• Chronic undernutrition in anorexia patients alters metabolism
• The plasma lipidome is a new marker of metabolic health
• Lipidomics of plasma from anorexia patients before and after refeeding therapy reveals dysmetabolism
ANOREXIA nervosa, an eating disorder, manifests itself as self-starvation, excessive weight loss and a distorted body image. Due to chronic undernutrition, anorexia patients may also experience changes in the body’s metabolism and endocrine system. Unfortunately, fewer than 50% of anorexia patients can expect to make a full recovery, highlighting the burden of this disorder and the need for better interventions.
Refeeding therapy – in which anorexia patients are hospitalized and fed a prescribed diet to induce weight gain – is the most successful current therapy. However, the optimal number of calories, nutritional content, and pacing of this therapy remain largely unexplored.
The plasma lipid profile has recently emerged as a marker of metabolic health. For example, increased concentrations of short, saturated triacylglycerols associate with type II diabetes risk; ceramide levels are elevated in obese patients with type II diabetes; and combining the plasma lipidome with machine learning algorithms can predict metabolic obesity status. Preliminary evidence suggests that the plasma lipidome may also provide insight on the metabolic health of patients with anorexia before, during, and/or after refeeding therapy.
Quote
Many psychological disorders manifest in metabolism, and therapeutic approaches must account for that.
Dr. Mathias Gerl
Head of Data & Statistical Analysis at Lipotype
A 2021 report, published in the Journal of the American Academy of Child & Adolescent Psychiatry by a research team based in Dresden, Germany, investigates the plasma lipidome in anorexia patients before and after refeeding therapy and compared to control patients. The results suggest that lipid metabolism is altered in anorexia patients.
The study cohort consisted of 76 adolescent females: 39 patients diagnosed with anorexia nervosa and 37 control patients. Plasma samples were collected from each patient and analyzed via mass spectrometry-based lipidomics. For patients with anorexia, additional plasma samples were collected and analyzed following standardized refeeding therapy. This study identified and quantified 204 lipid species distributed amongst 13 lipid classes.
Lipidome hierarchy: A hierarchical overview of the identified and quantified lipids featuring lipid categories, classes, species, and subspecies. Tam et al., JAAC (2021), doi: 10.1016/j.jaac.2021.02.014
Compared to control patients, the plasma lipidome of patients with anorexia before refeeding therapy was enriched with cholesterol and lipid byproducts of the lecithin-cholesterol acyl transferase reaction. Triacylglycerols in the plasma of anorexia patients were shorter but had the same saturation. Additionally, certain ceramide species correlated with body mass index in control patients and eating disorder inventory score in anorexia patients.
After refeeding therapy and compared to control patients, the concentrations of certain ceramides, cholesterols, phospholipids, and sphingomyelins were increased in the plasma lipidome of anorexia patients. Triacylglycerols remained shorter and were also more saturated.
Comparison of healthy controls and anorexia nervosa patients: Volcano plots comparing lipidomic differences on lipid class levels of healthy control participants and anorexia nervosa patients at A admission and B after refeeding therapy. Tam et al., JAAC (2021), doi: 10.1016/j.jaac.2021.02.014
Compared to the plasma lipidome in anorexia patients before refeeding therapy, the lipid profile after refeeding showed an increase in ceramide levels and changes to phospholipid concentrations, including increased ether phospholipids, namely ether-linked phosphatidylethanolamine, and decreased ester phospholipids: lyso-phosphatidylcholine and lyso-phosphatidylethanolamine. Additionally, triacylglycerols were shorter but had the same level of saturation.
Overall, this study reveals dysregulation of lipid metabolism in anorexia patients, before and after refeeding therapy, relative to control patients. The clinical implications of these findings have yet to be explored, but similar changes in the plasma lipid profile have previously been linked to metabolic disorders like obesity and type II diabetes.
Lipidomic analysis of plasma samples from anorexia patients can shed light on metabolic changes during both the eating disorder and subsequent refeeding therapy. Future work should examine the plasticity of plasma lipidomes in diverse patient populations, in response to different refeeding therapy regimens. Exploring plasma lipidome during and after refeeding can shed light on how food reintroduction could be individualized and pave the road towards harmonized guidelines on patient management.
together with University Hospital Carl Gustav Carus
The Carl Gustav Carus Hospital in Dresden has a long medical tradition and features excellent facilities for modern interdisciplinary teamwork in medical services and medical investigation, including internationally renown research in understanding cardiovascular disease, diabetes, neuroscience, and cancer.
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