title: Appetite regulatory hormones in women with anorexia nervosa: binge-eating/purging versus restricting type.
abstract: OBJECTIVE
  Anorexia nervosa is a psychiatric illness characterized by low weight, disordered eating, and hallmark neuroendocrine dysfunction. Behavioral phenotypes are defined by predominant restriction or bingeing/purging; binge-eating/purging type anorexia nervosa is associated with poorer outcome. The pathophysiology underlying anorexia nervosa types is unknown, but altered hormones, known to be involved in eating behaviors, may play a role.
  
  
  METHODS
  To examine the role of anorexigenic hormones in anorexia nervosa subtypes, we examined serum levels of peptide YY (PYY; total and active [3-36] forms), brain-derived neurotrophic factor (BDNF), and leptin as primary outcomes in women with DSM-5 restricting type anorexia nervosa (n = 50), binge-eating/purging type anorexia nervosa (n = 25), and healthy controls (n = 22). In addition, women completed validated secondary outcome measures of eating disorder psychopathology (Eating Disorder Examination-Questionnaire) and depression and anxiety symptoms (Hamilton Rating Scales for Depression [HDRS] and Anxiety [HARS]). The study samples were collected from May 22, 2004, to February 7, 2012.
  
  
  RESULTS
  Mean PYY 3-36 and leptin levels were lower and BDNF levels higher in binge-eating/purging type anorexia nervosa than in restricting type anorexia nervosa (all P values < .05). After controlling for body mass index, differences in PYY and PYY 3-36 between anorexia nervosa types were significant (P < .05) and differences in BDNF were at the trend level (P < .10). PYY 3-36 was positively (r = 0.27, P = .02) and leptin was negatively (r = -0.51, P < .0001) associated with dietary restraint; BDNF was positively associated with frequency of purging (r = 0.21, P = .04); and leptin was negatively associated with frequency of bingeing (r = -0.29, P = .007) and purging (r = -0.31, P = .004).
  
  
  CONCLUSIONS
  Among women with anorexia nervosa, the anorexigenic hormones PYY, BDNF, and leptin are differentially regulated between the restricting and binge/purge types. Whether these hormone pathways play etiologic roles with regard to anorexia nervosa behavioral types or are compensatory merits further study.
authors.affiliation: Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, 2 Longfellow Pl, Ste 200, Boston, MA 02114 keddy@mgh.harvard.edu.
authors.forename: Kamryn T
authors.initials: KT
authors.lastname: Eddy
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Lawson
authors.forename: Christina
authors.initials: C
authors.lastname: Meade
authors.forename: Erinne
authors.initials: E
authors.lastname: Meenaghan
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Horton
authors.forename: Madhusmita
authors.initials: M
authors.lastname: Misra
authors.forename: Anne
authors.initials: A
authors.lastname: Klibanski
authors.forename: Karen K
authors.initials: KK
authors.lastname: Miller
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000097:blood* / Q000145:classification / Q000453:epidemiology; D001066:Appetite / Q000502:physiology; D056912:Binge-Eating Disorder / Q000097:blood* / Q000453:epidemiology; D019208:Brain-Derived Neurotrophic Factor / Q000097:blood*; D015897:Comorbidity; D005260:Female; D006801:Humans; D020738:Leptin / Q000097:blood*; D019894:Peptide YY / Q000097:blood*; D055815:Young Adult
chemical_list: D019208:Brain-Derived Neurotrophic Factor; D020738:Leptin; D019894:Peptide YY
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