Abstract
BackgroundAnorexia nervosa (AN) is associated with structural brain abnormalities. Studies have reported less cerebral tissue and more cerebrospinal fluid (CSF) in individuals with AN relative to healthy controls, although findings are variable and inconsistent due to variations in sample size, age, and disease state (e.g., active AN, weight-recovered AN). Further, it remains unclear if structural brain abnormalities observed in AN are a consequence of specific brain pathologies or malnutrition, as very few longitudinal neuroimaging studies in AN have been completed.MethodsTo overcome this issue, this comprehensive meta-analysis will combine region-of-interest (ROI) and voxel-based morphometry (VBM) approaches to understand how regional and global structural brain abnormalities differ among individuals with AN and healthy controls (HCs). Additionally, we aim to understand how clinical characteristics and physiological changes during the course of illness, including acute illness vs. weight recovery, may moderate these structural abnormalities. We will create an online database of studies that have investigated structural brain abnormalities in AN. Data will be reviewed independently by two members of our team using MEDLINE databases, Web of Science, PsycINFO, EMBASE, and CINAHL. We will conduct ROI and VBM meta-analysis using seed-based d mapping in AN and HCs. We will include all studies that include structural neuroimaging of individuals with AN (both acute and weight-recovered) and HCs between January 1997 and 2020.DiscussionThis systematic review will assess the effects of AN compared to HC on brain structure. Futhermore, it will explore the role of acute AN and weight-recovered AN on brain structure. Findings will help researchers and clinicians to better understand the course of illness in AN and the nature of recovery, in terms of weight, malnutrition, and the state of the brain.Systematic review registrationPROSPERO CRD42020180921
Highlights
Anorexia nervosa (AN) is associated with structural brain abnormalities
Structural brain alterations in AN have been explored for three decades, with the first published study in 1990 [10]
It remains unclear whether the structural brain abnormalities reported in AN are a consequence of starvation or an indication of an underlying biological mechanism preceding AN symptomatology
Summary
Studies have reported less cerebral tissue and more cerebrospinal fluid (CSF) in individuals with AN relative to healthy controls, findings are variable and inconsistent due to variations in sample size, age, and disease state (e.g., active AN, weight-recovered AN) It remains unclear if structural brain abnormalities observed in AN are a consequence of specific brain pathologies or malnutrition, as very few longitudinal neuroimaging studies in AN have been completed. Structural brain alterations in AN have been explored for three decades, with the first published study in 1990 [10] It remains unclear whether the structural brain abnormalities reported in AN are a consequence of starvation or an indication of an underlying biological mechanism preceding AN symptomatology. A meta-analysis of all published studies can clarify cortical grey matter abnormalities in AN in relation to the course of disease and recovery in this complex illness
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