Shih P Betty, Morisseau Christophe, Le Thu, Woodside Blake, German J Bruce
University of California, San Diego, CA, USA.
University of California, Davis, CA, USA.
Prostaglandins Other Lipid Mediat. 2017 Nov;133:11-19. doi: 10.1016/j.prostaglandins.2017.08.010. Epub 2017 Sep 2.
Anorexia nervosa (AN) is a complex psychiatric disorder with high morbidity and mortality rates. While many individuals make full recoveries, up to a third of patients develop a chronic, treatment-resistant form of the illness that leads to a premature death in 15-20% of those affected. There have been few advances in treatment, both in terms of psychological or pharmacologic treatment over the last 30 years. Food aversion is commonly cited by patients with AN as a barrier to normalizing eating and weight. Our group has a keen interest in examining factors that might allow this to be addressed, thus improving treatment outcomes through personalized dietary plans or nutritional supplementation related to underlying genetic status. We demonstrated that polyunsaturated fatty acids (PUFAs)-derived bioactive lipids (eicosanoids) are implicated in not only the risk of AN, but also with its comorbid psychopathology. Of interest, the differential postprandial omega 6-derived eicosanoid shift observed in AN highlights the possibility that the metabolism of PUFAs is an important mechanism underlying the profound food version, contributing to pathological food restriction in AN. A concise knowledge of the relationships among PUFAs, eicosanoids, and AN clinical course and psychopathology could be the key to developing personalized nutritional rehabilitative treatments for those suffering from AN. This paper provides a comprehensive overview of the literature on PUFAs in AN. We also selectively reviewed the clinical benefits PUFA treatments exert in other psychiatric diseases, on weight and appetite regulation, and for resolution of inflammation, all of which are relevant in the disease course and outcome of AN. We propose that personalized PUFA formulation be developed and tested as a novel adjunctive treatment for patients with AN. We hypothesize that with personalized PUFA formulation, food aversion and anxiety about eating will decrease while mood, dietary behavior, and weight restoration will improve in AN, leading to improvements in the overall treatment outcome.
神经性厌食症（AN）是一种发病率和死亡率都很高的复杂精神疾病。虽然许多患者能完全康复，但仍有多达三分之一的患者会发展为慢性、难治性疾病形式，导致15% - 20%的患者过早死亡。在过去30年里，无论是心理治疗还是药物治疗，进展都很少。AN患者普遍将食物厌恶视为饮食和体重恢复正常的障碍。我们团队对研究可能解决这一问题的因素有着浓厚兴趣，从而通过与潜在基因状况相关的个性化饮食计划或营养补充来改善治疗效果。我们证明了多不饱和脂肪酸（PUFAs）衍生的生物活性脂质（类花生酸）不仅与AN的发病风险有关，还与其共病的精神病理学有关。有趣的是，在AN中观察到的餐后ω-6衍生类花生酸的差异变化突出了PUFAs代谢是导致严重食物厌恶的重要机制的可能性，这导致了AN患者的病理性食物限制。准确了解PUFAs、类花生酸与AN临床病程和精神病理学之间的关系可能是为AN患者开发个性化营养康复治疗的关键。本文全面概述了关于AN中PUFAs的文献。我们还选择性地回顾了PUFA治疗在其他精神疾病、体重和食欲调节以及炎症消退方面的临床益处，所有这些都与AN的病程和结局相关。我们建议开发并测试个性化PUFA配方，作为AN患者的一种新型辅助治疗方法。我们假设，通过个性化PUFA配方，AN患者的食物厌恶和进食焦虑将会减少，而情绪、饮食行为和体重恢复将会改善，从而导致整体治疗效果的提升。
