Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, USA.
Psychiatry Clin Neurosci. 2019 Sep;73(9):518-525. doi: 10.1111/pcn.12857. Epub 2019 Jul 1.
Anorexia nervosa (AN) has one of the highest mortality rates of any psychiatric disorder. Treatments are often ineffective and relapse is common. Most research attempting to understand the underlying causes and maintenance factors of AN has focused on environmental contributions, yet there is much to be explored in terms of biological risk and maintenance factors. In this paper, we focus primarily on AN research related to genetics and the complex microbial community in the gut (intestinal microbiota), and how these impact our conceptualization of this disorder. Emerging research identifying significant negative genetic correlations between AN and obesity suggests that the conditions may represent 'metabolic bookends'. The identification of underlying biological mechanisms may provide both insight into extreme weight dysregulation on both ends of the spectrum and new possible points of entry for AN treatment. Additionally, the reported microbial imbalance (dysbiosis) in the gut microbiota in AN patients, potentially due to a nutrient- and energy-deprived gut environment, implies alterations in functional and metabolic capacity of the gut microbiome. The extent to which AN and obesity can also be considered to be 'microbiome bookends' requires further investigation. Finally, we discuss ongoing and future AN projects exploring the interplay between host genomics, the environment, and cumulative microbial genomes (microbiome) as well as interventions at the microbial and gut level.
神经性厌食症 (AN) 的死亡率在所有精神障碍中是最高的之一。治疗通常效果不佳，且易复发。大多数试图了解 AN 的潜在原因和维持因素的研究都集中在环境贡献上，但在生物风险和维持因素方面还有很多需要探索。在本文中，我们主要关注与遗传学和肠道（肠道微生物群）复杂微生物群落相关的 AN 研究，以及这些如何影响我们对这种疾病的概念化。新出现的研究确定了 AN 和肥胖之间存在显著的负遗传相关性，这表明这两种情况可能代表“代谢的两端”。对潜在生物学机制的识别可能为我们提供对极端体重失调的深入了解，并为 AN 的治疗提供新的可能切入点。此外，据报道，AN 患者的肠道微生物群存在微生物失衡（失调），这可能是由于肠道环境中存在营养和能量不足，暗示了肠道微生物组的功能和代谢能力发生了改变。AN 和肥胖在多大程度上也可以被认为是“微生物的两端”需要进一步研究。最后，我们讨论了正在进行和未来的 AN 项目，这些项目探索了宿主基因组、环境和累积微生物基因组（微生物组）之间的相互作用，以及在微生物和肠道层面的干预措施。
