White Matter Abnormalities in Anorexia Nervosa: Psychoradiologic Evidence From Meta-Analysis of Diffusion Tensor Imaging Studies Using Tract Based Spatial Statistics.

Simin Zhang,Xiaorui Su,Graham J Kemp,Qiyong Gong,Lei Li,Jingkai Su,Weina Wang,Xibiao Yang,Qiaoyue Tan,Youjin Zhao,Huaiqiang Sun,Qiang Yue

doi:10.3389/fnins.2020.00159

Abstract

Background: Anorexia nervosa (AN) is a debilitating illness whose neural basis remains unclear. Studies using tract-based spatial statistics (TBSS) with diffusion tensor imaging (DTI) have demonstrated differences in white matter (WM) microarchitecture in AN, but the findings are inconclusive and controversial.Objectives: To identify the most consistent WM abnormalities among previous TBSS studies of differences in WM microarchitecture in AN.Methods: By systematically searching online databases, a total of 11 datasets were identified, including 245 patients with AN and 246 healthy controls (HC). We used Seed-based d Mapping to analyze fractional anisotropy (FA) differences between AN patients and HC, and performed meta-regression analysis to explore the effects of clinical characteristics on WM abnormalities in AN.Results: The pooled results of all AN patients showed robustly lower FA in the corpus callosum (CC) and the cingulum compared to HC. These two regions preserved significance in the sensitivity analysis as well as in all subgroup analyses. Fiber tracking showed that the WM tracts primarily involved were the body of the CC and the cingulum bundle. Meta-regression analysis revealed that the body mass index and mean age were not linearly correlated with the lower FA.Conclusions: The most consistent WM microstructural differences in AN were in the interhemispheric connections and limbic association fibers. These common “targets” advance our understanding of the complex neural mechanisms underlying the puzzling symptoms of AN, and may help in developing early treatment approaches.

Highlights

Anorexia nervosa (AN) is a serious mental and somatic disorder that typically develops during adolescence and primarily affects females (Zipfel et al, 2015)
Studies were included according to the following criteria: (a) articles written in the English language and published in peerreviewed journals; (b) a primary diagnosis of AN according to the international classification of diseases-10 (ICD-10) and/or
Diagnostic and Statistical Manual of Mental Disorders (DSM); (c) studies reported a tract-based spatial statistics (TBSS) comparison between patients with AN and HC; (d) studies detected FA differences at the wholebrain level and reported the results in stereotactic 3D coordinates (Talairach or MNI)

Summary

Introduction

Anorexia nervosa (AN) is a serious mental and somatic disorder that typically develops during adolescence and primarily affects females (Zipfel et al, 2015). AN is characterized by extreme restriction of energy intake, a distorted body image, excessive concerns over weight and shape, and emotional dysfunction (American Psychiatric Association (APA), 2013; Zipfel et al, 2015). There may be severe longterm medical and psychological sequelae besides acute effects of self-starvation (Steinhausen, 2002). The etiology of AN remains unknown, and the interaction of neurobiological, psychological and environmental factors in its onset and outcome is unclear (Kaye et al, 2013; Zipfel et al, 2015). Exploring the neurobiological abnormalities associated with AN will be important for improving the effectiveness of both diagnosis and treatment (Hill et al, 2016). Anorexia nervosa (AN) is a debilitating illness whose neural basis remains unclear. Studies using tract-based spatial statistics (TBSS) with diffusion tensor imaging (DTI) have demonstrated differences in white matter (WM) microarchitecture in AN, but the findings are inconclusive and controversial

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Conclusion