Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity最新文献

Purpose: Glucagon-like peptide-1 (GLP-1) receptor agonists have shown potential in managing eating disorders (EDs). Recent studies highlight their effects on pathophysiological pathways, indicating their therapeutic promise, particularly for binge eating disorder (BED). This systematic review evaluates the therapeutic effects of GLP-1 agonists on BED, focusing on weight management and eating behaviors.

Methods: A systematic search of PubMed, Scopus, Web of Science, and the Cochrane Library, along with manual searches, identified studies assessing GLP-1 agonists in BED patients up to November 8, 2024. Observational studies and clinical trials meeting inclusion criteria were analyzed.

Results: Five studies (182 participants) were included. Patients receiving GLP-1 agonists experienced greater weight loss (- 3.81 kg; 95% CI - 5.14 to - 2.49; p < 0.01, I²: 59.88%) compared to controls. GLP-1 agonists significantly reduced BMI (- 1.48 kg/m²) and waist circumference (- 3.14 cm). Binge Eating Scale (BES) scores improved significantly (- 8.14 points; 95% CI - 13.13 to - 3.15; p < 0.01), though heterogeneity was noted.

Conclusions: This review underscores the potential role of GLP-1 agonists in BED management. However, given the limited data, especially concerning EDs other than BED and the long-term effects of these medications, further comprehensive clinical trials are recommended to evaluate the impact of various GLP-1 agonists on different EDs across diverse demographic groups.

Level of evidence: Level I, randomized controlled trials.

Eating disorders (EDs) pose significant challenges to mental and physical health, particularly among adolescents and young adults, with the COVID-19 pandemic exacerbating risk factors. Despite advancements in psychosocial and pharmacological treatments, improvements remain limited. Early intervention in EDs, inspired by the model developed for psychosis, emphasizes the importance of timely identification and treatment initiation to improve prognosis. Challenges in identifying prodromal phases and measuring the duration of untreated illness highlight the complexity of early intervention efforts in EDs. Current research focuses on reducing the duration of untreated eating disorder (DUED) and understanding the cognitive and behavioral symptoms preceding ED onset. However, current early intervention programs for EDs showed mixed results, necessitating further investigation. We introduce here the chronopathogram, a tool that may aid in precisely investigating the role of development in EDs. A chronopathogram is a graphical representation of pathological events as they unfold over time. Understanding the neurodevelopmental aspects of EDs and utilizing tools like the chronopathogram can aid in tracking the unfolding of symptoms over time, facilitating early detection and intervention efforts. Overall, addressing the key factors influencing the onset and course of EDs is essential for effective early intervention in these conditions.Level of evidence: Level V narrative review.

Background: Bulimia nervosa (BN) is a serious mental illness with impulsivity as a cardinal symptom. Impulsivity contributes to various other, often comorbid, mental disorders, such as attention deficit/hyperactivity disorder (ADHD) and borderline personality disorder (BPD). The aim of this study was to explore comorbidities of BN with ADHD and BPD as well as the contribution of impulsivity as an underlying trait linking these disorders.

Methods: Hundred and fifteen females with BN and 98 healthy matched controls (HC) (age range between 16 and 48 years) were assessed regarding adult and childhood-ADHD, personality disorders and impulsivity.

Results: Patients with BN were more impulsive (p < 0.001) and more often fulfilled criteria of childhood/adulthood ADHD (p < 0.001) than HC, and criteria of BPD than expected in the general population. Childhood-ADHD (p = 0.009) and BPD (p = 0.017) both were significant positive predictors for impulsivity scores found in patients with BN.

Conclusion: Comorbidity with ADHD and BPD often is prevalent in BN and associated with an increase in impulsivity, the latter being a relevant transdiagnostic trait. It might be beneficial to explore impulsivity as well as comorbidities in the clinical care of patients with BN.

Level of evidence iii: Evidence obtained from well-designed cohort or case-control analytic studies.

