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Introduction Anorexia nervosa (AN) is a widespread, metabo-psychiatric disorder with high relapse rates, comorbidity, and mortality. Many regulatory proteins and neurohormones studied to date play essential roles in the etiopathogenesis of eating disorders and the maintenance of psychopathological symptoms. Nevertheless, the regulatory and pathophysiological mechanisms of AN are still poorly understood. Objectives The present study aimed to investigate the plasma levels of asprosin (ASP) and apelin-13 (APE-13) in malnourished (AN1) and partially cured (AN2) adolescent patients with AN. Correlations between protein levels and several dimensions of AN symptomatology, such as eating disorder, depressive, and obsessive compulsive symptoms, were investigated. Methods Sixty-four patients aged 11–18 years admitted to the Department of Child and Adolescent Psychiatry in the acute phase of AN participated in the study. Between the 1st and 3rd days of admission, patients with AN (AN1) underwent psychometric evaluation, height and weight assessment, and 15 mL of blood was drawn. The same procedures were repeated at a second time point about 11.2 ± 2.3 weeks later, after partial normalization of body weight on the day of discharge (AN2). The control group (CG) normal-weight girls with no history of psychiatric disorders, recruited from among the students of a local school. The Eating Attitudes Test (EAT-26), Beck Depression Inventory (BDI) Hamilton Depression Scale (HAMD) and Yale–Brown Obsessive Compulsive Scale (CYBOCS), were used to assess eating disorder symptoms, depression, obsessions and compulsions. Patients were included in a nutritional rehabilitation program. Daily caloric intake was 2000–2500 kcal and was gradually increased to 3500–4000 kcal depending on weight gain (1.0–1.5 kg per week). Results APE-13 levels were higher in the AN1 group than in the post-realimentation and the CG group. APE-13 levels were independent of insulin and glucose levels. Plasma ASP levels increased with increasing body weight in patients with AN, correlating with the severity of eating disorder symptoms in emaciation. Image: Image 2: Image 3: Conclusions The presented data suggest that APE-13 and ASP may be AN’s biomarkers-regulation of eating behavior by APE-13 and ASP, the close relationship between them and emotional behavior, and changes in neurohormone levels in patients with eating and affective disorders seem to support these hypotheses. Moreover, their plasma levels seem to be related to the severity of psychopathological symptoms of eating disorders. Disclosure of InterestNone Declared

Introduction Management of patients with anorexia nervosa (AN) desires psychiatric/medical care. In average AN disease onset they represent a younger generation than 18 y.o. In this age typically children and adolescents are under regular dental care. Whether young AN patients should be included to intensive oral supervision may be still questionable. In literature little information on changes in oral cavity caused by AN were reported. Objectives Therefore, the aim of the study was to evaluate caries incidence, tooth wear, gingival inflammation, and oral hygiene level among adolescent AN inpatients, highlighting the aspect of oral health manifestations in case-control study. Methods Based on clinically confirmed 130 AN restrictive subtype hospitalized female subjects (BMI

Background: The present study aimed to evaluate cognitive function and laboratory parameters in adolescent girls with anorexia nervosa (AN) before and after nutritional rehabilitation (NR) compared to healthy female peers (CG)., Methods: We evaluated 36 girls with AN at two-time points, during acute malnutrition (AN1) and after NR, in a partially normalized weight status (AN2). We compared their cognitive functions and laboratory parameters to 48 healthy CG subjects. Cognitive function was assessed using a Cognitive Assessment Battery (CAB) assessment, depressive symptom levels were assessed using a Beck Depression Inventory (BDI) assessment, and eating disorders were assessed using an Eating Attitude Test (EAT-26)., Results: The AN1 group scored better in total cognition, attention, estimation, and spatial perception than the CG group ( p < 0.05), with scores increasing in the AN2 group. Shifting and visual perception values did not differ between the study groups ( p = 0.677, p = 0.506, respectively). Laboratory tests showed no significant abnormalities and did not differ significantly between groups ( p > 0.05). There was a negative correlation for EAT-26 and CAB in the AN1 group (rho = -0.43, p = 0.01), but not for BDI., Conclusions: Cognitive function in adolescent girls with AN was better than CG and correlated with EAT-26 score. These results highlight the high compensatory capacity of the adolescent body to maintain cognitive function despite severe malnutrition. Our results suggest that although normalization of body weight is crucial, other factors can significantly influence improvements in cognitive function. Cognitive deficits and laboratory tests may not be biomarkers of early forms of AN.

