Homeostatic and non-homeostatic processing of food cues in anorexia nervosa

神经性厌食症（Anorexia nervosa，AN）是一种高发病率和终生死亡率的进食障碍。这种进食障碍的主要特征是尽管体重严重偏低，但食物摄入量仍然有限。鉴于明显的自我饥饿在AN，稳态食物加工的调查，以及它与奖励系统的相互作用是很大的科学兴趣。先前对AN患者的研究几乎完全集中在皮质，非稳态（例如，奖励相关）食品加工。因此，本研究的主要目的是通过关注下丘脑的反应性（即，稳态控制的核心区域）和中皮质边缘奖励系统。第二个目的是研究中皮质边缘奖励系统和稳态（即，下丘脑）系统。将通过应用葡萄糖或水的胃内输注的单盲、随机、交叉设计来评估代谢肠-脑信号传导。通过控制AN患者和健康对照组的食物摄入的感官方面（视觉、嗅觉和味觉），这种方法可以研究肠-脑向下丘脑和奖励系统的信号传导。此外，我们将测量控制视觉食物线索欲望的认知策略（自上而下控制）如何影响AN患者与健康对照组不同的中皮质边缘和下丘脑系统。下丘脑和中皮质边缘奖励系统之间的相互作用将使用有效的连接分析进行研究。功能磁共振成像与高空间分辨率和优化协议的下丘脑和mesocorticolimbic奖励系统的调查将被用于研究的第一次稳态和非稳态的食物线索处理在AN患者。

Anorexia nervosa (AN) is an eating disorder with high morbidity and lifetime mortality. This eating disorder is mainly characterized byrestricted food intake despite a severely low body weight. Given the pronounced self-starvation in AN, the investigation of homeostatic food processing, and its interaction with the reward system is of great scientific interest. Previous research in AN patients has almost exclusively focused on cortical, non-homeostatic (e.g., reward related) food processing. Therefore, the primary aim of the present study is to investigate metabolic gut-brain signaling by focusing on the responsivity of the hypothalamus (i.e., the core region of homeostatic control) and the mesocorticolimbic reward system. A secondary aim is to study the interaction between the mesocorticolimbic reward system and the homeostatic (i.e., hypothalamus) system. Metabolic gut-brain signaling will be assessed by applying a single-blind, randomized, crossover design of intragastric infusion of glucose or water. This approach allows the study of gut-brain signaling to the hypothalamus and the reward system by controlling for sensory aspects of food intake (sight, smell, and taste) in AN patients and healthy controls.Furthermore, we will measure how cognitive strategies to control the desire for visual food cues (top-down control) affect themesocorticolimbic and hypothalamic systems in AN patients differently than in healthy controls. The interaction between thehypothalamus and the mesocorticolimbic reward system will be investigated using an effective connectivity analysis. FMRI with highspatial resolution and with an optimized protocol for the investigation of the hypothalamus and the mesocorticolimbic reward system will be used to study for the first time homeostatic and non-homeostatic food cue processing in AN patients.