Binge Eating: Clinical Patterns & Biological Correlates

描述（由申请人提供）：该项目是我们工作的延伸，以提高对临床上显著和普遍的饮食失调症（未另行说明）的认识和理解，“清除障碍”（PD）。PD的特征是在经历体像障碍的正常体重个体中，在正常或少量食物后的复发性腹泻。该项目研究了一组心理和生理机制（缺乏饱腹感和钝化的肠肽，ghrelin和PYY，对食物摄入的反应）与暴饮暴食特别相关的建议，以及一组单独的改变（过度饱腹感，胃肠道不适和胃排空延迟）与清除有关。通过检查与暴饮暴食与净化相关的差异因素，这项新研究可以促进饮食障碍药物治疗的发展，特别是PD -一种新特征的疾病，没有基于证据的治疗方法。这项新研究还将增加必要的信息，以评估诊断系统中定义PD的有效性。参与者将包括患有PD（n=25）、神经性贪食症清除亚型（BNp; n=25）、BN非清除亚型（BNnp; n=25）和健康女性对照（n=25）的女性。在首次研究访视期间，受试者将完成结构化临床访谈、问卷调查和医学检查，以评价临床特征和合格性。在第2次研究访视期间，受试者将自由进食试验餐。结果将显示BNp和BNnp（均以反复暴食为特征）与对照相比是否表现出饱足不足，以及PD与对照相比是否表现出过度饱足。在第3次和第4次访视期间，受试者将食用固定的试验餐，并在双盲、安慰剂对照交叉设计中使用单次10 mg口服剂量的甲氧氯普胺进行胃排空的实验操作。来自固定膳食+安慰剂条件的结果将用于检查BNp和BNnp相对于对照和PD是否表现出减弱的胃饥饿素和PYY反应，以及PD和BNp（均以反复性排空为特征）相对于对照和BNnp是否表现出增加的胃肠道不适和延迟的胃排空。最后，将使用固定试验餐+安慰剂与固定试验餐+甲氧氯普胺条件下的组比较来检验相对于其他组，胃排空增加是否会导致PD患者胃肠道不适减少。所有4次访视都将在爱荷华州大学的临床和转化科学研究所进行，该研究所由NIH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有关肠道肽和胃排空对饱腹感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障碍。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。拟议的工作将通过确定有助于暴食与净化发展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.