Oxytocin (OXT) is a hypothalamic peptide that plays a number of roles in the body, being involved in labor and lactation, as well as cognitive-emotional processes and social behavior. In recent years, knowledge of the physiology of OXT has been repeatedly used to explore its potential role in the treatment of numerous diseases, identifying a significant role for OXT in appetite regulation, eating behavior, weight regulation, and food-related beliefs. In this review we provide an overview of publications on this topic, but due to the wealth of research, we have limited our focus to studies based on the use of intranasal OXT in psychiatric diseases, with a particular focus on the role of oxytocin in eating disorders and obesity. Accumulating evidence that OXT intranasal supplementation may provide some therapeutic benefit seems promising. In individuals with autistic spectrum disorders (ASD) and schizophrenia, OXT may affect core deficits, improving social cognition and reducing symptom severity in schizophrenia. Dysregulation of serum and CSF OXT levels, as well as polymorphisms of its genes, may affect emotion perception in patients with eating disorders and correlate with co-occurring depressive and anxiety disorders. Nevertheless, there are still many critical questions regarding the pharmacokinetics and pharmacodynamics of intranasal OXT that can only be answered in larger randomized controlled trials., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objectives: This 2023 update of the WFSBP guidelines for the pharmacological treatment of eating disorders (EDs) reflects the latest diagnostic and psychopharmacological progress and the improved WFSBP recommendations for the assessment of the level of evidence (LoE) and the grade of recommendation (GoR)., Methods: The WFSBP Task Force EDs reviewed the relevant literature and provided a timely grading of the LoE and the GoR., Results: In anorexia nervosa (AN), only a limited recommendation (LoE: A; GoR: 2) for olanzapine can be given, because the available evidence is restricted to weight gain, and its effect on psychopathology is less clear. In bulimia nervosa (BN), the current literature prompts a recommendation for fluoxetine (LoE: A; GoR: 1) or topiramate (LoE: A; GoR: 1). In binge-eating disorder (BED), lisdexamfetamine (LDX; LoE: A; GoR: 1) or topiramate (LoE: A; GoR: 1) can be recommended. There is only sparse evidence for the drug treatment of avoidant restrictive food intake disorder (ARFID), pica, and rumination disorder (RD)., Conclusion: In BN, fluoxetine, and topiramate, and in BED, LDX and topiramate can be recommended. Despite the published evidence, olanzapine and topiramate have not received marketing authorisation for use in EDs from any medicine regulatory agency.

Background: The aim of this study was to assess barriers and facilitators in the pathways toward specialist care for eating disorders (EDs)., Methods: Eleven ED services located in seven European countries recruited patients with an ED. Clinicians administered an adapted version of the World Health Organization "Encounter Form," a standardized tool to assess the pathways to care. The unadjusted overall time needed to access the ED unit was described using the Kaplan-Meier curve., Results: Four-hundred-nine patients were recruited. The median time between the onset of the current ED episode and the access to a specialized ED care was 2 years. Most of the participants did not directly access the specialist ED unit: primary "points of access" to care were mental health professionals and general practitioners. The involvement of different health professionals in the pathway, seeking help for general psychiatric symptoms, and lack of support from family members were associated with delayed access to ED units., Conclusions: Educational programs aiming to promote early diagnosis and treatment for EDs should pay particular attention to general practitioners, in addition to mental health professionals, and family members to increase awareness of these illnesses and of their treatment initiation process.

