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Background Superior mesenteric artery (SMA) syndrome is a well-known but relatively rare complication of anorexia nervosa. Although several reports have proposed surgery for SMA syndrome associated with anorexia nervosa, these have shown poor outcomes or did not reveal the long-term weight course. Thus, the long-term effectiveness of surgery for SMA syndrome in such cases remains unclear. This case report describes a patient with anorexia nervosa who underwent surgery for SMA syndrome. Case presentation An 18-year-old woman presented with anorexia nervosa when she was 16 years old. She also presented with SMA syndrome, which seemed to be caused by weight loss due to the eating disorder. Nutrition therapy initially improved her body weight, but she ceased treatment. She reported that symptoms related to SMA syndrome had led to her weight loss and desired to undergo surgery. Laparoscopic duodenojejunostomy was performed, but her body weight did not improve after the surgery. The patient eventually received conservative nutritional treatment along with psychological approaches, which led to an improvement in her body weight. Conclusions The case implies that surgery for SMA syndrome in patients with anorexia nervosa is ineffective for long-term weight recovery and that conservative treatment can sufficiently improve body weight; this is consistent with the lack of evidence on the topic and reports on potential complications of surgery. Due to difficulties in assessing psychological status, consultation with specialists on eating disorders is necessary for treating patients with severely low body weight.

Rapidly accumulating evidence supports the important role of gut microbiome in the regulation of mood, behaviour, appetite, gastrointestinal symptomology, and nutrient metabolism. These are all core features frequently altered in individuals with anorexia nervosa (AN). Current treatment recommendations for AN support the use of high-calorie diets as an essential part of nutritional rehabilitation, commonly achieved by elevating the fat content of the diet. However, in contrast to this approach, there is accumulating evidence suggesting the importance of balanced, high-fibre diets on the gut microbiome. Studies have demonstrated profound differences in the microbial composition of underweight people with AN and those of normal- or overweight individuals. Specific alterations vary widely between studies. It is thus far unclear to what extent the observed differences are brought on by iatrogenic effects of nutritional rehabilitation or the disorder itself. To date, only two studies have investigated the changes in the intestinal microbiota during nutritional rehabilitation and corresponding weight restoration. These studies suggest that the gut microbiome of AN patients was different to healthy controls both prior and following nutritional rehabilitation, though it is noted that these states were associated with lower and higher nutritional intakes, respectively. There is a clear need for further investigation regarding the effects of nutritional rehabilitation on the gut microbiome. Such research would provide insights into the potential role of gut microbiome in modulating the pathophysiology of AN and inform future treatment strategies.

