Abstract
Anorexia nervosa (AN) is a severe metabopsychiatric disorder characterised by caloric intake restriction and often excessive physical exercise. Our aim is to assess in female AN patients and in a rodent model, the co-evolution of physical activity and potential dysregulation of acyl—(AG) and desacyl—(DAG) ghrelin plasma concentrations during denutrition and weight recovery. AN inpatients were evaluated at inclusion (T0, n = 29), half—(T1) and total (T2) weight recovery, and one month after discharge (T3, n = 13). C57/Bl6 mice with access to a running wheel, were fed ad libitum or submitted to short—(15 days) or long—(50 days) term quantitative food restriction, followed by refeeding (20 days). In AN patients, AG and DAG rapidly decreased during weight recovery (T0 to T2), AG increased significantly one-month post discharge (T3), but only DAG plasma concentrations at T3 correlated negatively with BMI and positively with physical activity. In mice, AG and DAG both increased during short- and long-term food restriction. After 20 days of ad libitum feeding, DAG was associated to persistence of exercise alteration. The positive association of DAG with physical activity during caloric restriction and after weight recovery questions its role in the adaptation mechanisms to energy deprivation that need to be considered in recovery process in AN.
Highlights
Anorexia nervosa (AN) is a psychiatric disorder where the severe weight loss due to a reduction on food intake is associated with high levels of physical activity
We aimed to improve our understanding of the link between plasma concentrations of the two isoforms of ghrelin and the level of physical activity in condition of chronic food restriction and during nutritional recovery
In AN patients, under an inpatient therapeutic program, we observed that one month after discharge only plasma DAG concentrations were negatively correlated to body mass indexes (BMIs) and positively to the level of physical activity
Summary
Anorexia nervosa (AN) is a psychiatric disorder where the severe weight loss due to a reduction on food intake is associated with high levels of physical activity. 31% to 80% of AN patients display inappropriate quantity of exercise with respect to their energy resources [1,2]. Hyperactivity has been associated with an increase in the length of hospitalisation stay [3], a poor treatment outcome both interfering with refeeding therapies and increasing the risk of relapse [4]. One out of two patients relapses within a year following inpatient treatment and approximately 20% of patients experience recurrent patterns of remission and relapse or chronic disease [5,6]. The disorder affects predominantly women and girls, with female to male ratios of approximately 10/1 to 15/1 [7]. The etiology of AN is complex, but recent evidences emphasise metabolic and endocrine aspects as key pathophysiological determinants of the disorder [8,9,10,11,12]
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