Objectives: This study attempts to assess the concentration of two opposite-acting adipokines (anti-inflammatory adiponectin and pro-inflammatory resistin) in antidepressant-resistant patients undergoing ketamine infusion (KI) and electroconvulsive therapy (ECT)., Methods: The study group comprised 52 patients hospitalised due to episodes of depression in the course of bipolar disorders. The Hamilton depression scale was used to assess the intensity of the depression symptoms before starting therapy and one day after its completion. The serum concentration of adipokines was determined before and after the therapeutic intervention using an ELISA method., Results: Baseline adipokine levels differed between patients receiving KI and ECT therapy. Regardless of the procedure used, these levels changed after treatment, with the nature of these changes being different. In the case of KI, the adiponectin levels increased, and resistin levels decreased. In contrast, after ECT, the concentrations of both adipokines decreased. Changes in adipokine concentrations correlated with improvement in mental status, as assessed by the Hamilton Rating Scale, type of bipolar disorder, and gender., Conclusions: Adipokines remain interesting candidate biomarkers in assessing the state and course of the disease depending on the therapeutic procedure applied. However, the relatively small study group and limited original research available for discussion justify further investigation.

Anorexia nervosa (AN) is a widespread, metabo-psychiatric disorder with high relapse rates, comorbidity, and mortality. Many regulatory proteins and neurohormones studied to date play essential roles in the etiopathogenesis of eating disorders and the maintenance of psychopathological symptoms. Nevertheless, the regulatory and pathophysiological mechanisms of AN are still poorly understood. In the presented study, the plasma levels of apelin-13 (APE-13) and asprosin (ASP), as well as carbohydrate metabolism parameters and psychometric parameters, were evaluated in low-weight adolescent female patients with AN (AN1), after partial weight normalization (AN2) and in an age-matched healthy control group (CG) were evaluated. APE-13 levels were higher in the AN1 group than in the post-realimentation and the CG group. APE-13 levels were independent of insulin and glucose levels. Plasma ASP levels increased with increasing body weight in patients with AN, correlating with the severity of eating disorder symptoms in emaciation. The presented data suggest that APE-13 and ASP may be AN's biomarkers-regulation of eating behavior by APE-13 and ASP, the close relationship between them and emotional behavior, and changes in neurohormone levels in patients with eating and affective disorders seem to support these hypotheses. Moreover, their plasma levels seem to be related to the severity of psychopathological symptoms of eating disorders.

Background: Patients who suffer from anorexia nervosa (AN) are characterized by exceedingly lower body weight, micro- and macro-nutrient deficiencies, and hyposalivation as compared to healthy subjects. In addition, AN may predispose to difficulties in oral health maintenance. However, little is known about the relationship between stress-dependent salivary neuro/immunopeptidergic biomarkers such as opiorphin and immunoglobulins (Ig) and AN.The aim of this case-control study was to evaluate salivary opiorphin and immunoglobulins in female children and adolescents diagnosed with AN compared to healthy controls., Methods: Adolescent patients with clinically-confirmed severe restrictive subtype AN (Body Mass Index BMI < 15 kg/m 2 , mean age 15.0 ± 1.8, n = 83) were examined in the first week of hospital admission and compared to healthy matched controls (n = 79). Measurements of salivary opiorphin, IgA, IgG, IgM (ELISA technique), and oral hygiene levels (Plaque Control Record index-PCR) were performed., Results: In the AN group, a significantly higher concentration of opiorphin was evidenced (3.1 ± 4.1 ng/ml) compared to the control group (1.1 ± 1.2 ng/ml), (p < 0.001), contrary to IgM, which was significantly lower (311.0 ± 185.3 ng/ml) than in the control group (421.2 ± 168.1 ng/ml), (p < 0.001). There were no significant differences in the levels of IgA and IgG, despite a higher concentration of IgA in the AN group vs. controls (p = 0.14). Spearman analysis revealed a correlation between opiorphin and age (p < 0.05), but also with all immunoglobulins IgA, IgG, IgM (p = 0.006, p < 0.001, p < 0.001). Similarly a correlation was found between PCR index and immunoglobulins IgG, IgM (respectively p = 0.028, p < 0.001), and between body mass, BMI, IBW% and IgA, IgM (all p < 0.05)., Conclusions: In the acute phase of AN, salivary changes in opiorphin and immunoglobulins related to dental plaque suggest an essential role in oral health balance. Changes related to AN may affect the anti-inflammatory and analgesic components of saliva and suggest their use as neurobiological markers in severe malnutrition., (© 2022. The Author(s).)

