Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA.
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
Transl Psychiatry. 2023 Jun 23;13(1):220. doi: 10.1038/s41398-023-02494-3.
Anorexia nervosa (AN) and atypical AN (AtypAN) are complex neurobiological illnesses that typically onset in adolescence with an often treatment-refractory and chronic illness trajectory. Aberrant eating behaviors in this population have been linked to abnormalities in food reward and cognitive control, but prior studies have not examined respective contributions of clinical characteristics and metabolic state. Research is needed to identify specific disruptions and inform novel intervention targets to improve outcomes. Fifty-nine females with AN (n = 34) or AtypAN (n = 25), ages 10-22 years, all ≤90% expected body weight, and 34 age-matched healthy controls (HC) completed a well-established neuroimaging food cue paradigm fasting and after a standardized meal, and we used ANCOVA models to investigate main and interaction effects of Group and Appetitive State on blood oxygenation level-dependent (BOLD) activation for the contrast of exposure to high-calorie food images minus objects. We found main effects of Group with greater BOLD activation in the dorsal anterior cingulate cortex (dACC), dorsolateral prefrontal cortex (DLPFC), hippocampus, caudate, and putamen for AN/AtypAN versus HC groups, and in the three-group model including AN, AtypAN, and HC (sub-)groups, where differences were primarily driven by greater activation in the AtypAN subgroup versus HC group. We found a main effect of Appetitive State with increased premeal BOLD activation in the hypothalamus, amygdala, nucleus accumbens, and caudate for models that included AN/AtypAN and HC groups, and in BOLD activation in the nucleus accumbens for the model that included AN, AtypAN, and HC (sub-)groups. There were no interaction effects of Group with Appetitive State for any of the models. Our findings demonstrate robust feeding-state independent group effects reflecting greater neural activation of specific regions typically associated with reward and cognitive control processing across AN and AtypAN relative to healthy individuals in this food cue paradigm. Differential activation of specific brain regions in response to the passive viewing of high-calorie food images may underlie restrictive eating behavior in this clinical population.
神经性厌食症 (AN) 和非典型神经性厌食症 (AtypAN) 是复杂的神经生物学疾病，通常在青春期发病，且具有经常治疗抵抗和慢性疾病轨迹。该人群的异常进食行为与食物奖励和认知控制的异常有关，但先前的研究并未检查临床特征和代谢状态各自的贡献。需要研究来确定特定的中断并为改善结果提供新的干预目标。59 名女性 AN (n=34) 或 AtypAN (n=25)，年龄 10-22 岁，均≤90%预期体重，以及 34 名年龄匹配的健康对照组 (HC)，完成了一项成熟的神经影像学食物线索范式，在禁食和标准餐后进行，并使用 ANCOVA 模型研究了组和食欲状态对暴露于高热量食物图像减去物体对比时血氧水平依赖 (BOLD) 激活的主效应和交互效应。我们发现，与 HC 组相比，AN/AtypAN 组的背侧前扣带皮层 (dACC)、背外侧前额叶皮层 (DLPFC)、海马体、尾状核和壳核的 BOLD 激活有主要的组效应，并且在包括 AN、AtypAN 和 HC (亚) 组的三组模型中，差异主要是由 AtypAN 亚组与 HC 组相比的激活增加引起的。我们发现，食欲状态的主效应，即包括 AN/AtypAN 和 HC 组的模型中，下丘脑、杏仁核、伏隔核和尾状核的餐前 BOLD 激活增加，以及包括 AN、AtypAN 和 HC (亚) 组的模型中伏隔核的 BOLD 激活增加。对于任何模型，组与食欲状态都没有交互效应。我们的研究结果表明，在该食物线索范式中，与健康个体相比，AN 和 AtypAN 存在更强烈的神经激活，反映了特定区域的奖赏和认知控制处理的更强的进食状态独立的组效应。在这个临床人群中，对高热量食物图像的被动观察的特定大脑区域的不同激活可能是限制进食行为的基础。
