Scala Mauro, Tabone Mariangela, Paolini Marco, Salueña Andrea, Iturra Rocío Arroyo, Ferreiro Veronica Romero, Alvarez-Mon Miguel Ángel, Serretti Alessandro, Soltero Maria Del Rocío Gonzalez, Rodriguez-Jimenez Roberto
Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum-University of Bologna, Bologna, Italy.
Faculty of Biomedical and Health Sciences, European University of Madrid, Madrid, Spain.
Eur Eat Disord Rev. 2025 Jul;33(4):700-718. doi: 10.1002/erv.3179. Epub 2025 Jan 30.
This systematic review explores the associations between qualitative/quantitative changes in gut microbiota and psychopathological symptoms or other clinical features in patients with eating disorders (EDs). Secondary outcomes include exploring gut microbiota changes in EDs and potential relationships with psychotropic drug use.
A systematic search was conducted across biomedical databases from inception to June 2024 according to PRISMA guidelines. The risk of bias was assessed, and a narrative synthesis was performed due to the heterogeneity of the outcomes.
Only findings related to anorexia nervosa (AN) were identified. Ten studies, of which seven were longitudinal, two cross-sectional, and one interventional (N = 350 patients with AN, and 304 HCs), were included. Despite no clear links between diversity metrics and clinical symptoms being observed, specific taxa belonging to phylum Firmicutes, such as Clostridium, Roseburia, Lactobacillus, Faecalibacterium, and Bifidobacterium belonging to Actinobacteriota correlated with ED psychopathology, including anxiety and depressive symptoms.
Changes in microbiota were related to anxiety and depressive symptoms, as well as altered eating behaviours by modulating inflammation and insulin pathways through short-chain fatty acids (SCFAs), that also lead to neurotransmitter imbalances. Further studies are required to replicate these finding and to explore whether similar patterns are observed in other EDs.
本系统评价探讨饮食失调（ED）患者肠道微生物群的定性/定量变化与精神病理症状或其他临床特征之间的关联。次要结果包括探究饮食失调患者肠道微生物群的变化以及与使用精神药物的潜在关系。
根据PRISMA指南，从数据库建立至2024年6月在生物医学数据库中进行了系统检索。评估了偏倚风险，并由于结果的异质性进行了叙述性综合分析。
仅识别出与神经性厌食症（AN）相关的研究结果。纳入了10项研究，其中7项为纵向研究，2项为横断面研究，1项为干预性研究（350例神经性厌食症患者和304例健康对照）。尽管未观察到多样性指标与临床症状之间存在明确联系，但厚壁菌门的特定分类群，如梭菌属、罗斯氏菌属、乳杆菌属、粪杆菌属，以及放线菌门的双歧杆菌属与饮食失调的精神病理学相关，包括焦虑和抑郁症状。
微生物群的变化与焦虑和抑郁症状以及饮食行为改变有关，通过短链脂肪酸（SCFAs）调节炎症和胰岛素途径，这也会导致神经递质失衡。需要进一步研究来重复这些发现，并探究在其他饮食失调中是否观察到类似模式。
