Anorexia Nervosa Research Articles

Alexithymia in patients with an eating disorder

To date, eating disorders (anorexia nervosa, bulimia) have become widespread among the population. Alexithymia is considered to be one of the main features of patients with an eating disorder. In this regard, the purpose of this study was to identify and register the components of alexithymia in patients with an eating disorder, conceptually reflecting the features of this phenomenon. The research methods included: the Toronto Alexithymic Scale (TAS-20), the Lyusin Emotional Intelligence Test, the Karpov Reflexivity Questionnaire, the Giessen Questionnaire of Somatic Complaints (GBB), the Method «Identification of essential features». The methods of data processing and analysis were carried out using the IBM SPSS Statistics 26 program, which used the Spearman rank correlation coefficient and the Mann-Whitney U-criterion. As a result, it was revealed that patients with an eating disorder are characterized by a general deficiency of emotional regulation, which reflects the inability to identify, understand and describe emotions. At the same time, patients diagnosed with anorexia nervosa demonstrated a reduced ability to reflect, and were also characterized by a predominance of a specific situational style of thinking over an abstract logical one. The revealed features of the phenomenon of alexithymia in patients with an eating disorder can later be used in an integrated approach to the preparation and implementation of psychotherapeutic interventions, thereby increasing the effectiveness of therapeutic measures.

Maternal Eating Disorders, Body Mass Index, and Offspring Psychiatric Diagnoses

Maternal nutrition is essential in fetal development; thus, disordered eating may influence this process and contribute to the development of offspring psychiatric disorders. To investigate the association of maternal eating disorders and prepregnancy body mass index (BMI) with offspring psychiatric diagnoses. This population-based cohort study used Finnish national registers to assess all live births from January 1, 2004, through December 31, 2014, with follow-up until December 31, 2021. The data analyses were conducted from September 1, 2023, to September 30, 2024. Maternal eating disorder and prepregnancy BMI. Primary outcomes were 9 neurodevelopmental and psychiatric offspring diagnoses. Cox proportional hazards modeling adjusted for potential risk factors in the development of the outcome disorders was applied in 2 models. Secondary analyses were stratified for adverse birth outcomes (prematurity, small size for gestational age, and low Apgar score) or comorbid offspring eating disorders. Categories of BMI (calculated as weight in kilograms divided by height in meters squared) included underweight (BMI <18.5), normal weight (18.5-24.9), overweight (25.0-29.9), obesity (30.0-34.9), and severe obesity (≥35.0). The mean (SD) age of 392 098 included mothers was 30.15 (5.38) years, 42 590 mothers (10.86%) were born outside of Finland, 6273 mothers (1.60%) had a history of an eating disorder, 23 114 mothers (5.89%) had prepregnancy underweight, and 208 335 (53.13%) mothers had overweight or obesity. Among 649 956 included offspring, 332 359 (51.14%) were male, and 106 777 (16.43%) had received a neurodevelopmental or psychiatric diagnosis. Maternal eating disorders, prepregnancy underweight, and overweight or obesity were associated with most of the studied mental diagnoses in offspring, even after adjusting for potential covariates. The largest effect sizes were observed for maternal eating disorders not otherwise specified in association with offspring sleep disorders (hazard ratio [HR], 3.34 [95% CI, 2.39-4.67]) and social functioning and tic disorders (HR, 2.79 [95% CI, 2.21-3.52]), while for maternal severe prepregnancy obesity, offspring intellectual disabilities (HR, 2.04 [95% CI, 1.83-2.28]) had the largest effect size. Adverse birth outcomes further increased the risk of offspring having other feeding disturbances of childhood and infancy (eg, HR, 4.53 [95% CI, 2.97-6.89] for maternal eating disorders) and attention-deficit/hyperactivity disorder and conduct disorder (eg, HR, 2.27 [95% CI, 1.74-2.96] for maternal anorexia nervosa). In this population-based cohort study including 392 098 mothers and 649 956 offspring, offspring from mothers with an eating disorder history or prepregnancy BMI outside normal weight were at higher risk of psychiatric disorders. The results differed somewhat between the 2 exposures with regard to which offspring diagnoses had associations, and effect sizes were typically larger for maternal eating disorders vs BMI. These findings suggest a need to consider these 2 exposures clinically to help prevent offspring mental illness.