Este ensaio experimental foi delineado com objetivo de avaliar um possível ganho de peso compensatório em frangos de corte em diferentes idades submetidas a um programa de restrição alimentar quantitativo. Delineamento experimental inteiramente casualizado (DIC), com 5 tratamentos e 7 repetições com 32 aves por repetição, totalizando 35 parcelas experimentais, totalizando 1.120 aves. Os tratamentos consistiam em restrição alimentar quantitativa de 20% do consumo semanal esperado da tabela cobb, separados por semana: tratamento com restrição alimentar na segunda semana, tratamento com restrição alimentar na terceira semana, tratamento com restrição na quarta semana, tratamento com restrição na quinta semana, sexta semana com alimentação a vontade para todos os tratamentos e, tratamento controle sem restrição. Os dados coletados foram submetidos à ANOVA e foram avaliados por contraste. No desempenho semanal o consumo de ração foi sempre baixo no tratamento da restrição da semana quando comparado com tratamento controle, em consequencia, o peso médio também foi menor na mesma semana, e a conversão sempre maior na semana da restrição. Aos 42 dias, essas diferenças não foram observadas, sugerindo que as houve a recuperação de peso, ou seja, o frango de corte com restrição de 20% conseguiu apresentar ganho de peso compensatório. Para orgãos e tecidos, houve diferença significativa entre os tratamentos no peso relativo para trato gastrintestinal e intestino grosso, apresentando menor índice na semana que as aves passaram por restrição alimentar. Quanto a histomorfometria intestinal, de forma geral, altura de vilos e profundidade de cripta foram maiores nos tratamentos que passaram por restrição alimentar, visto que o epitélio intestinal das aves é constantemente renovado por mecanismos de reparo da muscosa intestinal, que pode ser alterado por agente nutricionais, o que os torna hiperplástico, com profundidade de cripta mais profunda. Para avaliação de graus de peito amadeirado , houve melhor resultado (dimunição da incidência) para os animais que passaram por restrição na segunda e quinta semana. Ao examinar as médias de lesões microscópicas do músculo pectoralis major, observa-se diferença somente no tecido adiposo. Conclui-se que as aves com restrição de 20% foram capazes de recuperar o peso e apresentarem o ganho de peso compensatório. Com relação à orgãos e tecidos, houve a diminuição do peso dos orgãos intestinais devido a diminuição de movimentos peristálticos frente a um período de restrição, exigindo menos do intestino e consequentemente, diminuindo o peso relativo deste. Da mesma forma, o organismo das aves reagem a restrição alimentar a nivel celular, aumentando a altura de vilos e profundidade de cripta como mecanismo para melhorar absorção de nutrientes e aumentar o reparado tecidual. Com relação as alterações musculares peitorais, a restrição aplicada neste trabalho, foi capaz de reduzir a incidência de peito madeira. This experimental trial was designed with the objective of evaluating a possible compensatory weight gain in broilers at different ages submitted to a quantitative food restriction program. Fully randomized experimental design (DIC), with 5 treatments and 7 repetitions with 32 birds per repetition, totaling 35 experimental plots, totaling 1,120 birds. The treatments consisted of quantitative food restriction of 20% of the expected weekly consumption of the cobb table, separated by week: treatment with food restriction in the second week, treatment with food restriction in the third week, treatment with restriction in the fourth week, treatment with restriction in the fifth week, sixth week with free feeding for all treatments and control treatment without restriction. The collected data were submitted to ANOVA and were evaluated by contrast. In the weekly performance the feed consumption was always low in the treatment of the week restriction when compared to the control treatment, in consequence, the average weight was also lower in the same week, and the conversion was always higher in the week of the restriction. At 42 days, these differences were not observed, suggesting that there was weight recovery, that is, the broiler chicken with a 20% restriction managed to show compensatory weight gain. For organs and tissues, there was a significant difference between treatments in the relative weight for gastrointestinal tract and large intestine, presenting a lower index in the week that the birds went through food restriction. As for intestinal histomorphometry, in general, villus height and crypt depth were higher in treatments that underwent food restriction, since the intestinal epithelium of birds is constantly renewed by mechanisms of intestinal muscosa repair, which can be changed by agent nutrients, which makes them hyperplastic, with deeper crypt depth. For evaluation of woody chest degrees, there was a better result (reduced incidence) for the animals that underwent restriction in the second and fifth week. When examining the means of microscopic lesions of the pectoralis major muscle, a difference is observed only in adipose tissue. It was concluded that birds with a 20% restriction were able to regain weight and present compensatory weight gain. With regard to organs and tissues, there was a decrease in the weight of intestinal organs due to a decrease in peristaltic movements in the face of a period of restriction, requiring less from the intestine and, consequently, decreasing its relative weight. Likewise, the birds' organisms react to food restriction at the cellular level, increasing villus height and crypt depth as a mechanism to improve nutrient absorption and increase tissue repair. With regard to pectoral muscle changes, the restriction applied in this study was able to reduce the incidence of wooden breast. Outro

Anorexia nervosa (AN) is a severe metabopsychiatric disorder characterised by caloric intake restriction and often excessive physical exercise. Our aim is to assess in female AN patients and in a rodent model, the co-evolution of physical activity and potential dysregulation of acyl—(AG) and desacyl—(DAG) ghrelin plasma concentrations during denutrition and weight recovery. AN inpatients were evaluated at inclusion (T0, n = 29), half—(T1) and total (T2) weight recovery, and one month after discharge (T3, n = 13). C57/Bl6 mice with access to a running wheel, were fed ad libitum or submitted to short—(15 days) or long—(50 days) term quantitative food restriction, followed by refeeding (20 days). In AN patients, AG and DAG rapidly decreased during weight recovery (T0 to T2), AG increased significantly one-month post discharge (T3), but only DAG plasma concentrations at T3 correlated negatively with BMI and positively with physical activity. In mice, AG and DAG both increased during short- and long-term food restriction. After 20 days of ad libitum feeding, DAG was associated to persistence of exercise alteration. The positive association of DAG with physical activity during caloric restriction and after weight recovery questions its role in the adaptation mechanisms to energy deprivation that need to be considered in recovery process in AN.

