Delayed gastric emptying in anorexia nervosa is improved by completion of a renutrition program

Rigaud, Daniel; Bedig, G; Merrouche, M.; Vulpillat, M.; Bonfils, S; Apfelbaum, M

doi:10.1007/bf01535985

Cited by 105 publications

(85 citation statements)

References 8 publications

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“…This delay has been hypothesized to perpetuate eating disorders by exacerbating fear of fatness due to bloating or by causing rectal distension, which may reflexively inhibit gastric emptying. Long-term rehabilitation improves gastrointestinal symptoms in AN, including gastric emptying (30), whereas short-term refeeding does not (8), although the time course for this improvement is not currently known. Future studies should assess whether the length of time in the weight-restored state results in normalization of the glucose and insulin response following ingestion of a meal and whether PP levels normalize in the recovered state.…”

Section: Discussionmentioning

confidence: 98%

Insulin, glucose, and pancreatic polypeptide responses to a test meal in restricting type anorexia nervosa before and after weight restoration

Kinzig¹,

Coughlin²,

Redgrave³

et al. 2007

American Journal of Physiology-Endocrinology and Metabolism

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Prolonged malnutrition in individuals with anorexia nervosa (AN) has been associated with alterations in endocrine function that may play a sustaining role in the disorder. We hypothesized that abnormalities in endocrine responses to ingestion of a meal in AN are reversible and depend on weight restoration. We measured meal-induced endocrine responses in AN subjects at three time points during hospitalization: before refeeding (n ϭ 13, mean BMI 16.7 kg/m 2 ), after 2 wk of refeeding (mean BMI 18.0 kg/m 2 ), and in the weight-restored state (mean BMI 20.3 kg/m 2 ). Control subjects (n ϭ 13, BMI 19 -24.9 kg/m 2 ) were tested once. Tests were 2.5-h sessions in which blood was drawn every 15 min before, during, and after a ϳ650-kcal test breakfast. Relative to controls, peak levels of glucose were depressed and peak levels of insulin in response to ingestion of the test meal were delayed, with response patterns in the third trial most similar to controls. Pancreatic polypeptide (PP) levels were increased in AN relative to controls regardless of weight status. The delay in insulin release and elevated PP levels did not correct with short-term refeeding and may contribute to the high relapse rates and maintenance of AN.eating disorders; pancreatic function; refeeding ANOREXIA NERVOSA (AN) is a highly morbid pathological condition with the highest mortality rate among psychiatric disorders (35,46). This disorder is characterized by multiple metabolic and endocrine abnormalities, including failure of the homeostatic responses to malnutrition and semistarvation. Although most of these alterations are believed to be state related and to reverse with weight restoration, some may be traitrelated vulnerability factors that differentiate at-risk individuals. Whether trait or state related, some of these alterations may play a role in sustaining the rewarding nature of restricting behavior, thereby acting as mediators for AN.Unlike starvation, AN is characterized by an excess of both orexigenic and anorexigenic signaling, indicating dysregulation of hunger and satiety (25). Reduced hunger and desire to eat, coupled with increased fullness and satiety after a test meal, have been reported in AN (21, 31), although the capacity to respond to physiological hunger and satiety cues may not be entirely absent (11,32). Delayed gastric emptying and intestinal transit times are likely contributors to the reports of increased fullness and satiety after meals (8,13,22,24,26). Some investigators argue that these findings reflect tight cognitive control of normal appetite. However, relative to healthy comparison women, those with AN show reduced salivation, a heightened autonomic response to food, and fear and disgust in response to images of food (27,43), suggesting conditioned responses similar to those seen in simple phobias.Knowledge regarding signals and systems involved in mealto-meal regulation of food intake is rapidly expanding. Although newly found systems are studied exhaustively as they relate to obesity, their roles and respons...

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Section: Discussionmentioning

confidence: 98%

Insulin, glucose, and pancreatic polypeptide responses to a test meal in restricting type anorexia nervosa before and after weight restoration

Kinzig¹,

Coughlin²,

Redgrave³

et al. 2007

American Journal of Physiology-Endocrinology and Metabolism

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“…This motivation to drink may be associated with refeeding, due to delayed gastric emptying prior to re-nutrition (Rigaud, Bedig, Merrouche, Vulpillat, Bonfils, & Apfelbaum, 1988).…”

Section: Discussionmentioning

confidence: 99%

The reasons why eating disorder patients drink

Hart

Abraham

Franklin

et al. 2010

Euro Eating Disorders Rev

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“…Gastric emptying is delayed in cases of severe malnutrition and is associated with nausea, vomiting and gastric fullness (Franco, et al, 1985;Rigaud et al, 1988). SF has a high viscosity, similar to peanut butter, and in theory SF may accentuate delayed gastric emptying observed during malnutrition and increase associated side effects.…”

Section: Introductionmentioning

confidence: 99%

Comparison of gastric emptying of a solid and a liquid nutritional rehabilitation food

2001

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Objective: To compare gastric emptying of a solid and a liquid nutritional rehabilitation food. Design: Cross-over trial. Eight volunteers took, in random order at least 1 week apart, 2100 kJ of a solid and a liquid nutritional rehabilitation food with added labelled [13 C] glycine. Setting: Research ward for healthy volunteers. Subjects: Eight healthy volunteers. Methods: Appearance of 13 CO 2 was monitored in expired gas every 15 min for 240 min after meal intake and compared between solid and liquid meals. Parameters of gastric emptying were then calculated. Results: Gastric half-emptying time was slightly longer for solid meal compared to liquid meal (101 AE 6.0 vs 88 AE 9.8 min, P ¼ 0.24).13 CO 2 excretion peaked 138AE 5.3 min after the solid meal compared with 119 AE 8.6 min with liquid meal (P ¼ 0.06).13 CO 2 excretion was higher for the liquid food up to 110 min after the meal but then became higher for the solid food. Analysis of variance for repeated measures of 13 CO 2 excretion showed a significant interaction term between the type of food and time indicating a delayed elimination of 13 CO 2 for the solid food (P ¼ 0.018). Conclusions: Attempts to replace liquid nutritional rehabilitation foods by a solid food in malnourished patients should take into account a possible slower gastric emptying. Sponsorship: Supported by a grant from Nutriset (Malaunay, France) and ANVAR (Agence Nationale de la Valorisation de la Recherche, contract no. A9703021P).

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Delayed gastric emptying in anorexia nervosa is improved by completion of a renutrition program

Cited by 105 publications

References 8 publications

Insulin, glucose, and pancreatic polypeptide responses to a test meal in restricting type anorexia nervosa before and after weight restoration

Insulin, glucose, and pancreatic polypeptide responses to a test meal in restricting type anorexia nervosa before and after weight restoration

The reasons why eating disorder patients drink

Comparison of gastric emptying of a solid and a liquid nutritional rehabilitation food

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