Preliminary examination of insulin and amylin levels in women with purging disorder

Abstract

Objective: This preliminary study explored whether differences in meal-stimulated insulin or amylin release are linked to altered ingestive behaviors in individuals with bulimia nervosa (BN) or purging disorder (PD).Method: Women with BN (n = 15), PD (n = 16), or no eating disorder (n = 18) underwent structured clinical interviews and assessments of gut hormone and subjective responses to a fixed test meal. Multilevel model analyses were used to explore whether gut hormone responses contribute to subjective responses to the test meal and whether these associations differed by group.Results: Insulin and amylin levels significantly increased following the test meal.Women with PD showed greater insulin release compared to those with BN, but not controls. Multilevel models support significant group X insulin interactions predicting subjective ratings of nausea and urge to vomit, with a stronger association between higher insulin responses and higher nausea and urge to vomit in women with PD and BN. Amylin responses did not differ by group.Conclusion: Increased sensitivity to the effects of insulin on nausea and urge to vomit may be linked to purging in both PD and BN. Differences in postprandial insulin levels may be linked to purging behavior in the absence versus presence of binge eating. K E Y W O R D Samylin, bulimia nervosa, insulin, purging disorder, self-induced vomiting

Disentangling the links between gastric emptying and binge eating v. purging in eating disorders using a case-control design

“…In addition, delayed gastric emptying was associated with greater postprandial gastrointestinal distress, suggesting that a mechanical disruption in the digestive process may contribute to urges to self-induce vomiting. Combined with prior findings of significantly greater postprandial release of PYY and insulin (Keel et al, 2018a ; Maske et al, 2020 ), findings shed further light on factors that may contribute to the development or maintenance of the core feature of PD. Such information is critical to identifying novel treatment targets.…”

“…Data from participants in the current study were included in prior analyses to examine whether postprandial peptide YY (PYY) and ghrelin responses contributed to differences in subjective responses to a fixed test meal (Keel et al, 2018a ) and whether a behavioral measure of satiation using an ad lib meal confirmed self-reported responses to a fixed meal (Keel et al, 2018b ). Data from these participants were also included in secondary analyses unrelated to the aims of the parent project (Davis, Smith, & Keel, 2020 ; Forney, Crosby, Brown, Klein, & Keel, 2021 ; Keel, Bodell, Haedt-Matt, Williams, & Appelbaum, 2017 ; Maske, Williams, & Keel, 2020 ). This is the first report of gastric emptying and of responses to the fixed meal in the medicated condition from this sample.…”

Evaluating the predictive validity of purging disorder by comparison to bulimia nervosa at long‐term follow‐up

“…In addition, purging disorder requires recurrent purging whereas bulimia nervosa may include non-purging compensatory behaviors, such as fasting or excessive exercise. Concurrent data support purging disorder as distinct from bulimia nervosa on indicators of comorbidity (Keel et al, 2005(Keel et al, , 2007(Keel et al, , 2008Koch et al, 2013;Smith et al, 2017) and subjective and physiological response to eating (Dossat et al, 2015;Keel et al, 2007Keel et al, , 2018Keel et al, , 2021Maske et al, 2020). The inclusion of purging disorder as an other specified feeding or eating disorder (OSFED) in DSM-5 reflected limited information regarding the clinical utility of identifying purging disorder as a full-threshold DSM-5 eating disorder that is distinct from established DSM-5 eating disorders.…”