Weight gain in anorexia nervosa does not ameliorate the faecal microbiota, branched chain fatty acid profiles and gastrointestinal complaints
Open accessAbstract
The gut microbiota not only influences host metabolism but can also affect brain function and behaviour through the microbiota-gut-brain axis. To explore the potential role of the intestinal microbiota in anorexia nervosa (AN), we comprehensively investigated the faecal microbiota and short-chain fatty acids in these patients before (n = 55) and after weight gain (n = 44) in comparison to normal-weight participants (NW, n = 55) along with dietary intake and gastrointestinal complaints. We show profound microbial perturbations in AN patients as compared to NW participants, with higher levels of mucin-degraders and members of Clostridium clusters I, XI and XVIII and reduced levels of the butyrate-producing Roseburia spp. Branched-chain fatty acid concentrations, being markers for protein fermentation, were elevated. Distinct perturbations in microbial community compositions were observed for individual restrictive and binge/purging AN-subtypes. Upon weight gain, microbial richness increased, however perturbations in intestinal microbiota and short chain fatty acid profiles in addition to several gastrointestinal symptoms did not recover. These insights provide new leads to modulate the intestinal microbiota in order to improve the outcomes of the standard therapy.
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Weight gain in anorexia nervosa does not result in change in gut microbial composition.
“In addition, amelioration of obesity by bariatric or Roux-en-Y gastric bypass surgery results in a change in gut microbial composition (Gralka et al., 2015;Tremaroli et al., 2015;Zhang et al., 2009), even though this is not the case for weight gain in anorexia nervosa (Mack et al., 2016).”
From The Microbiota-Gut-Brain Axis (2019) · cites this paper as Mack et al., 2016
The Results report that microbial richness increased significantly after weight gain, and the Discussion describes shifts in the relative abundance of several taxa. The paper says the microbiota did not converge with that of normal-weight participants—not that its composition did not change. (LLM, conf=0.90)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredConditions with dysregulated food intake, like anorexia nervosa and obesity, are associated with altered gut microbiota.
“This is supported by the fact that many conditions wherein food intake behavior is dysregulated, like anorexia nervosa and obesity (see Section XI J), are associated with an altered gut microbiota (Kleiman et al., 2015;Le Chatelier et al., 2013;Mack et al., 2016;Morita et al., 2015;Turnbaugh et al., 2008;Turnbaugh et al., 2006;Turnbaugh et al., 2009).”
From The Microbiota-Gut-Brain Axis (2019) · cites this paper as Mack et al., 2016
In an in-patient, medically supervised weight gain study in anorexic individuals, microbial richness increased, but perturbations in intestinal microbiota and SCFA profiles, as well as several gastrointestinal symptoms, did not recover during the in-patient stay.
“During an in-patient, medically supervised weight gain study in anorexic individuals, microbial richness increased, however perturbations in intestinal microbiota and SCFA profiles, in addition to several gastrointestinal symptoms, did not recover during the subject’s in-patient stay [169].”
From The athletic gut microbiota (2020) · cites this paper as [169]
Several studies of anorexia nervosa patients have reported decreased abundances of the butyrate-producing Roseburia, reduced butyrate levels, and lower microbial diversity and taxa abundance compared to healthy controls.
“Several studies of anorexia nervosa patients have reported decreased abundances of the butyrate producing Roseburia in combination with reduced butyrate levels and lower microbial diversity and taxa abundance compared to healthy controls [168–170].”
From The athletic gut microbiota (2020) · cites this paper as [169]
Literature on gut microbial profile in eating disorders is scarce, with only a handful of studies measuring gut microbial profile in patients with anorexia nervosa and no data available on other forms of eating disorders.
“Surprisingly though, literature on this area is scarce, with only a handful of studies measuring gut microbial profile in patients with AN [29,30,31,32] and no data are available on other forms of eating disorders.”
The abundance of the mucin-degrading taxa Verrucomicrobia is significantly increased in anorexia nervosa patients at baseline and returns to levels similar to healthy controls after weight gain.
“Following this notion, the abundance of the mucin-degrading taxa Verrucomicrobia was significantly increased in AN patients at baseline and returned to levels similar to that in healthy controls after weight gain [32].”
Mack et al. reported that the overall microbial structure was different between the two anorexia nervosa subtypes, but no specific species that drove this difference were identified, and they demonstrated a reduction in microbial diversity in those who reported using laxatives.
“Using constrained ordination techniques, Mack et al. [32] reported that the overall microbial structure (assessed using constrained ordination techniques) was different between the two AN subtypes, but no specific species that drove this difference were identified, and they further demonstrated a reduction in microbial diversity in those who reported using laxatives.”
In patients with anorexia nervosa following institutionalized nutritional rehabilitation programs, refeeding increases gut microbial diversity and shifts the composition towards, but remains significantly different from, that of healthy controls.
“There are some data on gut microbiota in patients with AN following institutionalized nutritional rehabilitation programs that suggest that refeeding increases gut microbial diversity and shifts the composition towards, but remains significantly different from that of healthy controls [30,32].”
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- Authors
- Mack, I., Cuntz, U., Grämer, C., Niedermaier, S., Pohl, C., Schwiertz, A., Zimmermann, K., Zipfel, S., Enck, P., & Penders, J.
- Affiliations
- Universitätsklinikum Tübingen (DE)
- Schön Klinik Roseneck (DE)
- Institut für Mikroökologie (DE)
- SymbioPharm (Germany) (DE)
- Maastricht University Medical Centre (NL)
- Corresponding author
- Mack, Isabelle
- ORCID
- Venue
- Scientific Reports
- Published
- 2016-05-27
- Volume
- 6
- Issue
- 1
- Pages
- 26752-26752
- ISSN
- 2045-2322 (ISSN-L)
- PMC
- PMC4882621
- OpenAlex
- W2395299385
- Cited by
- 313
- References
- 60
- Citations by year
- 2026: 17 · 2025: 28 · 2024: 27 · 2023: 39 · 2022: 37 · 2021: 47 · 2020: 38 · 2019: 41 · 2018: 19 · 2017: 15 · 2016: 3
- FWCI
- 13.51
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Scientific Reports (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- Deutsche Forschungsgemeinschaft
- Eberhard Karls Universität Tübingen
- Schweizerische Anorexia Nervosa Stiftung (32-13)
- Topics
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Gut microbiota and health
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Keywords
- anorexia nervosa, gut microbiota, fecal microbiota, weight gain, branched-chain fatty acids, short-chain fatty acids, microbiota-gut-brain axis, gastrointestinal problems, mucin-degrading bacteria, Clostridium, Roseburia, butyrate, restrictive anorexia nervosa, dietary intake
- MeSH terms
- Gastrointestinal Microbiome, Adolescent, Adult, Anorexia Nervosa, Diet, Eating, Fatty Acids, Volatile, Feces, Female, Gastrointestinal Diseases, Humans, Weight Gain, Young Adult
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