Binge Eating: Clinical Patterns & Biological Correlates

描述(由申请人提供)：这个项目是我们工作的延伸，目的是提高对一种临床意义重大和普遍存在的饮食失调(PD)的认识和理解，这种饮食失调并未另行规定。帕金森病的特点是在正常或少量食物摄入后，经历身体形象障碍的正常体重的人反复排泄。该项目研究了一套心理和生理机制(缺乏饱腹感和钝化的肠肽、Ghrelin和PYY，对食物摄取的反应)与暴饮暴食特别相关的建议，以及另一套单独的变化(过度饱腹感、胃肠道不适和胃排空延迟)与通便有关的建议。通过研究暴饮暴食与通便的不同相关因素，这项新的研究有助于开发治疗饮食障碍的药物，特别是帕金森病--一种新的特征障碍，目前尚无循证治疗方法。这项新的研究还将增加必要的信息，以评估在诊断系统中定义帕金森病的有效性。参与者将包括帕金森病患者(n=25)、神经性暴食症净化亚型(BNP；n=25)、BN非净化亚型(BNnp；n=25)和健康女性对照组(n=25)。在第一次研究访问期间，参与者将完成结构化的临床访谈、问卷调查和体检，以评估临床特征和资格。在第二次研究访问期间，参与者将吃一顿即兴测试餐。结果将显示，与对照组相比，BNP和BNNP(都以反复暴饮暴食为特征)是否表现出不足的饱足感，以及与对照组相比，帕金森病是否表现出过度饱足。在第三次和第四次访问中，参与者将以双盲、安慰剂对照的交叉设计，食用固定的测试餐，并使用单次10毫克口服甲氧氯普胺进行胃排空的实验性操作。固定膳食+安慰剂条件下的结果将被用来检查BNP和BNnp是否表现出相对于对照组和PD的迟钝的Ghrelin和PYY反应，以及PD和BNP(都以反复排泄为特征)是否表现出比对照组和BNnp更多的胃肠道不适和胃排空延迟。最后，在固定测试餐+安慰剂与固定测试餐+甲氧氯普胺条件下的组之间的比较将被用来测试与其他组相比，胃排空增加是否导致帕金森病患者胃肠不适的减少。所有四次访问都将在爱荷华大学的临床和翻译科学研究所进行，该研究所由美国国立卫生研究院临床和翻译科学奖资助。我们的心理生物学重点将使我们能够将关于肠肽和胃排空对饱腹感的影响的基础研究发现转化为有助于BN和PD的发展或维持的因素的解释性模型，并将有助于开发有效的药物治疗来治疗这些危险的饮食失调。公共卫生相关性：饮食失调是严重的精神健康问题，影响着美国500多万人。拟议的工作将通过确定导致暴饮暴食与净化的心理生物学因素来加强治疗努力，而暴饮暴食是大多数饮食障碍的核心特征。

DESCRIPTION (provided by applicant): This project is an extension of our work to improve the recognition and understanding of a clinically significant and prevalent Eating Disorder Not Otherwise Specified, "Purging Disorder" (PD). PD is characterized by recurrent purging after normal or small amounts of food in individuals of normal weight who experience body image disturbance. This project examines the proposal that one set of psychological and physiological mechanisms (deficient satiation and blunted gut peptide, ghrelin and PYY, responses to food intake) is particularly associated with bingeing, and that a separate set of alterations (excessive satiation, gastrointestinal distress and delayed gastric emptying) is linked to purging. By examining factors differentially associated with binge eating vs. purging, this new study can contribute to the development of pharmacological treatments for eating disorders, particularly PD - a newly characterized disorder for which no evidence-based treatments exist. The new study also will add necessary information for evaluating the validity of defining PD within diagnostic systems. Participants will include women with PD (n=25), bulimia nervosa purging subtype (BNp; n=25), BN nonpurging subtype (BNnp; n=25), and healthy female controls (n=25). During a 1st study visit, participants will complete structured clinical interviews, questionnaires, and medical exams for evaluation of clinical features and eligibility. During a 2nd study visit, participants will consume an ad lib test meal. Results will show whether BNp and BNnp (both characterized by recurrent bingeing) demonstrate deficient satiation compared to controls and whether PD demonstrates excessive satiation compared to controls. During a 3rd and 4th visit, participants will consume a fixed test meal and undergo an experimental manipulation of gastric emptying using a single 10 mg oral dose of metoclopramide in a double-blind, placebo-controlled cross-over design. Results from the fixed meal + placebo condition will be used to examine whether BNp and BNnp demonstrate blunted ghrelin and PYY responses relative to controls and PD and whether PD and BNp (both characterized by recurrent purging) demonstrate increased gastrointestinal distress and delayed gastric emptying relative to controls and BNnp. Finally, the comparison of groups in the fixed test meal + placebo vs. fixed test meal + metoclopramide conditions will be used to test whether increased gastric emptying causes reductions in gastrointestinal distress in PD relative to the other groups. All 4 visits will occur in the University of Iowa's Institute for Clinical and Translational Science, funded by an NIH Clinical and Translational Science Award. Our psychobiological focus will allow us to translate basic research discoveries on the effects of gut peptides and gastric emptying on satiation into explanatory models for factors that contribute to the development or maintenance of BN and PD and will contribute to the development of effective pharmacological treatments for these dangerous disorders of eating. PUBLIC HEALTH RELEVANCE: Eating disorders represent significant mental health problems that affect over 5 million people in the United States. The proposed work will enhance treatment efforts by identifying psychobiological factors that contribute to the development of binge eating versus purging, core features of most eating disorders.