Introduction: Restrictive type of anorexia nervosa (AN) is still one of the most severe eating disorders worldwide with an uncertain prognosis. Patients affected by AN should be encouraged to undertake psychiatric care and psychotherapy, but whether they should necessarily be included in careful dental care or not may still be questionable. Even though there is a constantly increasing number of AN studies, there are just a few data about the youngest group of AN children and adolescents aged < 18., Methodology: This case-control study aimed to compare the dental health and gingival inflammation level in female adolescent inpatients affected by severe AN restrictive subtype vs. controls. Based on clinically confirmed 117 AN cases (hospitalized in years 2016-2020 in public Psychiatric Unit, BMI < 15 kg/m 2 , mean age 14.9 ± 1.8), the dental status has been examined regarding the occurrence of caries lesions using Decay Missing Filling Teeth (DMFT), erosive wear as Basic Erosive Wear Examination (BEWE), gingival condition as Bleeding on Probing (BOP) and plaque deposition as Plaque Control Record (PCR). The results were compared with age-matched 103 female dental patients (BMI 19.8 ± 2.3 kg/m 2 , age 15.0 ± 1.8, p = 0.746) treated in a public University dental clinic., Results: AN patients were found to present a higher incidence of oral-related complications according to dental status (DMFT 3.8 ± 4.5 vs. 1.9 ± 2.1, p = 0.005), erosive tooth wear (BEWE 18.9 vs. 2.9%, p < 0.001), less efficient in controlling plaque (PCR 43.8 vs. 13.7%, p < 0.001) and gingival inflammation (BOP 20.0 vs. 3.9%, p < 0.001) compared with female adolescents. In the AN group, a significant correlation between BOP, BEWE, and duration of AN disease ( p < 0.05), similarly to the number of decayed teeth D, filled teeth F and PCR were detected ( p < 0.05)., Conclusions: Although the obtained results did not reveal any severe oral status, our findings indicated impaired dental and gingival conditions in young anorexics. Considering AN's potential role in oral health, it is essential to monitor dental treatment needs and oral hygiene levels in their present status to prevent forward complications in the future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Paszynska, Hernik, Slopien, Roszak, Jowik, Dmitrzak-Weglarz and Tyszkiewicz-Nwafor.)

Anorexia nervosa (AN) is a metabo-psychiatric disorder where alterations of cytokines, neuropeptides, neurotransmitters, and the interactions between these factors can play an important role. Thus, the primary goal of the presented study was a cross-sectional analysis of immune-related proteins in patients with AN. Moreover, the correlations between these molecules and selected neuropeptides were studied. Twenty-five adolescent inpatients girls in the acute stage of a restrictive type of AN were enrolled in the study within the first year of the disease. Additionally, thirty similar in age and height controls (CG) were also assessed. The levels of 24 immune-related proteins, including cytokines, chemokines, and proteases, were measured. Moreover, selected adipocytokines, gastrointestinal hormones, and centrally produced neuropeptides levels were determined. Finally, the correlations between these molecules were analyzed. The fasting levels of CXCL1, CXCL9, FGF2, GrB, IL1, IL6, IL8, MMP8, MMP9, CTSS were statistically lower in AN than in the CG. The concentrations of many immune-related proteins remain unchanged despite their metabolic and mental condition. Moreover, significant correlations were found between leptin and CXCL1, CXCL9, GrB, IL1, IL6, and MMP8. Leptin receptors were correlated with GrB, while resistin was associated with MMP9. Our findings suggest that the initial stage of restrictive AN among adolescents within the first year of the disease is not connected with a pro-inflammatory state. Some immune-related protein changes may be associated with altered neuropeptides, primarily leptin, its receptors, and resistin. Future research should clarify which changes are primary and secondary to weight loss and whether these changes normalize with increasing weight. This would aid in understanding the complex etiopathogenesis of AN and in the search for new methods of treatment., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: The use of easily accessible biomarkers for assessing young patients' health is weighty. This cohort study is aimed at measuring stress/immune biomarkers in the saliva of healthy school-age children and comparing subgroups according to age, sex, and stress perception. Material and Methods . 503 children under 12 years old (8.7 ± 1.3) were included with anthropometric evaluation (height, waist, hip circumference, body weight, and body mass index (BMI)). Levels of opiorphin (OPI), free cortisol, alpha-amylase (sAA), and secreted immunoglobulin (sIgA) were determined by quantitative assays (ELISA) in unstimulated saliva. Unpaired t -test, Welch test, and Mann-Whitney U test were applied for appropriate group comparisons, and the correlation between variables was analyzed with Spearman's rank coefficient. Results were considered significant at p < 0.05., Results: sIgA and sAA exhibited significant differences depending on age and sex: IgA (ng/mL): 86 ± 68.6 vs. 104.9 ± 72.1 for (6-7 y.o.) and (8-11 y.o.), respectively, and 108.1 ± 80.1 vs. 94.6 ± 62.2 for male and females, respectively; sAA (U/mL): 78.9 ± 54.4 vs. 100.5 ± 81.2 for (6-7 y.o.) and (8-11 y.o.). No difference related to age or sex between groups was observed for cortisol and OPI. However, OPI levels were higher and correlated to prior stress exposure in children (0.31 ± 0.4 vs. 0.26 ± 0.5 ng/mL, p = 0.031). sAA was negatively correlated to low mood self-declaration in children in the last two weeks ( r = -0.10, p = 0.045)., Conclusions: sIgA and sAA can be used as sex- and age-related biomarkers in children 6-12 y.o., which is not the case for free cortisol and opiorphin. However, OPI reflected previous exposure to stress, suggesting its use for evaluating stress-related changes in children., Competing Interests: The authors declare that they have no conflicts of interests., (Copyright © 2021 Anna Krahel et al.)