International audience; Anorexia nervosa (AN) is a severe metabopsychiatric disorder characterised by caloric intake restriction and often excessive physical exercise. Our aim is to assess in female AN patients and in a rodent model, the co-evolution of physical activity and potential dysregulation of acyl-(AG) and desacyl-(DAG) ghrelin plasma concentrations during denutrition and weight recovery. AN inpatients were evaluated at inclusion (T0, n = 29), half-(T1) and total (T2) weight recovery, and one month after discharge (T3, n = 13). C57/Bl6 mice with access to a running wheel, were fed ad libitum or submitted to short-(15 days) or long-(50 days) term quantitative food restriction, followed by refeeding (20 days). In AN patients, AG and DAG rapidly decreased during weight recovery (T0 to T2), AG increased significantly one-month post discharge (T3), but only DAG plasma concentrations at T3 correlated negatively with BMI and positively with physical activity. In mice, AG and DAG both increased during short-and long-term food restriction. After 20 days of ad libitum feeding, DAG was associated to persistence of exercise alteration. The positive association of DAG with physical activity during caloric restriction and after weight recovery questions its role in the adaptation mechanisms to energy deprivation that need to be considered in recovery process in AN.

OBJECTIVE: The aim of this study was to characterise the association between the cognitive profile and weight restoration in children and adolescents with anorexia nervosa.METHODS: The study was a longitudinal, matched case-control, multicentre study. An assessment of cognitive functions was conducted by using the Wechsler Intelligence Scale for Children-III/the Wechsler Adult Intelligence Scale-III, the Test of Memory and Learning-second edition, Trail Making Tests A and B, the Rey-Osterrieth Complex Figure Test and the Cambridge Neuropsychological Test Automated Battery.RESULTS: One hundred twenty individuals, 60 patients with anorexia nervosa with mean age of 14.65 (SD 1.820) years and 60 healthy controls with mean age of 14.76 (SD 1.704) years, participated. No association was found between weight recovery and cognitive functions. However, a significant increase in motor speed was found in Trail Making Test A (p = 0.004), Reaction Time (RTI) five-choice movement time (p = 0.002) and RTI simple movement time (p = 0.011), resulting in a normalisation corresponding to that found in healthy controls. Furthermore, a significantly lower score in the perceptual organization index (p = 0.029) was found at follow-up.CONCLUSIONS: Weight recovery appears not to be associated with cognition. Copyright © 2016 The Authors European Eating Disorders Review published by Eating Disorders Association and John Wiley & Sons Ltd.