Purpose: This study aimed to explore emotional functioning in individuals with varying levels of orthorexia nervosa (ON) symptoms. Given the established links between emotion dysregulation and other eating disorders (EDs), and the conceptualization of ON within the ED spectrum, this research sought to examine the relationships between ON symptomatology and emotion regulation strategies, alexithymia, and beliefs about emotions.

Methods: A large sample (N = 562) completed self-report measures with high psychometric properties, assessing ON traits (E-DOS), emotion regulation strategies (DERS-SF and ERQ), alexithymia (TAS-20), and beliefs about emotions (ERQ). The study used well-validated measures to address limitations of previous research.

Results: Individuals with high ON traits demonstrated difficulties in most aspects of emotional functioning compared to those with low ON traits. Suppression, but not reappraisal, partially mediated the relationship between beliefs about emotions and ON symptoms. Believing emotions are bad or useless, difficulty controlling impulses, and relying on suppression to regulate emotions were most strongly associated with ON symptoms.

Conclusion: This study provides evidence that emotion dysregulation plays an important role in ON symptomatology. The findings suggest that when emotions feel unhelpful or uncontrollable, and maladaptive strategies like suppression are employed, individuals may seek perceived control through pathologically 'healthy' eating. There is currently no diagnosis criteria for ON, and consequently no clear treatment pathway. Our research suggests that specific aspects of emotional functioning such as beliefs about the usefulness of emotions or difficulties with feeling out of control when upset may be a useful treatment target to help individuals with ON develop healthier coping mechanisms and reduce reliance on rigid dietary rules as a means of emotional regulation.

Level of evidence:

Level iii: Evidence obtained from well-designed cohort or case-control analytic studies.

Purpose: Obesity is a complex heterogeneous disease often associated with dysfunctional eating behavior patterns. Oxytocin (OT) is a neurohormone involved in the regulation of energy metabolism and eating behavior. The aim of the present study was to evaluate in a population of patients with obesity circulating levels of OT and dysfunctional eating behaviors in relation to anthropometric, hormonal and metabolic parameters.

Methods: A prospective, observational, single-center study was conducted at the Center of High Specialization for the Care of Obesity of Sapienza University of Rome. Adult subjects with body mass index (BMI) ≥ 30 kg/m2 were recruited. Body impedance assessment (BIA), biochemical and hormonal parameters, plasma OT concentration analysis and the Eating Behaviors Assessment for Obesity (EBA-O) questionnaire were evaluated.

Results: A total of 21 patients, 16 females and 5 males, with a mean age of 45.7 ± 15.1 years, mean BMI of 40.89 ± 8.02 kg/m² and plasma OT concentration of 1365.61 ± 438.03 pg/mL were recruited. The dysfunctional eating behavior traits investigated by the EBA-O appear significantly associated with metabolic derangements. In particular, night eating is associated with alterations in lipid metabolism (p < 0.01). Circulating OT correlates positively with BMI (r = 0,43; p < 0.05), and Hepatic Steatosis Index (HIS) (r = 0.46; p < 0.05), while its role in subjects with obesity and alterations in glucose metabolism is less clear. Interestingly, circulating OT levels < 1312.55 pg/mL may be predictive of food addiction (100% sensitivity; 62.5% specificity).

Conclusions: Despite the need for larger studies to confirm their validity, the clinical utility of the EBA-O and circulating OT in identifying dysfunctional eating behaviors appears promising.

Purpose: There is a consistent link between perfectionism and compulsive exercise, and both are implicated in the maintenance of eating disorders, however no meta-analysis to date has quantified this relationship. We hypothesised that there would be significant, small-moderate pooled correlations between perfectionism dimensions and compulsive exercise.

Methods: Published, peer-reviewed articles with standardised measures of perfectionism and the Compulsive Exercise Test were included. There were 7 studies included (N = 3117 participants, M age = 21.78 years, 49% female).

