Intestinal permeability is decreased in anorexia nervosa

Abstract

Malnutrition and absence of exogenous luminal nutrients in the gastrointestinal tract affect intestinal permeability (IP) leading to an increased penetration of substances that passively cross intestinal epithelium via intercellular pathways. We hypothesised that an increase in IP could occur in patients with anorexia nervosa because of their prolonged fasting and chronic malnutrition. Therefore, we assessed IP in 14 drug-free anorexic women and 19 drug-free agematched healthy women by means of the lactulose/mannitol (LA/MA) test. To this purpose, after an overnight fast, subjects ingested an oral solution containing 5 g lactulose and 2 g mannitol in 100 ml water. Urine specimens were collected immediately before and 30, 60, 120, 180, 240 and 300 min after the ingestion of the sugar solution. Urinary lactulose and mannitol were determined by high-performance anion exchange chromatography coupled with pulsed amperometric detection. We found that IP, as expressed by the 5-h LA/MA excretion ratio, was significantly decreased in anorexic women because of a lower urinary recovery of lactulose. Moreover, in patients, the time course of lactulose excretion significantly differs from healthy controls. These results do not confirm our hypothesis of increased IP in anorexia nervosa. Since IP reflects the anatomo-functional status of intestinal mucosa, the present findings support the idea that changes in the anatomo-physiology of intestinal mucosa occur in anorexia nervosa.

Increased intestinal permeability in malnourished patients with liver cirrhosis

“…One study in anorexia nervosa reported decreased permeability, and similarly in animal models, hypocaloric feeding had little or no effect on intestinal structure. 35 These findings indicate adaptation to long-term caloric restriction.…”

Alterations of gut barrier and gut microbiota in food restriction, food deprivation and protein-energy wasting

“…Interestingly, they also demonstrated that 300 kcal in severely obese subjects were sufficient to maintain mannitol absorption [44]. Surprisingly, in anorexia nervosa, which could be compared to a state of chronic calorie restriction, the L:M ratio was not increased compared to controls [45]. The authors found a significant reduction of urinary lactulose excretion and a non-significant decrease of urinary mannitol excretion.…”

The Role of “Mixed” Orexigenic and Anorexigenic Signals and Autoantibodies Reacting with Appetite-Regulating Neuropeptides and Peptides of the Adipose Tissue-Gut-Brain Axis: Relevance to Food Intake and Nutritional Status in Patients with Anorexia Nervosa and Bulimia Nervosa

“…Interestingly, the negative correlations were found between plasma autoantibodies and ghrelin peptides, and the decrease of bioavailable ghrelin autoantibodies may underlie an increase of plasma ghrelin levels and the resulting phenomenon of ghrelin resistance in patients with AN [48]. Indeed, starvation-induced changes decreased gut-barrier permeability [102] and may decrease ghrelin autoantibodies (IgM, IgG, and IgA classes) in AN. However, Terashi et al [48] found that refeeding in AN patients was accompanied by an increase of acylated ghrelin autoantibodies (IgM class), which may indicate new antigenic stimulation leading to realimentation-induced changes in the gut-barrier permeability in AN patients (Table 1, Figure 2).…”