Objectives: It is hypothesized that novel neuropeptides such as phoenixin (PNX), spexin (SPX), and kisspeptin (KISS) are involved in the pathogenesis of eating disorders. The study presented here analyzed neuropeptide concentrations during the course of anorexia nervosa (AN) and aimed to correlate those values with anthropometric and psychometric measurements., Methods: A longitudinal study was carried outin 30 AN adolescent patients and 15 age-matched healthy female controls. Selected neuroprotein serum levels were analyzed in malnourished patients (accAN) and following partial weight recovery (norAN), and these values were compared with the control group., Results: In accAN patients, decreased serum PNX levels were detected while SPX serum concentrations were lower in the accAN and norAN patients. No differences were observed in KISS concentrations in all studied groups., Conclusions: In malnourished adolescent inpatients with AN, serum PNX and SPX level were decreased. The partial weight recovery normalized PNX concentrations but failed to normalize SPX levels. Therefore these two neuropeptides might be crucial for the etiology and course of the AN. The KISS levels did not change in the course of AN. The PNX levels were associated with some symptoms of eating disorders which may indicate its potential contribution in the regulation of emotions and behaviors in AN.

Anorexia nervosa (AN) is a psycho-metabolic disorder with a high risk of somatic complications such as refeeding syndrome (RFS) and carries the highest mortality rate of all psychiatric illnesses. To date, the consensus on the care for patients with AN has been based on recommendations for a combination of alimentation and psychotherapy. It is important to establish an initial caloric intake that will provide weight gain and minimize the risk of complications in the treatment of undernourished patients. Research over the past few years suggests that current treatment recommendations may be too stringent and should be updated. The aim of this paper is to systematize the current reports on nutritional rehabilitation in AN, to present the results of studies on the safe supplementation of patients and its potential impact on improving prognosis and the healing process. This review of literature, from 2011-2021, describes the changing trend in the nutritional protocols used and the research on their efficacy, safety, and long-term effects. In addition, it presents previous reports on the potential benefits of introducing vitamin, pro-and prebiotic and fatty acid supplementation.

Background: Genetics and biology may influence the age of onset of anorexia nervosa (AN). The aims of this study were to determine whether common genetic variation contributes to age of onset of AN and to investigate the genetic associations between age of onset of AN and age at menarche., Methods: A secondary analysis of the Psychiatric Genomics Consortium genome-wide association study (GWAS) of AN was performed, which included 9335 cases and 31,981 screened controls, all from European ancestries. We conducted GWASs of age of onset, early-onset AN (<13 years), and typical-onset AN, and genetic correlation, genetic risk score, and Mendelian randomization analyses., Results: Two loci were genome-wide significant in the typical-onset AN GWAS. Heritability estimates (single nucleotide polymorphism- h 2 ) were 0.01-0.04 for age of onset, 0.16-0.25 for early-onset AN, and 0.17-0.25 for typical-onset AN. Early- and typical-onset AN showed distinct genetic correlation patterns with putative risk factors for AN. Specifically, early-onset AN was significantly genetically correlated with younger age at menarche, and typical-onset AN was significantly negatively genetically correlated with anthropometric traits. Genetic risk scores for age of onset and early-onset AN estimated from independent GWASs significantly predicted age of onset. Mendelian randomization analysis suggested a causal link between younger age at menarche and early-onset AN., Conclusions: Our results provide evidence consistent with a common variant genetic basis for age of onset and implicate biological pathways regulating menarche and reproduction., (© 2021 The Authors.)

