based on previous findings in AN, we hypothesized that young women with current or prior AN, as compared to HCs, would exhibit a reduced neural response in the medial prefrontal cortex (mPFC), the inferior frontal gyrus, and the temporo-parietal junction (TPJ) whilst completing a ToM task. We recruited 73 young women with AN, 45 WR young women, and 70 young women without a history of AN to take part in the current study. Whilst undergoing a functional magnetic resonance imaging (fMRI) scan, participants completed the Frith-Happé task, which is a commonly used measure of ToM with demonstrated reliability and validity in adult populations. In this task, participants viewed the movements of triangles, which depicted either action movements, simple interactions, or complex social interactions. Viewing trials with more complex social interactions in the Frith-Happé task was associated with increased brain activation in regions including the right TPJ, the bilateral mPFC, the cerebellum, and the dorsolateral prefrontal cortex. There were no group differences in neural activation in response to the ToM contrast. Overall, these results suggest that the neural basis of spontaneous mentalizing is preserved in most young women with AN.

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Cardiac changes in anorexia nervosa

Cardiology in the Young ◽

10.1017/s104795111500267x ◽

2016 ◽

Vol 26 (4) ◽

pp. 623-628 ◽

Cited By ~ 24

Author(s):

Michael A. Spaulding-Barclay ◽

Jessica Stern ◽

Philip S. Mehler

Keyword(s):

Weight Loss ◽

Anorexia Nervosa ◽

Treatment Outcome ◽

Eating Disorder ◽

Medical Complications ◽

Cardiac Complications ◽

Successful Treatment Outcome ◽

Comprehensive Literature Review ◽

Life Threatening ◽

Weight Restoration

AbstractIntroductionAnorexia nervosa is an eating disorder, which is associated with many different medical complications as a result of the weight loss and malnutrition that characterise this illness. It has the highest mortality rate of any psychiatric disorder. A large portion of deaths are attributable to the cardiac abnormalities that ensue as a result of the malnutrition associated with anorexia nervosa. In this review, the cardiac complications of anorexia nervosa will be discussed.MethodsA comprehensive literature review on cardiac changes in anorexia nervosa was carried out.ResultsThere are structural, functional, and rhythm-type changes that occur in patients with anorexia nervosa. These become progressively significant as ongoing weight loss occurs.ConclusionCardiac changes are inherent to anorexia nervosa and they become more life-threatening and serious as the anorexia nervosa becomes increasingly severe. Weight restoration and attention to these cardiac changes are crucial for a successful treatment outcome.

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