Stephanie Knatz Peck: Novel and innovative treatment for eating disorders

Dr. Stephanie Knatz Peck, Ph.D., is a practicing clinical psychologist and Associate Clinical Professor of Psychiatry at the University of California, San Diego (UCSD). Her career uniquely bridges clinical practice with innovative research, focusing on developing and evaluating novel psychiatric interventions, particularly for eating disorders. Dr. Knatz Peck's research journey began at the UCSD Eating Disorder Treatment and Research Center, where she skillfully translated complex neuroimaging and genetic findings into practical, innovative treatment approaches for anorexia nervosa (AN). This work culminated in the development and manualization of Temperament-Based Treatment with Supports (TBT-S), a groundbreaking behavioral intervention for AN. In recent years, Dr. Knatz Peck has expanded her research into the promising field of psychedelic-assisted therapies. She served as co-investigator on the first clinical trial evaluating psilocybin treatment for AN, marking a significant milestone in eating disorder research. Additionally, she contributes her expertise as a senior clinical consultant for Compass Pathways, where she leads training initiatives and plays a crucial role in developing psychological support models for psilocybin therapy across various psychiatric conditions. Beyond her academic pursuits, Dr. Knatz Peck founded and directs BrightMind Therapy, an outpatient practice providing evidence-based therapy for children and adolescents. Her comprehensive approach seamlessly integrates clinical practice with rigorous research, utilizing neuroimaging data, genetic findings, and hands-on clinical observations to develop targeted interventions for treatment-resistant psychiatric conditions. We are privileged to have Dr. Knatz Peck share her invaluable insights and experiences with our readers in this Genomic Press Interview.

Recent Advances and Therapeutic Benefits of Glucagon-Like Peptide-1 (GLP-1) Agonists in the Management of Type 2 Diabetes and Associated Metabolic Disorders.

Glucagon-like peptide-1 (GLP-1) agonists have emerged as a groundbreaking class of medications for managing type 2 diabetes and associated metabolic disorders. These agents not only improve glycemic control by increasing insulin secretion and reducing glucagon levels but also promote significant weight loss, enhance cardiovascular and renal health, and offer potential neuroprotective benefits. Their multifaceted mechanisms include appetite suppression, increased energy expenditure, and direct neuroprotective effects. GLP-1 agonists have shown recent benefits in Obstructive Sleep Apnea, and the treatment of neurodegenerative diseases such as Alzheimer's and Parkinson's, as well as reducing the risk of stroke. This review highlights the therapeutic potential of GLP-1 agonists in diabetes management and beyond, advocating for continued research to optimize their clinical use and explore new therapeutic avenues.

Proteins and Peptides from Food Sources with Effect on Satiety and Their Role as Anti-Obesity Agents: A Narrative Review.

Obesity, clinically defined as a body mass index (BMI) of 30 kg/m2 or higher, is a medical condition characterized by the excessive accumulation of body fat, which can lead to adverse health consequences. As a global public health issue with an escalating prevalence, controlling appetite and satiety is essential for regulating energy balance and managing body weight. Dietary proteins and peptides have gained interest in their potential to prevent and treat obesity by modulating satiety signals. This narrative review analyzes scientific evidence highlighting the role of dietary proteins and peptides in regulating satiety signals and investigates their therapeutic potential in preventing and treating obesity. A comprehensive literature search was conducted in multiple electronic databases, including PubMed, Scopus, and Web of Science. The search focused on articles examining the impact of dietary proteins and peptides on satiety and obesity, encompassing both preclinical and clinical trials. Several studies have demonstrated a correlation between the intake of specific proteins or peptides from plant and animal sources and satiety regulation. These investigations identified mechanisms where amino acids and peptides interact with enteroendocrine cell receptors, activating intracellular signaling cascades that promote the release of anorexigenic gut hormones such as cholecystokinin (CCK), glucagon-like peptide-1 (GLP-1), and peptide YY (PYY). Both in vitro and in vivo assays have shown that these interactions contribute to appetite regulation and the sensation of satiety. Using proteins and peptides in the diet may be an effective strategy for regulating appetite and controlling body weight. However, more research-including clinical trials-is needed to understand the underlying mechanisms better and optimize the application of these bioactive compounds in preventing and treating obesity.