Results: Total perfectionism (r = 0.37), perfectionistic strivings (r = 0.33), and perfectionistic concerns (r = 0.32) had significant pooled positive associations with compulsive exercise. Most studies (67%) were rated as fair or good quality as an indication of risk of bias. Limitations included the low number of available studies, the inclusion of only one clinical sample, and predominately cross-sectional studies which precluded causal inference.

Conclusion: Higher perfectionism was associated with higher compulsive exercise. More research is needed on compulsive exercise to determine the best intervention approach given its relationship to perfectionism and relevance in the context of eating disorders.

Level of evidence: Level I: Evidence obtained from a systematic review and meta-analysis.

Purpose: Transcranial magnetic stimulation (TMS) has emerged as a promising treatment for various neuropsychiatric conditions, including depression, obsessive-compulsive disorder, and Parkinson's disease. Recent research has focused on evaluating its effectiveness in treating patients with anorexia nervosa (AN). This systematic review and meta-analysis examined the impact of TMS on patients with AN and evaluated any potential adverse effects.

Methods: We conducted search according to PRISMA guidelines and comprehensively analyzed data from multiple databases, including Pubmed, Scopus, Embase, Web of Science, and the Cochrane Library, up to September 13th. Statistical analysis utilized the Comprehensive Meta-analysis software version 3.0.

Results: The systematic review encompassed 17 studies, with nine undergoing meta-analyses. The primary target for TMS was the dorsolateral prefrontal cortex, with two studies targeting the dorsomedial prefrontal cortex, one targeting the insula and one targeting the inferior parietal lobe. The findings revealed a significant increase in body mass index (BMI) following TMS (SMD: -0.025, 95% CI: -0.0505 to -0.005, P-value = 0.045). Additionally, the Eating Disorder Examination Questionnaire (EDE-Q) score was quantitatively reported in six studies, which permitted its inclusion in the meta-analysis. The analysis exhibited a significant decrease in EDE-Q score after TMS (SMD: 0.634, 95% CI: 0.349-0.919, P-value < 0.001). Subgroup analysis based on TMS session duration indicated that the effect size of TMS on EDE-Q score is more pronounced when the session duration exceeds 20 min.

Conclusion: TMS represents an effective therapy for patients with AN, leading to improvements in both BMI and core symptoms of AN, with minor and transient side effects.

Level of evidence: Level I, systematic reviews and meta-analyses.

Objective: This systematic review explores the intricate relationship between body composition, with a specific focus on skeletal muscle mass, and vascular health indices, including measures of arterial stiffness-pulse wave velocity (PWV) and cardio-ankle vascular index (CAVI)-as well as arterial structure, specifically carotid artery intima-media thickness (cIMT).

Methods: An extensive literature search, encompassing PubMed, Scopus, EMBASE, Web of Science, and Google Scholar, was conducted until January 2024. Inclusion criteria involved original observational studies, with cross-sectional or longitudinal designs, reporting body composition parameters and vascular health measures. The Newcastle-Ottawa Scale (NOS) assessed study quality. Statistical analyses utilized Stata 17.0, employing random-effects meta-analysis, sensitivity analysis, and evaluation of publication bias.

Results: Fifteen observational studies (n = 21,215) met the inclusion criteria. Pooled analyses revealed a positive association between fat-free mass (FFM) and carotid intima-media thickness (IMT) (effect size [ES]: 1.79, 95% CI 1.68-1.91), highlighting a relationship with arterial structure. Similarly, body fat percentage (BFP) was positively associated with PWV (ES: 1.45, 95% CI 1.15-1.82), and FFM showed a positive association with CAVI (ES: 1.46, 95% CI 0.78-2.71), both measures of arterial stiffness. Subgroup analyses revealed a non-significant association between appendicular skeletal muscle (ASM) and IMT (ES: 1.01, 95% CI 0.76-1.35).

