Binge Eating: Clinical Patterns & Biological Correlates

描述（由申请人提供）：本项目是我们工作的延伸，旨在提高对临床显著且普遍的进食障碍（未另行说明的进食障碍）的认识和理解，“进食障碍”（PD）。PD的特点是正常体重的个体在正常或少量进食后反复排便，并经历身体形象障碍。本项目研究了一组心理和生理机制（饱腹感不足、肠道肽迟钝、胃饥饿素和PYY，对食物摄入的反应）与暴饮暴食特别相关，而另一组变化（过度饱腹感、胃肠不适和胃排空延迟）与排便有关。通过检查与暴食和排便相关的不同因素，这项新研究可以促进饮食失调的药物治疗的发展，特别是PD -一种新的特征疾病，目前尚无循证治疗方法。这项新研究还将为评估诊断系统中PD定义的有效性提供必要的信息。参与者包括PD患者（n=25）、神经性贪食清除亚型（BNp, n=25）、BN非清除亚型（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、问卷调查和医学检查，以评估临床特征和资格。在第二次研究访问期间，参与者将食用一份即席测试餐。结果将显示与对照组相比，BNp和BNnp（两者都以复发性暴食为特征）是否表现出饱腹不足，以及PD是否表现出与对照组相比的过度饱腹。在第三次和第四次访问期间，参与者将食用固定的测试餐，并在双盲，安慰剂对照交叉设计中使用单次口服10mg甲氧氯普胺进行胃排空的实验操作。固定膳食+安慰剂条件下的结果将用于检查BNp和BNnp是否表现出相对于对照组和PD的胃饥饿素和PYY反应减弱，以及PD和BNp（均以反复泻泻为特征）是否表现出相对于对照组和BNnp的胃肠窘迫增加和胃排空延迟。最后，比较固定试验餐+安慰剂组与固定试验餐+甲氧氯普胺组的情况，将用于测试胃排空增加是否导致PD患者胃肠道窘迫相对于其他组的减少。所有4次访问都将在爱荷华大学临床和转化科学研究所进行，该研究所由美国国立卫生研究院临床和转化科学奖资助。我们的心理生物学重点将使我们能够将肠道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发展或维持的因素的解释模型，并将有助于开发有效的药物治疗这些危险的饮食失调。公共卫生相关性：饮食失调是影响美国500多万人的重大心理健康问题。这项提议的工作将通过识别导致暴饮暴食和排便的心理生物学因素来加强治疗工作，这是大多数饮食失调的核心特征。

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.