Assessment of trabecular bone score using updated TBSTT in anorexia nervosa-The AN-BO study.

Anorexia Nervosa (AN) is characterized by a distortion of body image, very low body weight, malnutrition and hormonal dysregulations, resulting in reduced bone mineral density (BMD) and impaired bone microarchitecture. The updated Trabecular Bone Score (TBS) algorithm accounts for soft tissue thickness (TBSTT) instead of BMI (TBSBMI). The aim of the study was to assess both TBS algorithms in adult AN patients compared to normal-weight controls(CTRL). This retrospective cross-sectional study investigated 34 adult female anorexia nervosa (AN) patients and 26 healthy normal-weighted age- and sex-matched controls (CTRL). Bone texture analysis was assessed by TBSTT and TBSBMI (TBS iNsight® V4.0 and V3.1), bone mineral density (BMD; lumbar spine LS, femoral neck, total hip) and body composition by DXA (GE Lunar iDXATM). Laboratory analyses included bone turnover markers (CTX; P1NP; sclerostin). Data analysis was performed using parametric (t-test) or non-parametric test (Mann-Whitney-U-Test) depending on normality, one-way ANCOVA and correlation analysis (Perason's or Spearman's). AN patients (BMI 14.7(1.6)) and CTRL (BMI 22.4(4.0)) were of comparable age (22.8(7.1) vs.25.0(4.0)years, p = 0.145). TBSTT(1.319±0.09 vs.1.502±0.07, p<0.001) and TBSBMI(1.317±0.10 vs.1.548±0.09, p<0.001) were significantly lower in AN patients compared to CTRL. Soft tissue thickness was lower in AN (p<0.001). Within the CTRL group, but not in AN, TBSTT and TBSBMI were significantly different (p<0.001). BMD was lower at all sites in AN patients (p<0.001 for all), being lowest at LS. Bone Mineral Content, Lean Body mass and Fat Mass were lower in AN (p<0.001). AN patients had lower P1NP (p = 0.05), but higher CTX (p = 0.001) and sclerostin (p = 0.003) levels. Adult AN patients have lower TBSTT and TBSBMI, reduced BMD and an uncoupling of bone turnover. In AN both TBS algorithms show similar reduced trabecular bone microarchitecture. The observed difference of TBSTT and TBSBMI in CTRL with normal body composition highlight the importance of the new algorithm.

Visual body size estimation in adolescent anorexia nervosa: Behavioural and neurophysiological data suggest intact visual perception and biased emotional attention

Body image disturbance is a key symptom of anorexia nervosa (AN). AN patients report body dissatisfaction and overestimate their own body size in several tasks. This study aimed to clarify whether this overestimation arises from deficits in visual perception. To this end, 36 adolescent restrictive-type AN patients and 42 matched healthy controls performed metric and depictive body size estimation (BSE) tasks. Magneto- and electroencephalography were measured during the size estimation of 66 computer-generated body pictures varying in size from underweight to overweight. AN patients versus controls showed overestimation across self-referential metric and depictive BSE tasks, but similar performance in a depictive BSE task without self-reference and similar early neurophysiological responses. Starting mid-latency (200 ms), AN patients showed relatively more neural activity in response to underweight body pictures and less neural activity in response to higher-weight body pictures in distributed brain regions. A secondary comparison of AN patients with slight vs. distinct overestimation during self-referential BSE uncovered relatively stronger neural responses to body pictures corresponding to the estimated body mass index. These results suggest that body image disturbances in adolescent restrictive-type AN patients depend on self-reference and do not represent a deficit of visual perception, but rather biased emotional attention.

Acute Activity Urges Predict Lower Early Weight Gain During Inpatient Treatment for Anorexia Nervosa.

Early weight gain is a primary goal in the treatment of anorexia nervosa (AN) and associated with more favorable discharge weights and clinical outcomes. Activity urges, that is, a motivational state to engage in activity, have been suspected to delay early weight gain, but their prognostic role remains barely explored. Here, we investigated whether acute (state-like) activity urges at treatment onset would predict within-person weight gain in patients with AN during the initial 2 weeks of inpatient treatment. Adults with AN from an inpatient unit (N = 53) completed an activity urges measure at treatment onset, and weight changes were monitored for the duration of their treatment. Regression analyses, controlling for admission body mass index and other patient variables (i.e., patient age and AN subtype), found that higher state activity urges were associated with lower initial weight gain. Mediation analyses showed that differences in early weight changes further linked higher activity urges at admission to lower discharge weights. An activity urge cutoff value of 2.76 for distinguishing between cases with optimal and suboptimal initial weight gain is proposed. We discuss potential mechanisms of the link between activity urges and early weight gain and the implications of activity urges as a prognostic factor for improving weight restoration during AN treatment.

