Reproducible changes in the anorexia nervosa gut microbiota following inpatient therapy remain distinct from non-eating disorder controls

Abstract

The composition of the gut microbiota in patients with anorexia nervosa (AN), and the ability of this microbial community to influence the host, remains uncertain. To achieve a broader understanding of the role of the intestinal microbiota in patients with AN, we collected fecal samples before and following clinical treatment at two geographically distinct eating disorder units (Center of Excellence for Eating Disorders [UNC-CH] and ACUTE Center for Eating Disorders [Denver Health]). Gut microbiotas were characterized in patients with AN, before and after inpatient treatment, and in non-eating disorder (non-ED) controls using shotgun metagenomic sequencing. The impact of inpatient treatment on the AN gut microbiota was remarkably consistent between eating disorder units. Although weight in patients with AN showed improvements, AN microbiotas post-treatment remained distinct from non-ED controls. Additionally, AN gut microbiotas prior to treatment exhibited more fermentation pathways and a lower ability to degrade carbohydrates than non-ED controls. As the intestinal microbiota can influence nutrient metabolism, our data highlight the complex microbial communities in patients with AN as an element needing further attention post inpatient treatment. Additionally, this study defines the effects of renourishment on the AN gut microbiota and serves as a platform to develop precision nutrition approaches to potentially mitigate impediments to recovery.

Plasma Concentrations of Short-Chain Fatty Acids in Active and Recovered Anorexia Nervosa

“…Another limitation is that fecal concentrations of SCFA and microbiota taxonomy were not measured in combination with the plasma concentrations. In addition, we required a one-year duration of recovery from AN, which is consistent with many definitions of recovery but it may not be adequate for the normalization of the microbiota [67]. It is also possible that the dietary habits of the AN-REC group still differ from individuals without any history of an eating disorder [68] in ways that could influence the gut microbiota (e.g., the amount of ingested dietary fibers and resistant starch).…”

Laxative Abuse Is Associated With a Depleted Gut Microbial Community Structure Among Women and Men With Binge-Eating Disorder or Bulimia Nervosa: The Binge Eating Genetics Initiative

“…Median BMI was 30.4 kg/m 2 (interquartile range [IQR] = 24.9-38.5 kg/m 2 ) among included participants and 17.3 kg/m 2 (IQR = 17.0-18.1 kg/m 2 ) among those excluded for a low BMI. Furthermore, individuals with a low BMI at the time of study participation may have been engaging in more restrictive eating disorder behaviors than those without a low BMI, which could impact the composition and diversity of the intestinal microbiota (42,43). These decisions align with the overarching objectives of the parent BEGIN study to extend genetic and microbiome research previously conducted in AN to individuals with BED and BN (37).…”

Inpatient treatments for adults with anorexia nervosa: a systematic review of literature

“…In patients with BMI < 13 enteral nutrition via NGT during the first 48 h. Initial enteral caloric intake 10 kcal/kg. Objective of caloric intake 30 kcal/kg/day 18 Yamazaki et al 2021 [ 47 ] 13.58 n.r n.r Expected weight gain 1 kg/week, usage of supplementary enteral nutrition 19 Smith et al 2021 [ 48 ] n.r n.r n.r n.r 20 Dauty et al [ 49 ] 13.80 1.00 n.r > 500 g per week , weight monitoring twice a week, NGT at entry > 1500 kcal × 36 gg approximately, dietary consultations once per week, supervised meals 21 Young et al [ 50 ] 12.70 n.r n.r n.r 22 Fouladi et al [ 51 ] 14.60 5.33 n.r 3200–3400 kcal at discharge 23 Funayama et al [ 52 ] 13.40 n.r n.r Mainly oral nutritional rehabilitation, intravenous feeding sometimes used, less frequently NGT. Initial caloric prescription 600–1400 kcal/day, increased by 200 kcal/day.…”