Foerde Karin, Walsh B Timothy, Dalack Maya, Daw Nathaniel, Shohamy Daphna, Steinglass Joanna E
New York State Psychiatric Institute, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA.
Psychiatry Department, Columbia University Irving Medical Center, 1051 Riverside Drive, Unit 98, New York, NY, 10032, USA.
J Eat Disord. 2021 Apr 17;9(1):48. doi: 10.1186/s40337-021-00402-y.
Anorexia nervosa is a severe illness with a high mortality rate, driven in large part by severe and persistent restriction of food intake. A critical challenge is to identify brain mechanisms associated with maladaptive eating behavior and whether they change with treatment. This study tested whether food choice-related caudate activation in anorexia nervosa changes with treatment.
Healthy women (n = 29) and women hospitalized with anorexia nervosa (n = 24), ages 18 to 40 years, completed a Food Choice Task during fMRI scanning at two timepoints. Among patients, procedures occurred upon hospital admission (Time 1) and again after patients had gained to normal weight (Time 2). Healthy controls were tested twice at an interval group-matched to patients. Choice-related caudate activation was assessed at each timepoint, using parametric analyses in an a priori region of interest.
Among patients, the proportion of high-fat foods selected did not change over time (p's > 0.47), but decreased neural activity in the caudate after treatment was associated with increased selection of high-fat foods (r = - 0.43, p = 0.037). Choice-related caudate activation differed among women with anorexia nervosa vs healthy control women at Time 1 (healthy control: M = 0.15 ± 0.87, anorexia nervosa: M = 0.70 ± 1.1, t = - 2.05, p = 0.045), but not at Time 2 (healthy control: M = 0.18 ± 1.0, anorexia nervosa: M = 0.37 ± 0.99, t = - 0.694, p = 0.49).
Caudate activity was more strongly associated with decisions about food among individuals with anorexia nervosa relative to healthy comparison individuals prior to treatment, and decreases in caudate engagement among individuals with anorexia nervosa undergoing treatment were associated with increases in high-fat food choices. The findings underscore the need for treatment development that more successfully alters both eating behavior and the neural mechanisms that guide it.
神经性厌食症是一种死亡率很高的严重疾病，很大程度上是由严重且持续的食物摄入限制所导致。一个关键挑战是确定与适应不良饮食行为相关的脑机制，以及它们是否会随着治疗而改变。本研究测试了神经性厌食症中与食物选择相关的尾状核激活是否会随着治疗而改变。
年龄在18至40岁之间的健康女性（n = 29）和因神经性厌食症住院的女性（n = 24）在两个时间点的功能磁共振成像扫描期间完成了一项食物选择任务。在患者中，程序在入院时（时间1）进行，在患者体重恢复正常后（时间2）再次进行。健康对照组在与患者组匹配的时间间隔内进行了两次测试。在每个时间点，使用先验感兴趣区域的参数分析评估与选择相关的尾状核激活。
在患者中，选择高脂肪食物的比例随时间没有变化（p值> 0.47），但治疗后尾状核神经活动的减少与高脂肪食物选择的增加相关（r = -0.43，p = 0.037）。在时间1时，神经性厌食症女性与健康对照女性之间与选择相关的尾状核激活存在差异（健康对照：M = 0.15±0.87，神经性厌食症：M = 0.70±1.1，t = -2.05，p = 0.045），但在时间2时没有差异（健康对照：M = 0.18±1.0，神经性厌食症：M = 0.37±0.99，t = -0.694，p = 0.49）。
相对于治疗前的健康对照个体，神经性厌食症个体中尾状核活动与食物决策的关联更强，接受治疗的神经性厌食症个体尾状核参与度的降低与高脂肪食物选择的增加相关。这些发现强调了开发更成功地改变饮食行为及其指导神经机制的治疗方法的必要性。