Exploring the therapeutic mechanisms of millet in obesity through molecular docking, pharmacokinetics, and dynamic simulation.

Obesity, a prevalent global health concern, is characterized by excessive fat accumulation, which confers significant nutritional and health risks, including a shortened lifespan and diminished wellbeing. Central to the regulation of energy balance and food intake is the fat mass and obesity-associated (FTO) protein, which modulates the interplay between caloric consumption and energy expenditure. Given its pivotal role in obesity regulation, the identification of effective inhibitors targeting the FTO protein is imperative for developing therapeutic interventions. Currently available anti-obesity drugs are often plagued by undesirable side effects. In contrast, natural plant-derived bioactive compounds are gaining prominence in the pharmaceutical industry due to their efficacy and lower incidence of adverse effects. Little Millet, a traditional cereal known for its rich nutritional profile and high satiety index, was investigated in this study using molecular docking and dynamics simulation approach for its potential as an anti-obesity agent. Our research demonstrates that four bioactive compounds from Little Millet exhibit superior binding energies ranging from 7.22 to 8.83 kcal/mol, compared to the standard anti-obesity drug, orlistat, which has a binding energy of 5.96 kcal/mol. These compounds fulfilled all drug-like criteria, including the Lipinski, Ghose, Veber, Egan, and Muegge rules, and exhibited favorable profiles in terms of distribution, metabolism, and prolonged half-life without toxicity. Conversely, orlistat was associated with hepatotoxicity, a reduced half-life, and multiple violations of drug-likeness parameters, undermining its efficacy. Molecular dynamics simulations and Gibbs free energy assessments revealed that the four identified compounds maintain stable interactions with key residues in the FTO protein's active site. We propose further validation through extensive In vitro, In vivo, and clinical studies to ascertain the therapeutic potential of these compounds in combating obesity.

Patient and carer feedback and engagement with ECHOMANTRA, a digital guided intervention for anorexia nervosa.

We developed ECHOMANTRA, a digital guided intervention for patients with anorexia nervosa and their carers to provide support during transition from inpatient care to community settings. This study reports on participants' engagement with, and feedback of, ECHOMANTRA. Patients and carers (N=184 dyads) were given access to ECHOMANTRA for 12months. The intervention included online groups, a workbook and recovery-oriented videoclips. Satisfactory engagement was defined as attendance of a minimum of four online groups by each dyad. Participants received an Intervention Feedback Form to measure frequency of use and provide feedback of the intervention. Those who did not meet the engagement criterion were asked to complete an Obstacles to Engagement Form. 19% of the sample reached the engagement criterion. Seventy-six patients and 60 carers completed the Intervention Feedback Form. Of those, approximately 60% reported using at least a quarter of the workbook and videoclips. Overall, participants found the materials useful and easy to access (median=3 on a scale 1-5). Obstacles to engagement (35 patients and 14 carers) included lack of time due to caring responsibilities, treatment, work/school commitments. A more personalised form of support may be needed to enhance motivation and ability to change following inpatient care.

Predictors of treatment outcome in higher levels of care among a large sample of adolescents with heterogeneous eating disorders

