Department of Biology and Biotechnology, University of Pavia, 27100 Pavia, Italy.
Department of Pharmaceutical Sciences, University of Perugia, 06126 Perugia, Italy.
Front Biosci (Landmark Ed). 2024 Aug 9;29(8):277. doi: 10.31083/j.fbl2908277.
Bulimia nervosa (BN) is a condition marked by a typical cyclical behavioural activity, characterized by restrictions, binges and vomiting, as well as a disturbance of the emotional value of food. Food stimuli acquire excessive relevance, giving rise to a succession of states of excitement and anxiety. The depressive condition accompanies very often BN. Most people with BN also experience one or more anxiety disorders. The aim of the review is to identify a link at a central and peripheral level that connects an eating disorder with a mood state. Altered nervous mechanisms are involved in BN. Among the cerebral areas, the insula is functionally compromised in BN. The insula is also implicated in depressive states. The insula is the primary gustatory cortex, where gustatory sensory information such as taste discrimination and higher cognitive functions such as food anticipation and reward are processed. The insula is anatomically connected to a wide range of cortical, limbic and paralimbic structures, and functionally implicated in high-order cognition, emotional responses, and empathic processes. The insula plays a crucial role in empathy, or in the ability to share the emotional states of others, and in particular negative emotions. In fact, the insular cortex is also activated in conditions of anxiety and depression. One of the pathophysiological factors that influences bulimia and depression is the composition of gut microbiota, as there is a strong association between the microbial signature and the brain function. Gut dysbiosis condition may contribute to the development of eating disorders, including BN. Dysbiosis may promote intestinal inflammation, alter gut permeability, and trigger immune reactions in the hunger/satiety regulation center contributing to the pathophysiological development of eating disorders. From this emerges the importance of adequate probiotic integration as a preventive and/or therapeutic tool in these pathologies.
神经性贪食症（BN）是一种以典型周期性行为为特征的疾病，其特征是限制、暴食和呕吐，以及食物情绪价值的紊乱。食物刺激获得了过度的相关性，导致一连串的兴奋和焦虑状态。抑郁状态经常伴随着 BN。大多数 BN 患者还经历一种或多种焦虑障碍。本综述的目的是确定在中枢和外周水平上连接饮食障碍和情绪状态的联系。神经机制发生改变与 BN 有关。在大脑区域中，BN 中脑岛的功能受到损害。脑岛也与抑郁状态有关。脑岛是主要的味觉皮质，在这里处理味觉感知信息，如味觉辨别和更高的认知功能，如食物预期和奖励。脑岛与广泛的皮质、边缘和边缘下结构在解剖上相连，并在高级认知、情绪反应和同理心过程中具有功能联系。脑岛在同理心或分享他人情绪状态（特别是负面情绪）方面起着至关重要的作用。事实上，脑岛皮质在焦虑和抑郁状态下也会被激活。影响贪食症和抑郁症的一个病理生理因素是肠道微生物群的组成，因为微生物特征与大脑功能之间存在很强的关联。肠道菌群失调可能会导致进食障碍的发展，包括 BN。失调可能会促进肠道炎症，改变肠道通透性，并触发饥饿/饱腹感调节中心的免疫反应，从而促进进食障碍的病理生理发展。由此可见，适当的益生菌整合作为这些疾病的预防和/或治疗工具非常重要。
