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The Intestinal Microbiota in Acute Anorexia Nervosa and During Renourishment: Relationship to Depression, Anxiety, and Eating Disorder Psychopathology
Open accessAbstract
OBJECTIVE: The relevance of the microbe-gut-brain axis to psychopathology is of interest in anorexia nervosa (AN), as the intestinal microbiota plays a critical role in metabolic function and weight regulation. METHODS: We characterized the composition and diversity of the intestinal microbiota in AN, using stool samples collected at inpatient admission (T1; n = 16) and discharge (T2; n = 10). At T1, participants completed the Beck Depression and Anxiety Inventories and the Eating Disorder Examination-Questionnaire. Patients with AN were compared with healthy individuals who participated in a previous study (healthy comparison group; HCG). Genomic DNA was isolated from stool samples, and bacterial composition was characterized by 454 pyrosequencing of the 16S rRNA gene. Sequencing results were processed by the Quantitative Insights Into Microbial Ecology pipeline. We compared T1 versus T2 samples, samples from both points were compared with HCG (n = 12), and associations between psychopathology and T1 samples were explored. RESULTS: In patients with AN, significant changes emerged between T1 and T2 in taxa abundance and beta (between-sample) diversity. Patients with AN had significantly lower alpha (within-sample) diversity than did HCG at both T1 (p = .0001) and T2 (p = .016), and differences in taxa abundance were found between AN patients and HCG. Levels of depression, anxiety, and eating disorder psychopathology at T1 were associated with composition and diversity of the intestinal microbiota. CONCLUSIONS: We provide evidence of an intestinal dysbiosis in AN and an association between mood and the enteric microbiota in this patient population. Future directions include mechanistic investigations of the microbe-gut-brain axis in animal models and association of microbial measures with metabolic changes and recovery indices.
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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 [170]
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 collective effect of chronic caloric deprivation in individuals with anorexia nervosa or malnourishment appears to be a reduction in the diversity of gut microbial communities that is often associated with poor clinical outcomes.
“The collective effect of chronic caloric deprivation in individuals who suffer from AN [30] or malnourishment [76] appears to be a reduction in the diversity of gut microbial communities that is often associated with poor clinical outcomes.”
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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References 85 · Cited by 303
Metadata
- Authors
- Kleiman, S. C., Watson, H. J., Bulik-Sullivan, E. C., Huh, E. Y., Tarantino, L. M., Bulik, C. M., & Carroll, I. M.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- Corresponding author
- Carroll, Ian M.
- Venue
- Psychosomatic Medicine
- Published
- 2015-11
- Volume
- 77
- Issue
- 9
- Pages
- 969-981
- ISSN
- 0033-3174 (ISSN-L)
- PMC
- PMC4643361
- OpenAlex
- W2311311994
- Cited by
- 303
- References
- 85
- Citations by year
- 2026: 17 · 2025: 24 · 2024: 20 · 2023: 35 · 2022: 31 · 2021: 42 · 2020: 39 · 2019: 38 · 2018: 23 · 2017: 17 · 2016: 15 · 2015: 2
- FWCI
- 8.25
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychosomatic Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- UWA Profiles and Research Repository (UWA) (submittedVersion)
- Funders
- National Institute of Mental Health (R01MH105684)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30 DK03498, K01DK092330, P30DK034987)
- 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, gut dysbiosis, depression, anxiety, eating disorder psychopathology, microbial diversity, bacterial community composition
- MeSH terms
- Firmicutes, Bacillota, Gastrointestinal Microbiome, Adolescent, Adult, Affect, Anorexia Nervosa, Anxiety, Body Composition, Convalescence, Depression, DNA, Bacterial, Feces, Feeding Behavior, Female, Humans, Lactobacillus, Surveys and Questionnaires, Case-Control Studies, Ribotyping, Methanobrevibacter, Bacteroidetes, Ruminococcus, Young Adult
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