Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany.
Psychological Institute, Heidelberg University, Heidelberg, Germany.
Psychol Med. 2021 Apr;51(6):1011-1019. doi: 10.1017/S0033291719003970. Epub 2020 Jan 14.
Restrictive food intake in anorexia nervosa (AN) has been related to an overactive cognitive control network inhibiting intuitive motivational responses to food stimuli. However, the influence of short-term homeostatic signaling on the neural regulation of cue-induced food craving in AN is still unclear.
Twenty-five women with AN and 25 matched normal-weight women were examined on two occasions after receiving either glucose or water directly into their stomach using a nasogastric tube. Participants were blinded to the type of infusion. An event-related functional magnetic resonance imaging paradigm was used to investigate the effect of intestinal glucose load on neural processing during either simple viewing or distraction from food stimuli.
Neural differences between patients with AN and normal-weight participants were found during the distraction from food stimuli, but not during the viewing condition. When compared to controls, patients with AN displayed increased activation during food distraction in the left parietal lobule/precuneus and fusiform gyrus after water infusion and decreased activation in ventromedial prefrontal and cingulate regions after intestinal glucose load.
Independent of the cephalic phase and the awareness of caloric intake, homeostatic influences trigger disorder-specific reactions in AN. Food distraction in patients with AN is associated with either excessive higher-order cognitive control during physiological hunger or decreased internally directed attention after intestinal glucose load. These findings suggest that food distraction plays an important role in the psychopathology of AN. This study was registered on clinicaltrials.gov with identifier: NCT03075371.
神经性厌食症 (AN) 中的限制进食与过度活跃的认知控制网络有关，该网络抑制了对食物刺激的直观动机反应。然而，短期体内平衡信号对 AN 中线索诱导的食物渴望的神经调节的影响尚不清楚。
在两次检查中，25 名 AN 女性和 25 名匹配的正常体重女性分别接受了经鼻胃管直接给予葡萄糖或水。参与者对输注类型不知情。使用事件相关功能磁共振成像范式，研究肠道葡萄糖负荷对简单观看或分散食物刺激时神经处理的影响。
与正常体重参与者相比，AN 患者在分散食物刺激时表现出不同的神经反应，但在观看条件下没有差异。与对照组相比，在水输注后，AN 患者在食物分散时左顶叶/楔前叶和梭状回显示出增加的激活，而在肠道葡萄糖负荷后，腹内侧前额叶和扣带回区域的激活减少。
独立于头期和热量摄入的意识，体内平衡的影响会在 AN 中引发特定于疾病的反应。AN 患者的食物分散与生理饥饿时过度的高级认知控制有关，或者在肠道葡萄糖负荷后内部指向注意力下降。这些发现表明，食物分散在 AN 的发病机制中起着重要作用。本研究在 clinicaltrials.gov 上注册，标识符为：NCT03075371。
