Structural brain correlates of eating pathology symptom dimensions: A systematic review

Cortical thickness and childhood eating behaviors: differences according to sex and age, and relevance for eating disorders

PURPOSE

This study investigated the association between childhood eating behaviors and cortical morphology, in relation to sex and age, in a community sample.

METHODS

Neuroimaging data of 71 children (mean age = 9.9 ± 1.4 years; 39 boys/32 girls) were obtained from the Nathan Kline Institute-Rockland Sample. Emotional overeating, food fussiness, and emotional undereating were assessed using the Children's Eating Behavior Questionnaire. Cortical thickness was obtained at 81,924 vertices covering the entire cortex. Generalized Linear Mixed Models were used for statistical analysis.

RESULTS

There was a significant effect of sex in the association between cortical thickness and emotional overeating (localized at the right postcentral and bilateral superior parietal gyri). Boys with more emotional overeating presented cortical thickening, whereas the opposite was observed in girls (p < 0.05). Different patterns of association were identified between food fussiness and cortical thickness (p < 0.05). The left rostral middle frontal gyrus displayed a positive correlation with food fussiness from 6 to 8 years, but a negative correlation from 12 to 14 years. Emotional undereating was associated with cortical thickening at the left precuneus, left middle temporal gyrus, and left insula (p < 0.05) with no effect of sex or age.

CONCLUSIONS

Leveraging on a community sample, findings support distinct patterns of associations between eating behaviors and cortical thickness, depending on sex and age.

Similarities and differences between eating disorders and obsessive-compulsive disorder in childhood and adolescence: a systematic review

Background

The developmental age, comprising childhood and adolescence, constitutes an extremely important phase of neurodevelopment during which various psychiatric disorders can emerge. Obsessive-Compulsive Disorder (OCD) and Eating Disorders (ED) often manifest during this critical developmental period sharing similarities but also differences in psychopathology, neurobiology, and etiopathogenesis. The aim of this study is to focus on clinical, genetic and neurobiological similarities and differences in OCD and ED.

Methods

This study is based on a PubMed/MEDLINE and Cochrane Central Register for Controlled Trial (CENTRAL). The research adhered to the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA).

Results

The aforementioned search yielded an initial collection of 335 articles, published from 1968 to September 2023. Through the application of inclusion and exclusion criteria, a total of 324 articles were excluded, culminating in a final selection of 10 articles.

Conclusions

Our findings showed both differences and similarities between OCD and ED. Obsessive-compulsive (OC) symptoms are more prevalent in ED characterized by a binge/purge profile than in those with a restrictive profile during developmental age. OC symptomatology appears to be a common dimension in both OCD and ED. When presents, OC symptomatology, exhibits transversal characteristic alterations in the anterior cingulate cortex and poorer cognitive flexibility. These correlations could be highlighted by genetic overlaps between disorders. A comprehensive definition, integrating psychopathological and neurobiological aspects could significantly aid treatment selection and thereby influence the prognosis of these patients.

Loss of control eating in children is associated with altered cortical and subcortical brain structure

Introduction

Loss of control (LOC) eating is the perceived inability to control how much is eaten, regardless of actual amount consumed. Childhood LOC-eating is a risk factor for the development of binge-eating disorder (BED), but its neurobiological basis is poorly understood. Studies in children with BED have shown both increased gray matter volume in regions related to top-down cognitive control (e.g., dorsolateral prefrontal cortex) and reward-related decision making (e.g., orbital frontal cortex) relative to healthy controls. However, no studies have examined brain structure in children with LOC-eating. To identify potential neurobiological precursors of BED, we conducted secondary analysis of five studies that conducted T1 MPRAGE scans.

Methods

A total of 143, 7-12-year-old children (M = 8.9 years, 70 boys) were included in the study, 26% of which (n = 37) reported LOC-eating (semi-structured interview). Age, sex, and obesity status did not differ by LOC-eating. Differences between children with and without LOC were examined for gray matter volume, cortical thickness, gyrification, sulci depth, and cortical complexity after adjusting for age, sex, total intercranial volume, weight status, and study.

Results

Children with LOC, relative to those without, had greater gray matter volume in right orbital frontal cortex but lower gray matter volume in right parahippocampal gyrus, left CA4/dentate gyrus, and left cerebellar lobule VI. While there were no differences in cortical thickness or gyrification, children with LOC-eating had great sulci depth in left anterior cingulate cortex and cuneus and greater cortical complexity in right insular cortex.

Discussion

Together, this indicates that children with LOC-eating have structural differences in regions related to cognitive control, reward-related decision-making, and regulation of eating behaviors.

Genetics and neurobiology of eating disorders

Eating disorders (anorexia nervosa, bulimia nervosa and binge-eating disorder) are a heterogeneous class of complex illnesses marked by weight and appetite dysregulation coupled with distinctive behavioral and psychological features. Our understanding of their genetics and neurobiology is evolving thanks to global cooperation on genome-wide association studies, neuroimaging, and animal models. Until now, however, these approaches have advanced the field in parallel, with inadequate cross-talk. This review covers overlapping advances in these key domains and encourages greater integration of hypotheses and findings to create a more unified science of eating disorders. We highlight ongoing and future work designed to identify implicated biological pathways that will inform staging models based on biology as well as targeted prevention and tailored intervention, and will galvanize interest in the development of pharmacologic agents that target the core biology of the illnesses, for which we currently have few effective pharmacotherapeutics.

Ketamine as a Novel Psychopharmacotherapy for Eating Disorders: Evidence and Future Directions

Eating disorders (EDs) are serious, life-threatening psychiatric conditions associated with physical and psychosocial impairment, as well as high morbidity and mortality. Given the chronic refractory nature of EDs and the paucity of evidence-based treatments, there is a pressing need to identify novel approaches for this population. The noncompetitive N-methyl-D-aspartate receptor (NMDAr) antagonist, ketamine, has recently been approved for treatment-resistant depression, exerting rapid and robust antidepressant effects. It is now being investigated for several new indications, including obsessive–compulsive, post-traumatic, and substance use disorder, and shows transdiagnostic potential for EDs, particularly among clinical nonresponders. Hence, the aim of this review is to examine contemporary findings on the treatment of EDs with ketamine, whether used as a primary, adjunctive, or combination psychopharmacotherapy. Avenues for future research are also discussed. Overall, results are encouraging and point to therapeutic value; however, are limited to case series and reports on anorexia nervosa. Further empirical research is thus needed to explore ketamine efficacy across ED subgroups, establish safety profiles and optimize dosing, and develop theory-driven, targeted treatment strategies at the individual patient level.