Weight restoration therapy rapidly reverses cortical thinning in anorexia nervosa: A longitudinal study

• Published in: NeuroImage (Orlando, Fla.) Vol. 130; pp. 214 - 222
• Main Authors: Bernardoni, Fabio, King, Joseph A., Geisler, Daniel, Stein, Elisa, Jaite, Charlotte, Nätsch, Dagmar, Tam, Friederike I., Boehm, Ilka, Seidel, Maria, Roessner, Veit, Ehrlich, Stefan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.04.2016; Elsevier Limited
• Subjects: Adolescent; Anorexia; Anorexia nervosa; Anorexia Nervosa - diet therapy; Anorexia Nervosa - pathology; Body Mass Index; Body Weight; Brain injury; Cerebral cortex; Cerebral Cortex - pathology; Child; Cortex; Cortical thickness; Eating disorders; Female; FreeSurfer; Humans; Hydration; Image Interpretation, Computer-Assisted; Longitudinal; Longitudinal Studies; Macromolecules; Magnetic Resonance Imaging; Neurogenesis; Neuroimaging; Neuronal-glial interactions; NMR; Nuclear magnetic resonance; Rehabilitation; Starvation; Structural MRI; Studies; Subcortical structures; Substantia grisea; Thinning; Weight Gain; Young Adult; Cerebral cortex; Cortical thickness; Longitudinal; Structural MRI; Anorexia nervosa; FreeSurfer; Subcortical structures
• ISSN: 1053-8119; 1095-9572
• DOI: 10.1016/j.neuroimage.2016.02.003

Structural magnetic resonance imaging studies have documented reduced gray matter in acutely ill patients with anorexia nervosa to be at least partially reversible following weight restoration. However, few longitudinal studies exist and the underlying mechanisms of these structural changes are elusive. In particular, the relative speed and completeness of brain structure normalization during realimentation remain unknown. Here we report from a structural neuroimaging study including a sample of adolescent/young adult female patients with acute anorexia nervosa (n=47), long-term recovered patients (n=34), and healthy controls (n=75). The majority of acutely ill patients were scanned longitudinally (n=35): at the beginning of standardized weight restoration therapy and again after partial weight normalization (>10% body mass index increase). High-resolution structural images were processed and analyzed with the longitudinal stream of FreeSurfer software to test for changes in cortical thickness and volumes of select subcortical regions of interest. We found globally reduced cortical thickness in acutely ill patients to increase rapidly (0.06mm/month) during brief weight restoration therapy (≈3months). This significant increase was predicted by weight restoration alone and could not be ascribed to potentially mediating factors such as duration of illness, hydration status, or symptom improvements. By comparing cortical thickness in partially weight-restored patients with that measured in healthy controls, we confirmed that cortical thickness had normalized already at follow-up. This pattern of thinning in illness and rapid normalization during weight rehabilitation was largely mirrored in subcortical volumes. Together, our findings indicate that structural brain insults inflicted by starvation in anorexia nervosa may be reversed at a rate much faster than previously thought if interventions are successful before the disorder becomes chronic. This provides evidence drawing previously speculated mechanisms such as (de-)hydration and neurogenesis into question and suggests that neuronal and/or glial remodeling including changes in macromolecular content may underlie the gray matter alterations observed in anorexia nervosa. •First longitudinal study of cortical thickness in anorexia nervosa.•Cortical thinning in young patients is reversed by brief weight restoration therapy.•Regionally unspecific thinning is rapidly normalized relative to healthy controls.•Normalization was driven by weight gain but not by symptoms or illness duration.•Rapid changes may reflect neuronal/glial remodeling but not neurogenesis.