Department of Medicine and Surgery, University of Salerno, via S. Allende, 84084 Baronissi (Salerno), Italy.
Psychoneuroendocrinology. 2013 Mar;38(3):312-30. doi: 10.1016/j.psyneuen.2012.10.021. Epub 2013 Jan 11.
A large body of literature documents the occurrence of alterations in the physiology of both central and peripheral modulators of appetite in acute patients with anorexia nervosa (AN) and bulimia nervosa (BN). Until more recently the role of most of the appetite modulators in the control of eating behavior was conceptualized solely in terms of their influence on homeostatic control of energy balance. However, it is becoming more and more evident that appetite modulators also affect the non-homeostatic cognitive, emotional and rewarding component of food intake as well as non food-related reward, and, recently, AN and BN have been pathophysiologically linked to dysfunctions of reward mechanisms. Therefore, the possibility exists that observed changes in appetite modulators in acute AN and BN may represent not only homeostatic adaptations to malnutrition, but also contribute to the development and/or the maintenance of aberrant non-homeostatic behaviors, such as self-starvation and binge eating. In the present review, the evidences supporting a role of leptin, ghrelin, brain-derived neurotrophic factor and endocannabinoids in the homeostatic and non-homeostatic dysregulations of patients with AN and BN will be presented. The reviewed literature is highly suggestive that changes in the physiology of these modulators may play a pivotal role in the pathophysiology of eating disorders by providing a possible link between motivated behaviors, reward processes, cognitive functions and energy balance.
大量文献记录了厌食症（AN）和贪食症（BN）急性患者中枢和外周食欲调节剂的生理学变化。直到最近，大多数食欲调节剂在控制进食行为方面的作用仅被概念化为它们对能量平衡的体内平衡控制的影响。然而，越来越明显的是，食欲调节剂也会影响与摄入食物相关的非体内平衡认知、情绪和奖励成分以及非食物相关的奖励，最近，AN 和 BN 与奖励机制的功能障碍在病理生理学上相关联。因此，急性 AN 和 BN 中观察到的食欲调节剂的变化不仅可能代表对营养不良的体内平衡适应，而且可能导致异常的非体内平衡行为（如自我饥饿和暴食）的发展和/或维持。在本综述中，将提出支持瘦素、胃饥饿素、脑源性神经营养因子和内源性大麻素在 AN 和 BN 患者的体内平衡和非体内平衡失调中的作用的证据。综述文献强烈表明，这些调节剂的生理学变化可能通过在动机行为、奖励过程、认知功能和能量平衡之间提供可能的联系，在进食障碍的病理生理学中发挥关键作用。
