Gut microbiota and body composition in anorexia nervosa inpatients in comparison to athletes, overweight, obese, and normal weight controls

Mörkl, Sabrina; Lackner, Sonja; Müller, Wolfram; Gorkiewicz, Gregor; Kashofer, Karl; Oberascher, Andreas; Painold, Annamaria; Holl, Anna K.; Holzer, Peter; Meinitzer, Andreas; Mangge, Harald; Holasek, Sandra

doi:10.1002/eat.22801

Cited by 121 publications

(125 citation statements)

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“…Since microbial alpha-diversity did not significantly differ between the high and low-zonulin groups investigated in this study, bacterial diversity cannot be solely responsible for strengthening the gut barrier. In contrast, alpha-diversity was shown to be significantly different between BMI groups and athletes [22]. Nevertheless, there were no significant differences regarding serum zonulin between BMI groups and athletes in the current study.…”

Section: Discussioncontrasting

confidence: 71%

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Gut microbiota, dietary intakes and intestinal permeability reflected by serum zonulin in women

et al. 2018

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PurposeIncreased gut permeability causes the trespass of antigens into the blood stream which leads to inflammation. Gut permeability reflected by serum zonulin and diversity of the gut microbiome were investigated in this cross-sectional study involving female study participants with different activity and BMI levels.Methods102 women were included (BMI range 13.24–46.89 kg m−2): Anorexia nervosa patients (n = 17), athletes (n = 20), normal weight (n = 25), overweight (n = 21) and obese women (n = 19). DNA was extracted from stool samples and subjected to 16S rRNA gene analysis (V1–V2). Quantitative Insights Into Microbial Ecology (QIIME) was used to analyze data. Zonulin was measured with ELISA. Nutrient intake was assessed by repeated 24-h dietary recalls. We used the median of serum zonulin concentration to divide our participants into a “high-zonulin” (> 53.64 ng/ml) and “low-zonulin” (< 53.64 ng/ml) group.ResultsThe alpha-diversity (Shannon Index, Simpson Index, equitability) and beta-diversity (unweighted and weighted UniFrac distances) of the gut microbiome were not significantly different between the groups. Zonulin concentrations correlated significantly with total calorie-, protein-, carbohydrate-, sodium- and vitamin B12 intake. Linear discriminant analysis effect size (LEfSe) identified Ruminococcaceae (LDA = 4.163, p = 0.003) and Faecalibacterium (LDA = 4.151, p = 0.0002) as significantly more abundant in the low zonulin group.ConclusionButyrate-producing gut bacteria such as Faecalibacteria could decrease gut permeability and lower inflammation. The diversity of the gut microbiota in women does not seem to be correlated with the serum zonulin concentration. Further interventional studies are needed to investigate gut mucosal permeability and the gut microbiome in the context of dietary factors.Electronic supplementary materialThe online version of this article (10.1007/s00394-018-1784-0) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 71%

“…The workflow for microbiome analysis with Ion torrent has already been described in detail in Mörkl et al 2017 [22]. The PSP spin stool DNA stool collection kit (Stratec, Birkenfeld, Germany) was used for the collection of stool samples.…”

Section: Methodsmentioning

confidence: 99%

Gut microbiota, dietary intakes and intestinal permeability reflected by serum zonulin in women

et al. 2018

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“…Seventeen studies (27%) sampled regular menstruating participants during the follicular phase of their cycle (de Alvaro et al, 2007;Dostálová et al, 2009;Estour et al, 2017;Galusca et al, 2015;Germain et al, 2010Germain et al, , 2007Germain et al, , 2016Grinspoon et al, 2001;Kaválková et al, 2012;Kirchengast & Huber, 2004;Mayer et al, 2005Mayer et al, , 2009Nakai, Hamagaki, Takagi, Taniguchi, & Kurimoto, 1999;Prioletta et al, 2011;Scalfi et. al, 2002;Weinbrenner et al, 2004), whereas 14 studies (23%) did not provide details about the cycle phase (Bachmann et al, 2014;Bredella et al, 2012;Delporte, Brichard, Hermans, Beguin, & Lambert, 2003;DiVasta et al, 2011;Fazeli et al, 2010;Fernández-Soto et al, 2013;Germain et al, 2010;Gniuli, Liverani, Capristo, Greco, & Mingrone, 2001;Grinspoon et al, 1996;Guo, Jiang, Liao, Liu, & He, 2013;Haas et al, 2005;Karczewska-Kupczewska et al, 2010;Maïmoun et al, 2018;Mörkl et al, 2017;Nakahara et al, 2007;Rigaud, Boulier, Tallonneau, Brindisi, & Rozen, 2010;Tagami et al, 2004;Tanaka et al, 2003). However, studies were retained to achieve the largest possible sample size, and--depending on data availability--meta-regressions were fitted to investigate study characteristics as possible moderators.…”

Section: Results Of the Search And Selection Of Studiesmentioning

confidence: 99%

Body composition in anorexia nervosa: Meta‐analysis and meta‐regression of cross‐sectional and longitudinal studies

