Restraint of appetite and reduced regional brain volumes in anorexia nervosa: a voxel-based morphometric study. BMC Psychiatry 11:179

Section of Eating Disorders, Institute of Psychiatry, King's College London, London, SE5 8AF UK.
BMC Psychiatry (Impact Factor: 2.21). 11/2011; 11(1):179. DOI: 10.1186/1471-244X-11-179
Source: PubMed


Previous Magnetic Resonance Imaging (MRI) studies of people with anorexia nervosa (AN) have shown differences in brain structure. This study aimed to provide preliminary extensions of this data by examining how different levels of appetitive restraint impact on brain volume.
Voxel based morphometry (VBM), corrected for total intracranial volume, age, BMI, years of education in 14 women with AN (8 RAN and 6 BPAN) and 21 women (HC) was performed. Correlations between brain volume and dietary restraint were done using Statistical Package for the Social Sciences (SPSS).
Increased right dorsolateral prefrontal cortex (DLPFC) and reduced right anterior insular cortex, bilateral parahippocampal gyrus, left fusiform gyrus, left cerebellum and right posterior cingulate volumes in AN compared to HC. RAN compared to BPAN had reduced left orbitofrontal cortex, right anterior insular cortex, bilateral parahippocampal gyrus and left cerebellum. Age negatively correlated with right DLPFC volume in HC but not in AN; dietary restraint and BMI predicted 57% of variance in right DLPFC volume in AN.
In AN, brain volume differences were found in appetitive, somatosensory and top-down control brain regions. Differences in regional GMV may be linked to levels of appetitive restraint, but whether they are state or trait is unclear. Nevertheless, these discrete brain volume differences provide candidate brain regions for further structural and functional study in people with eating disorders.

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Available from: Steven C R Williams, Oct 13, 2015
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    • "Several studies found that regional GM changes correlated with BMI, e.g. GM changes in the hypothalamus (Boghi et al., 2011) and the right frontal and temporal cortical structures (Brooks et al., 2011; Amianto et al., 2013); GM changes in the cingulum correlated with lowest lifetime BMI (Muhlau et al., 2007). Still, other studies did not find any correlations of GM changes with BMI (Joos et al., 2010; Fonville et al., 2013). "
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    ABSTRACT: Acute anorexia nervosa (AN) is associated with marked brain volume loss potentially leading to neuropsychological deficits. However, the mechanisms leading to this brain volume loss and its influencing factors are poorly understood and the clinical relevance of these brain alterations for the outcome of these AN-patients is yet unknown. Brain volumes of 56 female adolescent AN inpatients and 50 healthy controls (HCs) were measured using MRI scans. Multiple linear regression analyses were used to determine the impact of body weight at admission, prior weight loss, age of onset and illness duration on volume loss at admission and to analyse the association of brain volume reduction with body weight at a 1-year follow-up (N = 25). Cortical and subcortical grey matter (GM) and cortical white matter (WM) but not cerebellar GM or WM were associated with low weight at admission. Amount of weight loss, age of onset and illness duration did not independently correlate with any volume changes. Prediction of age-adjusted standardized body mass index (BMI-SDS) at 1-year follow-up could be significantly improved from 34% of variance explained by age and BMI-SDS at admission to 47.5-53% after adding cortical WM, cerebellar GM or WM at time of admission. Whereas cortical GM changes appear to be an unspecific reflection of current body weight ("state marker"), cortical WM and cerebellar volume losses seem to indicate a longer-term risk (trait or "scar" of the illness), which appear to be important for the prediction of weight rehabilitation and long-term outcome. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Journal of Psychiatric Research 09/2015; 68:228-237. DOI:10.1016/j.jpsychires.2015.06.019 · 3.96 Impact Factor
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    • "In AN, we also found hippocampal atrophy that confirmed previous findings (Connan et al., 2006; Brooks et al., 2011). "
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    ABSTRACT: Recent studies focussing on neuroimaging features of eating disorders have observed that anorexia nervosa (AN) is characterized by significant grey matter (GM) atrophy in many brain regions, especially in the cerebellum and anterior cingulate cortex. To date, no studies have found GM atrophy in bulimia nervosa (BN) or have directly compared patients with AN and BN. We used voxel-based morphometry (VBM) to characterize brain abnormalities in AN and BN patients, comparing them with each other and with a control group, and correlating brain volume with clinical features. We recruited 17 AN, 13 BN and 14 healthy controls. All subjects underwent high-resolution magnetic resonance imaging (MRI) with a T1-weighted 3D image. VBM analysis was carried out with the FSL-VBM 4.1 tool. We found no global atrophy, but regional GM reduction in AN with respect to controls and BN in the cerebellum, fusiform area, supplementary motor area, and occipital cortex, and in the caudate in BN compared to AN and controls. Both groups of patients had a volumetric increase bilaterally in somatosensory regions with respect to controls, in areas that are typically involved in the sensory-motor integration of body stimuli and in mental representation of the body image. Our VBM study documented, for the first time in BN patients, the presence of volumetric alterations and replicated previous findings in AN patients. We evidenced morphological differences between AN and BN, demonstrating in the latter atrophy of the caudate nucleus, a region involved in reward mechanisms and processes of self-regulation, perhaps involved in the genesis of the binge-eating behaviors of this disorder.
    07/2013; 213(3). DOI:10.1016/j.pscychresns.2013.03.010
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    • "One may hypothesise that the central executive compensates for the impaired phonological store, either directly or via the visuo-spatial sketchpad [54], the WM ''slave'' system dealing with visual, spatial and kinaesthetic information [3]. This would be in line with increased DLPFC grey matter volume [8] and fMRI studies showing that the DLPFC and IFG exhibit higher activation when healthy people undertake dieting behaviour [28] [32]. "
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    ABSTRACT: Literature regarding verbal working memory (vWM) in anorexia nervosa (AN) has been inconsistent due to a misunderstanding of the key components of vWM and introduction of confounding stimuli. Furthermore, there are no studies looking at how brain function in people with AN relates to vWM performance. The present study used functional magnetic resonance imaging (fMRI) with a letter n-back paradigm to study the effect of increasing vWM task difficulty on cortical functioning in the largest AN sample to date (n=31). Although the AN group had low BMI and higher anxious and depressive symptomology compared to age-matched controls (HC), there were no between-group differences in accuracy and speed at any task difficulty. fMRI data revealed no regions exhibiting significant differences in activation when groups were compared at each difficulty separately and no regions showing group x condition interaction. Although there was a trend towards lower accuracy as duration of illness increased, this was not correlated with activity in regions associated with vWM. These findings indicate that vWM in AN is as efficient and performed using the same cognitive strategy as HC, and that there may not be a need for therapies to pursue remediation of this particular neurocognitive faculty.
    European Psychiatry 07/2013; 29(4). DOI:10.1016/j.eurpsy.2013.05.003 · 3.44 Impact Factor
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