title: Weight restoration therapy rapidly reverses cortical thinning in anorexia nervosa: A longitudinal study.
abstract: 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 (0.06 mm/month) during brief weight restoration therapy (≈3 months). 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.
authors.affiliation: Eating Disorder Services and Researech Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
authors.forename: Fabio
authors.initials: F
authors.lastname: Bernardoni
authors.affiliation: Eating Disorder Services and Researech Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: King
authors.affiliation: Eating Disorder Services and Researech Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Geisler
authors.affiliation: Eating Disorder Services and Researech Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
authors.forename: Elisa
authors.initials: E
authors.lastname: Stein
authors.affiliation: Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Jaite
authors.affiliation: Eating Disorder Services and Researech Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
authors.forename: Dagmar
authors.initials: D
authors.lastname: Nätsch
authors.affiliation: Eating Disorder Services and Researech Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
authors.forename: Friederike I
authors.initials: FI
authors.lastname: Tam
authors.affiliation: Eating Disorder Services and Researech Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
authors.forename: Ilka
authors.initials: I
authors.lastname: Boehm
authors.affiliation: Eating Disorder Services and Researech Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
authors.forename: Maria
authors.initials: M
authors.lastname: Seidel
authors.affiliation: Eating Disorder Services and Researech Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany.
authors.forename: Veit
authors.initials: V
authors.lastname: Roessner
authors.affiliation: Eating Disorder Services and Researech Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; MGH/MIT/HMS Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA; Harvard Medical School, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA. Electronic address: transden.lab@uniklinikum.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Ehrlich
mesh_terms: D000293:Adolescent; D000856:Anorexia Nervosa / Q000178:diet therapy* / Q000473:pathology*; D015992:Body Mass Index; D001835:Body Weight; D002540:Cerebral Cortex / Q000473:pathology*; D002648:Child; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D015430:Weight Gain; D055815:Young Adult
keywords: Anorexia nervosa; Cerebral cortex; Cortical thickness; FreeSurfer; Longitudinal; Structural MRI; Subcortical structures