Brain Structure in Acutely Underweight and Partially Weight-Restored Individuals With Anorexia Nervosa: A Coordinated Analysis by the ENIGMA Eating Disorders Working Group

Esther Walton; Fabio Bernardoni; Victoria-Luise Batury; Klaas Bahnsen; Sara Larivière; Giovanni Abbate-Daga; Susana Andres-Perpiña; Lasse Bang; Amanda Bischoff-Grethe; Samantha J Brooks; Iain C Campbell; Giammarco Cascino; Josefina Castro-Fornieles; Enrico Collantoni; Federico D'Agata; Brigitte Dahmen; Unna N Danner; Angela Favaro; Jamie D Feusner; Guido K W Frank; Hans-Christoph Friederich; John L Graner; Beate Herpertz-Dahlmann; Andreas Hess; Stefanie Horndasch; Allan S Kaplan; Lisa-Katrin Kaufmann; Walter H Kaye; Sahib S Khalsa; Kevin S LaBar; Luca Lavagnino; Luisa Lazaro; Renzo Manara; Amy E Miles; Gabriella F Milos; Alessio Maria Monteleone; Palmiero Monteleone; Benson Mwangi; Owen O'Daly; Jose Pariente; Julie Roesch; Ulrike H Schmidt; Jochen Seitz; Megan E Shott; Joe J Simon; Paul A M Smeets; Christian K Tamnes; Elena Tenconi; Sophia I Thomopoulos; Annemarie A van Elburg; Aristotle N Voineskos; Georg G von Polier; Christina E Wierenga; Nancy L Zucker; Neda Jahanshad; Joseph A King; Paul M Thompson; Laura A Berner; Stefan Ehrlich

doi:10.1016/j.biopsych.2022.04.022

Brain Structure in Acutely Underweight and Partially Weight-Restored Individuals With Anorexia Nervosa: A Coordinated Analysis by the ENIGMA Eating Disorders Working Group

Biol Psychiatry. 2022 Nov 1;92(9):730-738. doi: 10.1016/j.biopsych.2022.04.022. Epub 2022 May 31.

Authors

Esther Walton¹, Fabio Bernardoni², Victoria-Luise Batury², Klaas Bahnsen², Sara Larivière³, Giovanni Abbate-Daga⁴, Susana Andres-Perpiña⁵, Lasse Bang⁶, Amanda Bischoff-Grethe⁷, Samantha J Brooks⁸, Iain C Campbell⁹, Giammarco Cascino¹⁰, Josefina Castro-Fornieles⁵, Enrico Collantoni¹¹, Federico D'Agata¹², Brigitte Dahmen¹³, Unna N Danner¹⁴, Angela Favaro¹⁵, Jamie D Feusner¹⁶, Guido K W Frank⁷, Hans-Christoph Friederich¹⁷, John L Graner¹⁸, Beate Herpertz-Dahlmann¹³, Andreas Hess¹⁹, Stefanie Horndasch²⁰, Allan S Kaplan²¹, Lisa-Katrin Kaufmann²², Walter H Kaye⁷, Sahib S Khalsa²³, Kevin S LaBar¹⁸, Luca Lavagnino²⁴, Luisa Lazaro⁵, Renzo Manara¹¹, Amy E Miles²¹, Gabriella F Milos²⁵, Alessio Maria Monteleone²⁶, Palmiero Monteleone¹⁰, Benson Mwangi²⁴, Owen O'Daly²⁷, Jose Pariente²⁸, Julie Roesch²⁹, Ulrike H Schmidt⁹, Jochen Seitz¹³, Megan E Shott⁷, Joe J Simon¹⁷, Paul A M Smeets³⁰, Christian K Tamnes³¹, Elena Tenconi¹⁵, Sophia I Thomopoulos³², Annemarie A van Elburg¹⁴, Aristotle N Voineskos³³, Georg G von Polier³⁴, Christina E Wierenga⁷, Nancy L Zucker³⁵, Neda Jahanshad³², Joseph A King², Paul M Thompson³², Laura A Berner³⁶, Stefan Ehrlich³⁷

