Marano Giuseppe, Rossi Sara, Sfratta Greta, Acanfora Mariateresa, Anesini Maria Benedetta, Traversi Gianandrea, Lisci Francesco Maria, Rinaldi Lucio, Pola Roberto, Gasbarrini Antonio, Sani Gabriele, Gaetani Eleonora, Mazza Marianna
Unit of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy.
Department of Neurosciences, Università Cattolica del Sacro Cuore, 00168 Rome, Italy.
Nutrients. 2025 Jul 14;17(14):2316. doi: 10.3390/nu17142316.
Emerging evidence highlights the critical role of the gut microbiota in the development and progression of eating disorders (EDs), particularly in women, who are more frequently affected by these conditions. Women with anorexia nervosa, bulimia nervosa, and binge eating disorder exhibit distinct alterations in gut microbiota composition compared to healthy controls. These alterations, collectively termed dysbiosis, involve reduced microbial diversity and shifts in key bacterial populations responsible for regulating metabolism, inflammation, and gut-brain signaling. The gut microbiota is known to influence appetite regulation, mood, and stress responses-factors closely implicated in the pathogenesis of EDs. In women, hormonal fluctuations related to menstruation, pregnancy, and menopause may further modulate gut microbial profiles, potentially compounding vulnerabilities to disordered eating. Moreover, the restrictive eating patterns, purging behaviors, and altered dietary intake often observed in women with EDs exacerbate microbial imbalances, contributing to intestinal permeability, low-grade inflammation, and disturbances in neurotransmitter production. This evolving understanding suggests that microbiota-targeted therapies, such as probiotics, prebiotics, dietary modulation, and fecal microbiota transplantation (FMT), could complement conventional psychological and pharmacological treatments in women with EDs. Furthermore, precision nutrition and personalized microbiome-based interventions tailored to an individual's microbial and metabolic profile offer promising avenues for improving treatment efficacy, even though these approaches remain exploratory and their clinical applicability has yet to be fully validated. Future research should focus on sex-specific microbial signatures, causal mechanisms, and microbiota-based interventions to enhance personalized treatment for women struggling with eating disorders.
新出现的证据凸显了肠道微生物群在饮食失调（EDs）发生和发展中的关键作用，尤其是在女性中，她们更频繁地受到这些疾病的影响。与健康对照相比，患有神经性厌食症、神经性贪食症和暴饮暴食症的女性肠道微生物群组成表现出明显变化。这些变化统称为生态失调，包括微生物多样性降低以及负责调节新陈代谢、炎症和肠脑信号的关键细菌种群的改变。已知肠道微生物群会影响食欲调节、情绪和应激反应，这些因素与饮食失调的发病机制密切相关。在女性中，与月经、怀孕和更年期相关的激素波动可能会进一步调节肠道微生物谱，潜在地增加饮食紊乱的易感性。此外，饮食失调女性中常见的限制性饮食模式、清除行为和饮食摄入改变会加剧微生物失衡，导致肠道通透性增加、低度炎症和神经递质产生紊乱。这种不断发展的认识表明，针对微生物群的疗法，如益生菌、益生元、饮食调节和粪便微生物群移植（FMT），可以补充饮食失调女性的传统心理和药物治疗。此外，根据个体的微生物和代谢特征量身定制的精准营养和基于个性化微生物组的干预措施为提高治疗效果提供了有前景的途径，尽管这些方法仍处于探索阶段，其临床适用性尚未得到充分验证。未来的研究应关注性别特异性微生物特征、因果机制以及基于微生物群的干预措施，以加强对饮食失调女性的个性化治疗。
