Opinion
Reframing anorexia nervosa as a metabo-psychiatric disorder

https://doi.org/10.1016/j.tem.2021.07.010Get rights and content
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Highlights

  • Anorexia nervosa (AN) is a severe and frequently lethal illness for which there are no biologically informed evidence-based interventions, notwithstanding decades of research.

  • Genome-wide association studies have identified significant loci that have been previously implicated in metabolic traits as well as robust significant genetic correlations between anorexia nervosa and psychiatric, anthropometric, and metabolic traits.

  • An imbalance in the intestinal microbiota (dysbiosis) of individuals with anorexia nervosa has been reported. Studies of intestinal morphology also suggest disturbances in gut villus architecture and a decrease in intestinal permeability in the gastrointestinal systems of individuals with AN, both of which might impede recovery.

  • Integrating the study of human genomics and the intestinal microbiota, with input from experienced clinicians, has the potential to develop and deploy precision nutrition approaches to improve AN renourishment interventions and sustain meaningful recovery.

Anorexia nervosa (AN) is a serious and often fatal illness. Despite decades of research, investigators have failed to adequately advance our understanding of the biological aspects of AN that could inform the development of effective interventions. Genome-wide association studies are revealing the important role of metabolic factors in AN, and studies of the gastrointestinal tract are shedding light on disruptions in enteric microbial communities and anomalies in gut morphology. In this opinion piece, we review the state of the science through the lens of the clinical presentation of illness. We project how the integration of rigorous science in genomics and microbiology, in collaboration with experienced clinicians, has the potential to markedly enhance treatment outcome via precision interventions.

Keywords

eating disorders
endocrinology
metabolism
genetics
GWAS
microbiome

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