BackgroundDespite widespread use of higher levels of care in treating eating disorders in adolescents, research supporting the use of these treatments remains limited by small sample sizes and a predominant focus on anorexia nervosa. Further, existing data regarding predictors of outcome have yielded mixed findings. In the current study, we evaluated treatment outcomes and predictors of outcome among a large sample of adolescents with eating disorders presenting to inpatient, residential, partial hospitalization programs, and intensive outpatient programs across the United States.MethodsAdolescents (N = 1,971) completed self-report measures of eating disorder symptoms, depression, and anxiety at treatment admission, stepdown, and discharge. Using linear mixed effect models, we evaluated changes in symptoms over treatment separately among youth admitted to inpatient/residential treatment and those admitted to partial hospitalization/intensive outpatient programs, and used established metrics to gauge frequency of reliable (i.e., statistically reliable) and clinically significant change.ResultsResults suggested decreases in eating disorder symptoms, depression, and anxiety from intake to discharge. Around 50% of the sample reported reliable decreases in eating disorder symptoms at stepdown and discharge, with 30% of the sample reporting reliable reductions in depression and anxiety. Psychiatric comorbidity, primary diagnosis, age, and eating disorder symptoms at admission consistently predicted treatment-related change, although patterns in findings varied across symptoms.ConclusionsData from our sample are consistent with past work suggesting that adolescents enrolled in higher levels of care report clinical benefit; however, these effects are heterogenous, and a significant portion of individuals may not report reliable change in symptoms. Ultimately, ongoing work is required to better understand how and for whom higher levels of care may achieve their benefit and to identify the optimal approach for improving outcomes for adolescents with eating disorders.

Fortifikasi Nak Nan Jelly Bog Segamur

Abstract: Abundant banana stem waste is often wasted and becomes an environmental problem. In fact, research results show that banana stems are rich in benefits, one of which is the potential as an anti-obesity agent. Seeing this potential, the community service team tried to process banana stem waste into nutritious and economically valuable food products. This community service activity focused on assisting PKK Metuk mothers in processing banana stems into innovative food products. With intensive training and assistance, it is hoped that PKK mothers can produce value-added food products from banana stem waste. In addition to providing health benefits to the community, this activity is also expected to improve the community's economy through the development of small and medium enterprises based on local resources. The results of this community service activity show that the processing of banana stem waste into food products can be successful. PKK mothers succeeded in producing food products that are not only beneficial for health, but also have good market potential. This success proves that banana stem waste can be a valuable resource if managed properly. Keywords: Musa paradisiaca, economy, health

Potent and Protease Resistant Azapeptide Agonists of the GLP‐1 and GIP Receptors

AbstractThe gut‐derived peptide hormones glucagon‐like peptide‐1 (GLP‐1) and glucose‐dependent insulinotropic polypeptide (GIP) play important physiological roles including glucose homeostasis and appetite suppression. Stabilized agonists of the GLP‐1 receptor (GLP‐1R) and dual agonists of GLP‐1R and GIP receptor (GIPR) for the management of type 2 diabetes and obesity have generated widespread enthusiasm and have become blockbuster drugs. These therapeutics are refractory to the action of dipeptidyl peptidase‐4 (DPP4), that catalyzes rapid removal of the two N‐terminal residues of the native peptides, in turn severely diminishing their activity profiles. Here we report that a single atom change from carbon to nitrogen in the backbone of the entire peptide makes them refractory to DPP4 action while still retaining full potency and efficacy at their respective receptors. This was accomplished by use of aza‐amino acids, that are bioisosteric replacements for α‐amino acids that perturb the structural backbone and local side chain conformations. Molecular dynamics simulations reveal that aza‐amino acid can populate the same conformational space that GLP‐1 adopts when bound to the GLP‐1R. The insertion of an aza‐amino acid at the second position from the N‐terminus in semaglutide and in a dual agonist of GLP‐1R and GIPR further demonstrates its capability as a viable alternative to current DPP4 resistance strategies while offering additional structural variation that may influence downstream signaling.

Causal relationship between IgA nephropathy and common neuropsychiatric disorders: A two-sample Mendelian randomization analysis

ObjectiveUtilizing two-sample Mendelian randomization (TSMR), this study seeks to determine the causal relationship between IgA nephropathy and five prevalent neuropsychiatric disorders. By exploring the genetic associations between IgA nephropathy and neuropsychiatric disorders, this research aims to contribute to the prevention of neuropsychiatric disorders in patients with IgA nephropathy. MethodsPublic genome-wide association study databases were searched, with IgA nephropathy as the exposure factor, including 15,587 patients with IgA nephropathy and 462,197 healthy controls. The outcome factors were five common neuropsychiatric disorders (bipolar disorder, depressive disorder, schizophrenia, anorexia nervosa, and Alzheimer's disease), with outcome data drawn from five datasets in the PGC and GWAScatalog databases. Inverse-variance weighting served as the primary method for causal effect estimation, supplemented by MR-Egger, weighted median, weighted mode, and simple mode methods. Heterogeneity was tested using Cochran's Q test, and sensitivity analysis was conducted using MR-Egger and MR-presso. ResultsMR analysis indicated a positive causal relationship between IgA nephropathy and depressive disorder (OR = 1.010, 95%CI: 1.003–1.017, P = 3.27 × 10−3), and a potential positive causal relationship between IgA nephropathy and anorexia nervosa (OR = 1.165, 95%CI: 1.030–1.319, P = 0.015). ConclusionThere is a positive causal relationship between IgA nephropathy and depressive disorder, and a potential positive causal relationship with anorexia nervosa. No causal relationship was found with schizophrenia, bipolar disorder, or Alzheimer's disease.