Conclusion: This meta-analysis highlights the complex relationship between body composition and vascular health. Subgroup analyses suggest the need for further research into specific body composition indices and their clinical implications.

Level of evidence: III evidence obtained from well-designed cohort and cross-sectional studies.

Purpose: To report data on the real-world effectiveness and safety of injectable (IS) and oral (OS) therapies in obese or overweight diabetes (T2DM) patients on glycometabolic control, weight loss (WL) and weight maintenance after the use of semaglutide.

Methods: 175 subjects with obesity or overweight and T2DM were retrospectively assessed. Of these, 129 (75F, 54 M; mean age 61.2 ± 9.8 years) patients were treated with IS and 46 (24F, 22 M; mean age 65.7 ± 12.8 years) with OS for T2DM and WL. At baseline, mean weight (mW) was 101.8 ± 24.6 kg and 95.2 ± 15.0 kg; mean body mass index (mBMI) was 36.7 ± 8.7 kg/m² and 34.3 ± 5.3 kg/m².

Results: After 6 months, in the IS group, 127 patients had a mW and mBMI reduction of - 10.4 ± 8.1 kg and - 3.9 ± 3.0 kg/m². 46 patients in the OS group had a mW and mBMI reduction of - 6.7 ± 5.3 kg and - 2.6 ± 2.1 kg/m². After 12 months, 102 patients in the IS group achieved a mW and mBMI reduction of - 9.3 ± 7.5 kg and - 3.4 ± 2.6 kg/m². 44 patients in the OS group of treatment had a mW and mBMI reduction of - 10.7 ± 6.5 kg and - 3.9 ± 2.4 kg/m². After 24 months, 92 patients in the IS group of therapy achieved a mW and mBMI reduction of - 15.9 ± 11.4 kg and - 5.8 ± 3.7 kg/m². There was a mean percentage reduction of glycated hemoglobin (HBA1C) of - 1.9 ± 1.4%, - 1.5 ± 1.9%, and - 1.5 ± 1.7% after 6, 12 and 24 months in the IS group. In the OS group there was a mean reduction of - 1.5 ± 1.6% after 6 months and of - 0.8 ± 0.6% after 12 months of therapy.

Conclusions: Semaglutide induces WL maintenance after 12 and 24 months of treatment. Our results show a comparable effectiveness of IS and OS in T2DM patients with obesity or overweight. IS and OS treatment provide significant WL that allows reaching the glycometabolic therapeutic goal in a short time. Level of Evidence Level II.

Purpose: The weight-adjusted waist index (WWI) is a novel anthropometric measure. WWI is linked to reduced muscle mass and strength; however, its efficacy for assessing sarcopenia and predicting adverse outcomes has yet to be validated. This study compared and examined the relationship between sarcopenia and WWI across different diagnostic criteria and aimed to evaluate its potential as a predictor of sarcopenia and all-cause mortality.

Methods: This study used data from 2946 NHANES (1999-2002) participants to analyze the relationship between weight-adjusted waist index (WWI) and sarcopenia (diagnosed using five different established criteria). Multivariable logistic regression, ROC analysis, Kaplan-Meier curves, and Cox regression were used to assess the association between WWI and sarcopenia and mortality.

Results: WWI was inversely correlated with walking speed, muscle strength, and muscle mass. It served as a significant predictor of sarcopenia, particularly in men, with an area under the ROC curve (AUC) of 0.86 for men according to FNIH criteria. Furthermore, a higher mortality rate from all causes was linked to a higher WWI. The mortality rate among patients with sarcopenia, as predicted by the WWI and FNIH criteria, was higher than that of patients diagnosed by a single criterion.

Conclusions: WWI proves to be a valuable tool in predicting sarcopenia and mortality risk, particularly when using the FNIH criteria. However, its performance varied significantly across different criteria and populations. Further research is needed to define the specific clinical contexts where WWI may be a useful supplementary tool. Level of Evidence Level III, evidence obtained from a cohort analytic study.