Affiliations

¹ Department of Psychology, University of Bath, Bath, United Kingdom.
² Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
³ Multimodal Imaging and Connectome Analysis Laboratory, McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital, McGill University, Montreal, Quebec.
⁴ Eating Disorders Center for Treatment and Research, University of Turin, Turin, Italy.
⁵ Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Centro de Investigación Biomédica en Red de Salud Mental, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain.
⁶ Norwegian Institute of Public Health, Oslo; Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
⁷ Department of Psychiatry, University of California San Diego, La Jolla, California; Eating Disorders Center for Treatment and Research, University of California San Diego, La Jolla, California.
⁸ School of Psychology, Faculty of Health Sciences, Liverpool John Moores University, Liverpool, United Kingdom; Department of Neuroscience, Uppsala University, Sweden.
⁹ Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Eating Disorders Unit, Department of Psychological Medicine, King's College London, London, United Kingdom.
¹⁰ Section of Neurosciences, Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Salerno, Italy.
¹¹ Department of Neuroscience, University of Padova, Padova, Italy.
¹² Department of Neuroscience, University of Turin, Turin, Italy.
¹³ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany.
¹⁴ Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, the Netherlands; Faculty of Social Sciences, Utrecht University, Utrecht, the Netherlands.
¹⁵ Department of Neuroscience, University of Padova, Padova, Italy; Padova Neuroscience Center, University of Padova, Padova, Italy.
¹⁶ Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, California.
¹⁷ Centre for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany.
¹⁸ Center for Cognitive Neuroscience, Duke University, Durham, North Carolina.
¹⁹ Institute for Pharmacology and Toxicology, University Erlangen-Nuremberg, Erlangen, Germany.
²⁰ Department of Child and Adolescent Psychiatry, University Clinic Erlangen, Erlangen, Germany.
²¹ Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
²² Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich; Division of Neuropsychology, Department of Psychology, University of Zurich, Zurich, Switzerland.
²³ Laureate Institute for Brain Research, University of Tulsa, Tulsa, Oklahoma; Oxley College of Health Sciences, University of Tulsa, Tulsa, Oklahoma.
²⁴ Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences, McGovern Medical School, University of Texas Health Science Center at Houston, Houston Texas.
²⁵ Department of Consultation-Liaison Psychiatry and Psychosomatics, University Hospital Zurich, University of Zurich.
²⁶ Department of Psychiatry, University of Campania L. Vanvitelli, Naples, Italy.
²⁷ Centre for Neuroimaging Studies, King's College London, London, United Kingdom; Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.
²⁸ Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain.
²⁹ Department of Neuroradiology, University Clinic Erlangen, Erlangen, Germany.
³⁰ UMC Utrecht Brain Center, Utrecht University, Utrecht, the Netherlands; Division of Human Nutrition and Health, Wageningen University, Wageningen, the Netherlands.
³¹ Norwegian Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.
³² Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey, California.
³³ Campbell Family Mental Health Research Institute, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
³⁴ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Rheinisch-Westfälische Technische Hochschule Aachen, Aachen, Germany; Institute for Neuroscience and Medicine: Brain and Behaviour, Forschungszentrum Jülich, Jülich, Germany; Department of Child and Adolescent Psychiatry, University Hospital Frankfurt, Goethe University, Frankfurt, Germany.
³⁵ Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
³⁶ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.
³⁷ Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Eating Disorders Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany. Electronic address: transden.lab@uniklinikum-dresden.de.

PMID: 36031441
DOI: 10.1016/j.biopsych.2022.04.022

Abstract

Background: The pattern of structural brain abnormalities in anorexia nervosa (AN) is still not well understood. While several studies report substantial deficits in gray matter volume and cortical thickness in acutely underweight patients, others find no differences, or even increases in patients compared with healthy control subjects. Recent weight regain before scanning may explain some of this heterogeneity. To clarify the extent, magnitude, and dependencies of gray matter changes in AN, we conducted a prospective, coordinated meta-analysis of multicenter neuroimaging data.

Methods: We analyzed T1-weighted structural magnetic resonance imaging scans assessed with standardized methods from 685 female patients with AN and 963 female healthy control subjects across 22 sites worldwide. In addition to a case-control comparison, we conducted a 3-group analysis comparing healthy control subjects with acutely underweight AN patients (n = 466) and partially weight-restored patients in treatment (n = 251).

Results: In AN, reductions in cortical thickness, subcortical volumes, and, to a lesser extent, cortical surface area were sizable (Cohen's d up to 0.95), widespread, and colocalized with hub regions. Highlighting the effects of undernutrition, these deficits were associated with lower body mass index in the AN sample and were less pronounced in partially weight-restored patients.

Conclusions: The effect sizes observed for cortical thickness deficits in acute AN are the largest of any psychiatric disorder investigated in the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) Consortium to date. These results confirm the importance of considering weight loss and renutrition in biomedical research on AN and underscore the importance of treatment engagement to prevent potentially long-lasting structural brain changes in this population.

Keywords: BMI; Cortical thickness; MRI; Subcortical volume; Surface area.

Publication types

Meta-Analysis
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Anorexia Nervosa* / diagnostic imaging
Anorexia Nervosa* / therapy
Brain / diagnostic imaging
Cerebral Cortex / diagnostic imaging
Female
Humans
Magnetic Resonance Imaging / methods
Multicenter Studies as Topic
Prospective Studies
Thinness

Abstract

Publication types

MeSH terms

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