Heart rate variability as a biomarker for anorexia nervosa: A review

Peyser, Deena; Scolnick, Barbara; Hildebrandt, Tom; Taylor, J. Andrew

doi:10.1002/erv.2791

Cited by 29 publications

(23 citation statements)

References 75 publications

(114 reference statements)

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“…The majority of studies that assessed HRV in the time domain demonstrated increased beat-to-beat variability in HR in individuals with a current diagnosis of AN, consistent with a recent review (Peyser et al, 2020 ). Moreover, increased time domain HRV parameters were demonstrated in patients with AN when compared to lean controls (Petretta et al, 1997 ; Galetta et al, 2003 ).…”

Section: Discussionsupporting

confidence: 80%

Autonomic Nervous System Function in Anorexia Nervosa: A Systematic Review

et al. 2021

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Background: Autonomic nervous system (ANS) dysfunction has been suggested to contribute to the high prevalence of cardiovascular complications in individuals with anorexia nervosa (AN), yet has not been thoroughly investigated. The current review aimed to synthesize the evidence of basal ANS function in individuals with a current diagnosis of AN and those with a previous diagnosis who had achieved weight restoration, as compared to controls.Methods: A systematic review of nine databases was conducted and studies that were published in a peer-review journal, in English, that included at least one assessment of ANS function in individuals with a current or previous diagnosis of AN were selected. Forty-six studies were included with a total of 811 participants with a current diagnosis of AN and 123 participants with a previous diagnosis of AN.Results: ANS function was assessed through heart rate variability (n = 27), orthostatic challenge, blood pressure variability or baroreflex sensitivity (n = 11), adrenergic activity (n = 14), skin conductance level (n = 4), and pupillometry (n = 1). Individuals with AN demonstrated increased parasympathetic activity and decreased sympathetic activity, suggestive of autonomic dysregulation. Following weight restoration, autonomic function trended toward, or was equivalent to, control levels.Discussion: Autonomic dysregulation is indicated through a range of assessments in individuals with AN. Future investigations should utilize a variety of assessments together in order to conclusively establish the nature of autonomic dysfunction in AN, and following extended weight restoration. Moreover, investigation into the co-occurrence of ANS function and cardiovascular risk is required.

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Section: Discussionsupporting

confidence: 80%

Autonomic Nervous System Function in Anorexia Nervosa: A Systematic Review

et al. 2021

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“…Although Lechin et al described increased adrenal sympathetic activity in patients with AN, they typically present with bradycardia, hypotension, increased HRV, and domination of parasympathetic modulation (increased SDNN and HF) [ 40 , 41 ]. In ABA rats, we observed a relatively increased sympathovagal ratio, but such interpretation based solely on several variables needs to be made cautiously.…”

Section: Discussionmentioning

confidence: 99%

Is the Activity-Based Anorexia Model a Reliable Method of Presenting Peripheral Clinical Features of Anorexia Nervosa?

et al. 2021

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Anorexia nervosa (AN) causes the highest number of deaths among all psychiatric disorders. Reduction in food intake and hyperactivity/increased anxiety observed in AN are also the core features of the activity-based anorexia animal model (ABA). Our aim was to assess how the acute ABA protocol mimics common AN complications, including gonadal and cardiovascular dysfunctions, depending on gender, age, and initial body weight, to form a comprehensive description of ABA as a reliable research tool. Wheel running, body weight, and food intake of adolescent female and male rats were monitored. Electrocardiography, heart rate variability, systolic blood pressure, and magnetic resonance imaging (MRI) measurements were performed. Immediately after euthanasia, tissue fragments and blood were collected for further analysis. Uterine weight was 2 times lower in ABA female rats, and ovarian tissue exhibited a reduced number of antral follicles and decreased expression of estrogen and progesterone receptors. Cardiovascular measurements revealed autonomic decompensation with prolongation of QRS complex and QT interval. The ABA model is a reliable research tool for presenting the breakdown of adaptation mechanisms observed in severe AN. Cardiac and hormonal features of ABA with underlying altered neuroendocrine pathways create a valid phenotype of a human disease.

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“…Generally, the higher the HRV, the greater the parasympathetic activation compared to sympathetic activation. Patients with AN have markedly and consistently elevated HRV compared to controls and young athletes, thus supporting the role of reduced SNS activity in AN (Peyser et al, 2021). Pirke (1996) has suggested that the clinical consequences of reduced SNS activity include hypothermia, hypotension, and bradycardia, as well as reduced peripheral perfusion, all factors evident in ANs (Freyschuss et al, 1978;Luck and Wakeling, 1981).…”

Section: Reduced Vasoconstrictionmentioning

confidence: 93%

The Central Role of Hypothermia and Hyperactivity in Anorexia Nervosa: A Hypothesis

Smith

2021

Front. Behav. Neurosci.

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Typically, the development of anorexia nervosa (AN) is attributed to psycho-social causes. Several researchers have recently challenged this view and suggested that hypothermia and hyperactivity (HyAc) are central to AN. The following hypothesis will attempt to clarify their role in AN. Anorexia nervosa patients (ANs) have significantly lower core temperatures (Tcore) compared to healthy controls (HCs). This reduced temperature represents a reset Tcore that needs to be maintained. However, ANs cannot maintain this Tcore due primarily to a reduced basal metabolic rate (BMR); BMR usually supplies heat to sustain Tcore. Therefore, to generate the requisite heat, ANs revert to the behavioral-thermoregulatory strategy of HyAc. The majority of ANs (~89%) are reportedly HyAc. Surprisingly, engagement in HyAc is not motivated by a conscious awareness of low Tcore, but rather by the innocuous sensation of “cold- hands” frequently reported by ANs. That is, local hand-thermoreceptors signal the brain to initiate HyAc, which boosts perfusion of the hands and alters the sensation of “cold-discomfort” to one of “comfort.” This “rewarding” consequence encourages repetition/habit formation. Simultaneously, hyperactivity increases the availability of heat to assist with the preservation of Tcore. Additionally, HyAc induces the synthesis of specific brain neuromodulators that suppress food intake and further promote HyAc; this outcome helps preserve low weight and perpetuates this vicious cycle. Based on this hypothesis and supported by rodent research, external heat availability should reduce the compulsion to be HyAc to thermoregulate. A reduction in HyAc should decrease the production of brain neuromodulators that suppress appetite. If verified, hopefully, this hypothesis will assist with the development of novel treatments to aid in the resolution of this intractable condition.

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Heart rate variability as a biomarker for anorexia nervosa: A review

Cited by 29 publications

References 75 publications

Autonomic Nervous System Function in Anorexia Nervosa: A Systematic Review

Autonomic Nervous System Function in Anorexia Nervosa: A Systematic Review

Is the Activity-Based Anorexia Model a Reliable Method of Presenting Peripheral Clinical Features of Anorexia Nervosa?

The Central Role of Hypothermia and Hyperactivity in Anorexia Nervosa: A Hypothesis

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