Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Eating Disorder Treatment and Research Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
Lipotype GmbH, Dresden, Germany.
J Am Acad Child Adolesc Psychiatry. 2021 Dec;60(12):1479-1490. doi: 10.1016/j.jaac.2021.02.014. Epub 2021 Mar 1.
Refeeding is the cornerstone of anorexia nervosa (AN) treatment, but little is known regarding the optimal pace and dietary composition or possible adverse effects of current clinical practices. Plasma lipids may be a moderating factor underlying unfavorable refeeding effects in AN, such as an abnormal central body fat distribution. The objective of this study was to analyze the plasma lipidome in the acutely underweight state of AN before and after refeeding.
Using high-throughput quantitative mass spectrometry-based shotgun lipidomics, we measured 13 lipid classes and 204 lipid species or subspecies in the plasma of young female patients with acute AN, before (n = 39) and after (n = 23) short-term weight restoration during an intensive inpatient refeeding program (median body mass index [BMI] increase = 26.4%), in comparison to those in healthy control participants (n = 37).
Before inpatient treatment, patients with AN exhibited increased concentrations of cholesterol and several other lipid classes. After refeeding, multiple lipid classes including cholesterol and ceramides, as well as certain ceramide species previously associated with obesity or overfeeding, showed increased concentrations, and a pattern of shorter and more saturated triacylgycerides emerged. A machine learning model trained to predict BMI based on the lipidomic profiles revealed a sizable overprediction in patients with AN after weight restoration.
The results point toward a profound lipid dysregulation with similarities to obesity and other features of the metabolic syndrome after short-term weight restoration. Thus, this study provides evidence for possible short-term adverse effects of current refeeding practices on the metabolic state and should inspire more research on nutritional interventions in AN.
营养治疗是神经性厌食症（AN）治疗的基石，但目前对于最佳的营养治疗速度和饮食组成，以及临床实践中可能存在的不良反应，人们知之甚少。血浆脂质可能是导致 AN 营养治疗不良的一个调节因素，例如异常的中心体脂分布。本研究旨在分析 AN 患者在营养治疗前和营养治疗后急性体重减轻期的血浆脂质组学。
采用高通量定量质谱shotgun 脂质组学方法，我们测量了 39 名急性 AN 年轻女性患者在短期强化住院营养治疗（体重指数 [BMI] 平均增加 26.4%）前（n=39）和后（n=23）的血浆中 13 种脂质类和 204 种脂质种类或亚类，同时与健康对照参与者（n=37）进行比较。
在住院治疗前，AN 患者表现出胆固醇和其他几种脂质类浓度升高。在营养治疗后，包括胆固醇和神经酰胺在内的多种脂质类，以及之前与肥胖或过度喂养相关的某些神经酰胺种类，其浓度升高，短链和更饱和的三酰基甘油也呈现出一种出现模式。一个基于脂质组学特征预测 BMI 的机器学习模型在患者体重恢复后显示出较大的预测误差。
这些结果表明，在短期体重恢复后，存在明显的脂质失调，与肥胖和代谢综合征的其他特征相似。因此，本研究为当前营养治疗实践对代谢状态可能存在的短期不良影响提供了证据，并应激发更多关于 AN 营养干预的研究。