Hübel

Yılmaz

Schaumberg

et al. 2019

Intl J Eating Disorders

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Objective Clinically, anorexia nervosa (AN) presents with altered body composition. We quantified these alterations and evaluated their relationships with metabolites and hormones in patients with AN longitudinally. Method In accordance with PRISMA guidelines, we conducted 94 meta‐analyses on 62 samples published during 1996–2019, comparing up to 2,319 pretreatment, posttreatment, and weight‐recovered female patients with AN with up to 1,879 controls. Primary outcomes were fat mass, fat‐free mass, body fat percentage, and their regional distribution. Secondary outcomes were bone mineral density, metabolites, and hormones. Meta‐regressions examined relationships among those measures and moderators. Results Pretreatment female patients with AN evidenced 50% lower fat mass (mean difference [MD]: −8.80 kg, 95% CI: −9.81, −7.79, Q = 1.01 × 10−63) and 4.98 kg (95% CI: −5.85, −4.12, Q = 1.99 × 10−28) lower fat‐free mass, with fat mass preferentially stored in the trunk region during early weight restoration (4.2%, 95% CI: −2.1, −6.2, Q = 2.30 × 10−4). While the majority of traits returned to levels seen in healthy controls after weight restoration, fat‐free mass (MD: −1.27 kg, 95% CI: −1.79, −0.75, Q = 5.49 × 10−6) and bone mineral density (MD: −0.10 kg, 95% CI: −0.18, −0.03, Q = 0.01) remained significantly altered. Discussion Body composition is markedly altered in AN, warranting research into these phenotypes as clinical risk or relapse predictors. Notably, the long‐term altered levels of fat‐free mass and bone mineral density suggest that these parameters should be investigated as potential AN trait markers. ResumenObjetivo Clínicamente, la anorexia nervosa (AN) se presenta con alteraciones en la composición corporal. Cuantificamos estas alteraciones y evaluamos longitudinalmente su relación con metabolitos y hormonas en pacientes con AN. Método De acuerdo con las pautas PRISMA, realizamos 94 meta‐análisis en 62 muestras publicadas entre 1996–2019, comparando hasta 2,319 pacientes mujeres en pre‐tratamiento, post‐tratamiento, y recuperadas en base al peso con hasta 1,879 controles. Las principales medidas fueron masa grasa, masa libre de grasa, porcentaje de grasa corporal y su distribución regional. Las medidas secundarias fueron densidad mineral ósea, metabolitos y hormonas. Las meta‐regresiones examinaron las relaciones entre esas medidas y moderadores. Resultados Las pacientes femeninas con AN pre‐tratamiento mostraron un 50% menos de masa grasa (MD: −8.80 kg, CI 95%: −9.81, −7.79, Q = 1.01 × 10–63) y 4.98 kg (CI 95%: −5.85, −4.12, Q = 1.99 × 10–28) menos de masa libre de grasa, con masa grasa preferentemente almacenada en la región del tronco durante la recuperación temprana del peso (4.2%, CI 95%: −2.1, −6.2, Q = 2.30 × 10–4). Aunque la mayoría de los rasgos regresaron a los niveles vistos en los controles sanos después de la restauración del peso, la masa libre de grasa (MD: −1.27 kg, CI 95%: −1.79, −0.75, Q = 5.49 × 10–6) y la densidad mineral ósea (MD: −0.10 kg, CI 95%: −0.18, −0.03, Q = 0.01) perm...

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“…They present compelling evidence demonstrating how intestinal microbiota affects key features of AN, including weight regulation, metabolism, and psychological well‐being. Similarly, Mörkl et al () report differences in gut microbiome characteristics across women with different levels of BMI and physical activity. Kleiman et al () outline potential avenues for future microbiota research in relation to eating disorders that may unlock novel and effective intervention strategies for AN.…”

Section: Investigating the Role Of The Gut Microbiome In Eating Disormentioning

confidence: 96%

Innovation in eating disorders research and practice: Expanding our community and perspectives at the 2018 International Conference on Eating Disorders: Editorial to accompany IJED Virtual Issue in honor of the 2018 International Conference on Eating Disorders.

Diedrichs

Ranson

Thomas

2018

Intl J Eating Disorders

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Gut microbiota and body composition in anorexia nervosa inpatients in comparison to athletes, overweight, obese, and normal weight controls

Cited by 121 publications

References 67 publications

Gut microbiota, dietary intakes and intestinal permeability reflected by serum zonulin in women

Gut microbiota, dietary intakes and intestinal permeability reflected by serum zonulin in women

Body composition in anorexia nervosa: Meta‐analysis and meta‐regression of cross‐sectional and longitudinal studies

Innovation in eating disorders research and practice: Expanding our community and perspectives at the 2018 International Conference on Eating Disorders: Editorial to accompany IJED Virtual Issue in honor of the 2018 International Conference on Eating Disorders.

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