Patientinnen mit Anorexia nervosa (AN) zeigen hirnmorphologische, neuropsychologische und funktionelle Veränderungen, deren Ursprung, Verlauf und ggf. Reversibilität kontrovers diskutiert werden. Erste Untersuchungen bestätigen für den akuten Hungerzustand ein vermehrtes Auftreten minimaler neurologischer Auffälligkeiten („Neurological Soft Signs“, NSS) und eine beeinträchtigte psychomotorische Leistungsgeschwindigkeit. Die Studie untersucht, ob sich die im akuten Untergewicht beobachteten NSS und die kognitiven Beeinträchtigungen im Laufe des Genesungsprozesses normalisieren (State- Marker) oder ob die Veränderungen im Sinne eines krankheitstypischen Trait-Markers im Verlauf unverändert nachweisbar sind. Dazu wurden Patientinnen mit der Diagnose einer AN zu drei verschiedenen Zeitpunkten der Erkrankung untersucht. Die NSS wurden mit einer standardisierten graphomotorischen Untersuchung am Schreibtablett (MM) und mit der Neurological Evaluation Scale (NES) untersucht. Die psychomotorische Verarbeitungs- geschwindigkeit wurde mithilfe des Zahlenverbindungstests (ZVT) ermittelt. Im Längsschnitt wurden die Ergebnisse von 26 Patientinnen im akuten Untergewicht (T1) und nach Kurzzeit-Gewichtszunahme von mind. 10% (T2) untersucht. Außerdem erfolgte die Gegenüberstellung der Ergebnisse von 52 Patientinnen im akuten Untergewicht (T1) und 18 Langzeit-Gewichtsrehabilitierten (T3) im Querschnitt. Nach Gewichtszunahme zeigten die Patientinnen in beiden Untersuchungsarmen signifikante Verbesserungen bei MM und ZVT. Die Abnahme dieser NSS nach Gewichtszunahme lässt deren Deutung als hungerbedingte State-Merkmale zu. Im Gegensatz dazu zeigte die neurologische Testung mit der NES jedoch keine signifikanten Verbesserungen. Unklar bleibt, ob dies auf krankheitsspezifische NSS hinweist (Trait-Marker) oder z.B. als Zeichen für eine irreversible Schädigung zu verstehen ist. Die Ergebnisse passen zu aktuellen bildmorphologischen Studien, die nach Gewichtsnormalisierung für einen Großteil der veränderten Hirnregionen eine rasche Regeneration fanden, während andere Bereiche unverändert blieben. Weitere longitudinale Studien mit größerer Teilnehmerzahl, entsprechenden gesunden Vergleichsgruppen und bildmorphologischer Kontrolle sind sinnvoll., Loss of cerebral gray and white matter volume which cause brain function deficits are described in patients with anorexia nervosa (AN). Neurological soft signs (NSS) are minor neurological signs which indicate non-specific cerebral dysfunction. First investigations have shown their presence in Anorexia nervosa (AN) - including particularly poor motor coordination and difficulties in sequencing complex motor tasks. It is uncertain whether these deficiencies are endophenotype of AN, independent of current disease or nutritional status (“trait-marker”), or if they are just a temporary consequence of starvation, respectively psychopathology (“state-marker”). The present study aims to clarify the development of NSS in the course of AN, to indicate whether the presence of NSS is trait- or state-related. Therefore NSS have been investigated in patients with AN in three different stages of their illness, conducting a digitizing graphic tablet for kinematic analysis of handwriting movements. For neurological assessment, the study has used the Neurological Evaluation Scale (NES). For examination of mental flexibility and speed of processing, a German version of the Trail Making Test (“Zahlenverbindungstest”, ZVT) has been applied. Longitudinally the study has followed up 26 patients with current illness (T1) after short-time weight recovery (T2). Additionally a cross-sectional analysis has compared the results of 52 acute underweight patients (T1) with the outcome of 18 patients after long-time recovery (T3). It has been shown that the velocity of handwriting movements as well as the observed impaired cognitive flexibility in the stage of under-nutrition has improved significantly after weight recovery in both comparison groups (T2, T3). This might indicate that NSS diminishes in the course of recovery, being potentially state-related to AN. Unexpectedly the number of mistakes in NES did not show a considerable decrease. It remains uncertain whether this is associated with trait-related deficiencies, or is a consequence of irreversible impairment. The controversial results correspond to the latest neuro-imaging studies. More longitudinal studies which integrate neurological assessment and imaging procedures are needed to evaluate the cause and development of Neurological Soft Signs in Anorexia nervosa.

Objective To evaluate the time course of bone mineral density (BMD) in women with anorexia nervosa (AN) during 2-year follow-up. Method We prospectively studied 51 female with AN aged 18–38 years, and 40 age-matched healthy women (19–34 years). BMD was measured in lumbar spine (LS), femoral neck (FN), and total hip (TH) by DXA. Results At baseline, weight, body mass index, and lumbar and hip BMD were significantly (p < .001) lower in AN patients than in controls. Patients who gain weight showed a significant increase in BMD at FN (+1.6%; p < .05), and TH (+4.4%; p < .05) and lower nonsignificant changes in LS (+1.3%). Weight at entry, and percent change of weight were significant determinants (p < .05) of the variability in percent change of BMD at FN and TH, whereas weight at entry was the main determinant of bone modifications at lumbar spine. Discussion Our data emphasize the influence of weight gain in recovery of bone mass in AN patients, especially at the hip. © 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2010; 43:537–542