Walton Esther, Bernardoni Fabio, Batury Victoria-Luise, Bahnsen Klaas, Larivière Sara, Abbate-Daga Giovanni, Andres-Perpiña Susana, Bang Lasse, Bischoff-Grethe Amanda, Brooks Samantha J, Campbell Iain C, Cascino Giammarco, Castro-Fornieles Josefina, Collantoni Enrico, D'Agata Federico, Dahmen Brigitte, Danner Unna N, Favaro Angela, Feusner Jamie D, Frank Guido K W, Friederich Hans-Christoph, Graner John L, Herpertz-Dahlmann Beate, Hess Andreas, Horndasch Stefanie, Kaplan Allan S, Kaufmann Lisa-Katrin, Kaye Walter H, Khalsa Sahib S, LaBar Kevin S, Lavagnino Luca, Lazaro Luisa, Manara Renzo, Miles Amy E, Milos Gabriella F, Monteleone Alessio Maria, Monteleone Palmiero, Mwangi Benson, O'Daly Owen, Pariente Jose, Roesch Julie, Schmidt Ulrike H, Seitz Jochen, Shott Megan E, Simon Joe J, Smeets Paul A M, Tamnes Christian K, Tenconi Elena, Thomopoulos Sophia I, van Elburg Annemarie A, Voineskos Aristotle N, von Polier Georg G, Wierenga Christina E, Zucker Nancy L, Jahanshad Neda, King Joseph A, Thompson Paul M, Berner Laura A, Ehrlich Stefan
Department of Psychology, University of Bath, Bath, United Kingdom.
Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
Biol Psychiatry. 2022 Nov 1;92(9):730-738. doi: 10.1016/j.biopsych.2022.04.022. Epub 2022 May 31.
The pattern of structural brain abnormalities in anorexia nervosa (AN) is still not well understood. While several studies report substantial deficits in gray matter volume and cortical thickness in acutely underweight patients, others find no differences, or even increases in patients compared with healthy control subjects. Recent weight regain before scanning may explain some of this heterogeneity. To clarify the extent, magnitude, and dependencies of gray matter changes in AN, we conducted a prospective, coordinated meta-analysis of multicenter neuroimaging data.
We analyzed T1-weighted structural magnetic resonance imaging scans assessed with standardized methods from 685 female patients with AN and 963 female healthy control subjects across 22 sites worldwide. In addition to a case-control comparison, we conducted a 3-group analysis comparing healthy control subjects with acutely underweight AN patients (n = 466) and partially weight-restored patients in treatment (n = 251).
In AN, reductions in cortical thickness, subcortical volumes, and, to a lesser extent, cortical surface area were sizable (Cohen's d up to 0.95), widespread, and colocalized with hub regions. Highlighting the effects of undernutrition, these deficits were associated with lower body mass index in the AN sample and were less pronounced in partially weight-restored patients.
The effect sizes observed for cortical thickness deficits in acute AN are the largest of any psychiatric disorder investigated in the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) Consortium to date. These results confirm the importance of considering weight loss and renutrition in biomedical research on AN and underscore the importance of treatment engagement to prevent potentially long-lasting structural brain changes in this population.
神经性厌食症（AN）患者大脑结构异常的模式仍未得到很好的理解。虽然多项研究报告称，急性体重过轻的患者存在灰质体积和皮质厚度的显著缺陷，但其他研究发现患者与健康对照者之间没有差异，甚至患者的灰质体积和皮质厚度有所增加。扫描前近期体重恢复可能解释了这种异质性的部分原因。为了阐明AN患者灰质变化的程度、大小和相关性，我们对多中心神经影像数据进行了一项前瞻性、协调性的荟萃分析。
我们分析了来自全球22个地点的685名AN女性患者和963名健康对照女性的标准化T1加权结构磁共振成像扫描数据。除了病例对照比较外，我们还进行了三组分析，将健康对照者与急性体重过轻的AN患者（n = 466）以及接受治疗的部分体重恢复患者（n = 251）进行比较。
在AN患者中，皮质厚度、皮质下体积以及在较小程度上的皮质表面积均有显著减少（Cohen's d高达0.95），分布广泛且与枢纽区域共定位。这些缺陷突出了营养不良的影响，与AN样本中较低的体重指数相关，并且在部分体重恢复的患者中不太明显。
在急性AN患者中观察到的皮质厚度缺陷的效应大小是迄今为止在ENIGMA（通过荟萃分析增强神经影像遗传学）联盟研究的所有精神疾病中最大的。这些结果证实了在AN的生物医学研究中考虑体重减轻和重新营养的重要性，并强调了治疗参与对于预防该人群潜在的长期大脑结构变化的重要性。