Comorbidity studies show that children with ADHD have a higher risk of being overweight and obese than healthy children. This study aimed to assess the genetic alternations that differ between and are shared by ADHD and excessive body weight (EBW). The sample consisted of 743 Polish children aged between 6 and 17 years. We analyzed a unique set of genes and polymorphisms selected for ADHD and/or obesity based on gene prioritization tools. Polymorphisms in the KCNIP1, SLC1A3, MTHFR, ADRA2A , and SLC6A2 genes proved to be associated with the risk of ADHD in the studied population. The COMT gene polymorphism was one that specifically increased the risk of EBW in the ADHD group. Using the whole-exome sequencing technique, we have shown that the ADHD group contains rare and protein-truncating variants in the FBXL17, DBH, MTHFR, PCDH7, RSPH3, SPTBN1 , and TNRC6C genes. In turn, variants in the ADRA2A, DYNC1H1, MAP1A, SEMA6D , and ZNF536 genes were specific for ADHD with EBW. In this way, we confirmed, at the molecular level, the existence of genes specifically predisposing to EBW in ADHD patients, which are associated with the biological pathways involved in the regulation of the reward system, intestinal microbiome, and muscle metabolism.

Anorexia nervosa (AN) is associated with significant weight loss; thus, it is crucial to discern the contribution of hormones produced by adipose tissue. Some of the adipokines have not been sufficiently studied. Therefore, the present study aims to measure serum concentrations of omentin and visfatin, in adolescent inpatients with AN. The correlations between selected adipokines and psychopathological symptoms of AN were also analyzed. Thirty adolescent inpatients with anorexia nervosa and thirty healthy age and height matched girls (CONT) were enrolled in the study. The physical and mental examination, anthropometric and psychometric assessment - Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS), Eating Attitude Test (EAT-26) and Yale-Brown Obsessive-Compulsive Scale (YBOCS), and blood analysis were performed at two-time points - in the malnourished patients (AN T1) and after partial weight recovery (8.30 ± 3.75 weeks) (AN T2). The omentin concentration was not significantly different from the CONT neither in AN T1 nor AN T2. The visfatin level was altered in AN T1 and did not change after partial weight normalization (AN T2). A positive correlation between visfatin and YBOCS was found in AN T2. Visfatin concentrations were decreased in adolescent inpatients suffering from AN in the acute phase of the disease and did not normalize after partial weight restoration. The studies considering visfatin as a biomarker of the acute phase of AN should be continued. Moreover, the visfatin showed association with the obsessive and compulsive symptoms; thus its participation in non-homeostatic regulation of food intake should be investigated in further studies., (Copyright © 2021. Published by Elsevier Ltd.)

Neuropeptide Y (NPY) and peptide YY (PYY) are involved in metabolic regulation. The purpose of the study was to assess the serum levels of NPY and PYY in adolescents with anorexia nervosa (AN) or obesity (OB), as well as in a healthy control group (CG). The effects of potential confounders on their concentrations were also analysed. Eighty-nine adolescents were included in this study (AN = 30, OB = 30, and CG = 29). Anthropometric measurements and psychometric assessment of depressive symptoms, eating behaviours, body attitudes, and fasting serum levels of NPY and PYY were analysed. The AN group presented severe depressive symptoms, while the OB group held different attitudes towards the body. The levels of NPY were lower in the AN and OB groups as compared with the CG. The PYY levels were higher in the OB group than in the AN group and the CG. The severity of eating disorder symptoms predicted fasting serum concentrations of NPY. Lower levels of NPY in AN, as well as in OB suggests the need to look for a common link in the mechanism of this effect. Higher level of PYY in OB may be important in explaining complex etiopathogenesis of the disease. The psychopathological symptoms may have an influence on the neurohormones regulating metabolism.