The Nature of Taboo within Cultural Complexes: Theoretical and Clinical Applications.

The symbolic nature of taboo is examined as a container that differentiates developmental stages between the social values order/disorder through a ritual, liminal process of separating order as clean/blessed/safety and disorder as polluted/disassociated/risky. Unconscious/conscious taboos embody that perilous journey across margins in rites of passage and their emotional value and intensity in the form of symptomology varies cross-culturally. Two clinical cases are presented to illustrate the influence of taboo on obsessive compulsions and anorexia nervosa. Particular attention is given as to whether dirt as disorder/rubbish can be recycled at the margins between safety and risk and value redistributed to the intrapsychic and psychosocial anomalous bits and pieces that are discarded as rubbish.

Management of eating and feeding disorders

The World Health Organization and the American Psychiatric Association have identified eating disorders. This is the most common disease in the world. According to a systematic review, the prevalence of eating and feeding disorders was 3.5% between 2000 and 2006 and increased between 2013 and 2017 to 7.8 percent. Approximately 28.8 million people will suffer from this disease in USA. Eating and feeding disorders can be lifelong issue. These disorders are more common among women. Anorexia nervosa, effects on systemic as well as general oral and dental health.

Educational Method to Promote Recognition, Diagnosis, and Treatment of Eating Disorders: A Cluster-Randomized Study of the Effects of Retrieval Practice Amongst Medical Trainees.

Background Eating disorder (ED) education during medical training is lacking.Few medical trainees feel comfortable managing EDs, and an alarming 78% of healthcare providers report feeling insecure in treating EDs.Recognizing EDs early is crucial as the standardized mortality ratio for patients with anorexia nervosa is more than five times higher than that of the general population.Retrieval practice is a powerful tool in producing meaningful learning of complex concepts in education.We investigated the effectiveness of retrieval practice in ED education among medical trainees to improve recognition, diagnosis, and treatment of EDs among adolescent patients. Methods This exploratory, prospective, cluster-randomized trial enrolled residents and medical students over 14, four-week blocks. Participants were randomized by block to either the conventional lecture-based format (control group) or the retrieval-based educational format (intervention group). The control group received case-based lectures. The intervention group received education via 21 case-based quiz questions over the block with immediate feedback. Groups completed nine-item, multiple choice pre (T1)- and post (T2)-rotation knowledge tests, covering recognizing, diagnosing, and treating EDs.All participants also completed pre- and post-rotation surveys designed to measure self-perceived comfort, confidence in training, knowledge, and skills on the topic of EDs. Results The study's primary outcome was the difference between T1 and T2 scores between study groups. The intervention group showed greater improvement from T1 to T2 (5.8 to 7.4, respectively) than the control group (5.1 to 6.0, respectively). The difference between mean T1 and T2 scores in the control group versus the intervention group was significant (p=0.020).Despite the control group reporting improvements in confidence regarding training on EDs, this increased confidence was inversely correlated with scores on T2 (r=-0.502, p=0.011). Conclusions Trainees benefit from retrieval practice to improve knowledge acquisition regarding EDs.Standard lectures may confer false confidence to learners, which may not accurately align with actual knowledge acquisition.

Is severe carbohydrate restriction necessary for appetite suppression? The ASKED randomized controlled trial.

This trial aimed to compare three low-energy diets (LEDs) with different amounts of carbohydrates (CHO) on ketosis and changes in hunger feelings in adults with obesity. A total of 101 adults (51 female) with obesity (BMI, mean [SEM], 34.7 [0.4] kg/m2) were randomized to follow three isocaloric LEDs (1000 kcal/day) for 8 weeks, containing either low, medium, or high CHO (70, 100, and 130 g/day, respectively), and 4 weeks of refeeding and weight stabilization. Body weight (BW) and composition, hunger and other appetite ratings, concentrations of β-hydroxybutyrate (βHB), and appetite-related hormones were measured at baseline and at the end of weeks 8 and 12. At week 8, weight loss and βHB concentrations were significantly different among groups: Low CHO group versus Medium CHO group (BW: 2.32 [0.95] kg, 95% CI: 0.44 to 4.21, p = 0.016; βHB: -0.40 [0.09] mM, 95% CI: -0.67 to -0.09, p < 0.001); Low CHO group versus High CHO group (BW: 2.29 [0.96] kg, 95% CI: 0.39 to 4.19, p = 0.016; βHB: -0.644 [0.10] mM, 95% CI: -0.84 to -0.44, p < 0.001); and Medium CHO group versus High CHO group (BW: -0.03 [0.94] kg, 95% CI: -1.89 to 1.84, p = 0.977; βHB: -0.15 [0.08] mM, 95% CI: -0.30 to 0.002, p = 0.054). No significant differences in hunger were found among groups: Low CHO group versus Medium CHO group (-10.87 [5.92] mm, 95% CI: -0.82 to 22.57, p = 0.068); Low CHO group versus Medium CHO group (7.74 [7.36] mm, 95% CI: -6.77 to 22.26, p = 0.294); and Medium CHO group versus High CHO group (-3.13 [7.48] mm, 95% CI: -17.89 to 11.63, p = 0.676). Although the findings of this trial are not definitive, changes in hunger ratings with weight loss did not differ among groups. Additional studies with CHO intake of up to 130 g in 1000-kcal/day LEDs are warranted to replicate these findings.

Anorexia nervosa: A narrative review of diagnostic criteria, pathophysiology, and innovative management approaches

This narrative review delves into the complexities of anorexia nervosa (AN), focusing on its unique manifestations within diverse contexts, particularly in cancer patients. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic approach was employed via electronic databases such as PubMed, Scopus, and Google Scholar. AN has been explored in the context of cancer-related anorexia‒cachexia syndrome, aging, and autoimmune disorders. The diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) are outlined, emphasizing severe disturbances in eating behavior and self-imposed starvation. A thorough examination of the physiological, psychological, and social aspects of AN provides a comprehensive understanding of its multifactorial nature. This review outlines diverse management strategies for AN, encompassing nutritional rehabilitation, psychotherapeutic interventions, and potential pharmacological treatments. Various studies have summarized emerging signaling pathways in cancer-related AN, the bidirectional associations between AN and autoimmune disorders, and potential therapeutic modalities such as acupuncture. Emphasis is placed on the importance of family support, psychoeducation, and early intervention in cancer patients with AN, highlighting the integral role of a comprehensive approach in improving outcomes. In conclusion, this narrative review offers valuable insights into the intricate nature of AN, providing a basis for future research and clinical efforts to refine targeted interventions, particularly within the context of cancer patients. The article provides a broad overview of AN, serving as a resource for those interested in understanding its diverse manifestations.

Contemporary reflections on William Gull's case studies of anorexia nervosa, 150years on.

To analyse and compare the original four published anorexia nervosa (AN) case histories of William Gull with modern-day approaches. Case histories of the patients described by Gull were reviewed and placed in a tabulated format (which included demographics, clinical presentation, treatment, and prognosis) along with his general comments on AN, for easier comparison. Many of the presenting features of AN are similar to cases seen in more modern times but lack weight or body image disturbances. The cases described by Gull can be categorised as AN under the Diagnostic and Statistical Manual-Fifth Edition (DSM-5) and the Text Revision (DSM-5-TR) however, they were excluded by the Diagnostic and Statistical Manual-Fourth Edition (DSM-IV) and the International Classification of Diseases-10th Revision (ICD-10) criteria. Reference to Gull's work might have avoided the necessary change in diagnostic criteria. 150years on, Gull's cases resemble presentations of AN without weight or body image issues and emphasise the heterogeneity of the diagnostic conceptualisation of AN in the modern era. Nutritional rehabilitation remains core to the treatment with other interventions supporting this goal while aetiology remains elusive.