Background . This cross-sectional study aimed to evaluate stress and immune biomarkers in saliva samples of attention-deficit/hyperactivity disorder ADHD compared to healthy non-ADHD children. Material and methods . A total of 132 children under 11 years old (8.5 ± 1.1) enrolled in a cross-sectional study: with confirmed ADHD (n = 60) and healthy controls (n = 72). The clinical evaluation included physical measurements (height, waist, hip circumference, body weight, body mass index BMI, BMI z-score) and unstimulated saliva collection and measurements of free cortisol, salivary alpha-amylase (sAA), and secreted immunoglobulins (sIgA, IgG, and IgM) with quantitative assay (ELISA) analysis. Unpaired t -test, Welch test, or Mann-Whitney U test were applied for group comparisons when appropriate, and the correlation between variables was analyzed with Spearman's rank coefficient. Results were considered significant at p < 0.05. Results . In the ADHD group, body weight ( p ≤ 0.01), BMI ( p ≤ 0.009), and hip circumference ( p ≤ 0.001) significantly differed, while waist size and BMI z-score did not ( p > 0.05). Significant elevation of the salivary sAA ( p = 0.03), sIgA ( p = 0.02), and IgM ( p ≤ 0.001) biomarkers were detected, without differences in the morning cortisol ( p > 0.05). Significant correlations between cortisol and BMI, hip size, and IgA, as well as between IgG and sAA and IgA were obtained. Conclusions. Saliva can be used to monitor ADHD status with regard to biomarkers indicating the hypothalamus-pituitary-adrenal axis, as HPA axis, and sympathetic activity. The results indicate that morning collection of saliva in contrast to unchanged salivary cortisol, may evaluate mentioned above system dysregulations by measurements of sAA and immunoglobulins among ADHD children.

Eating disorders and substance use disorders frequently co-occur. Twin studies reveal shared genetic variance between liabilities to eating disorders and substance use, with the strongest associations between symptoms of bulimia nervosa and problem alcohol use (genetic correlation [r g ], twin-based = 0.23-0.53). We estimated the genetic correlation between eating disorder and substance use and disorder phenotypes using data from genome-wide association studies (GWAS). Four eating disorder phenotypes (anorexia nervosa [AN], AN with binge eating, AN without binge eating, and a bulimia nervosa factor score), and eight substance-use-related phenotypes (drinks per week, alcohol use disorder [AUD], smoking initiation, current smoking, cigarettes per day, nicotine dependence, cannabis initiation, and cannabis use disorder) from eight studies were included. Significant genetic correlations were adjusted for variants associated with major depressive disorder and schizophrenia. Total study sample sizes per phenotype ranged from ~2400 to ~537 000 individuals. We used linkage disequilibrium score regression to calculate single nucleotide polymorphism-based genetic correlations between eating disorder- and substance-use-related phenotypes. Significant positive genetic associations emerged between AUD and AN (r g = 0.18; false discovery rate q = 0.0006), cannabis initiation and AN (r g = 0.23; q < 0.0001), and cannabis initiation and AN with binge eating (r g = 0.27; q = 0.0016). Conversely, significant negative genetic correlations were observed between three nondiagnostic smoking phenotypes (smoking initiation, current smoking, and cigarettes per day) and AN without binge eating (r gs = -0.19 to -0.23; qs < 0.04). The genetic correlation between AUD and AN was no longer significant after co-varying for major depressive disorder loci. The patterns of association between eating disorder- and substance-use-related phenotypes highlights the potentially complex and substance-specific relationships among these behaviors., (© 2020 Society for the Study of Addiction.)

Neuropeptides are involved in numerous brain activities being responsible for a wide spectrum of higher mental functions. The purpose of this concise, structural and qualitative investigation was to map the possible immunoreactivity of the novel neuropeptide spexin (SPX) within the human magnocellular hypothalamus. SPX is a newly identified peptide, a natural ligand for the galanin receptors (GALR) 2/3, with no molecular structure similarities to currently known regulatory factors. SPX seems to have multiple physiological functions, with an involvement in reproduction and food-intake regulation recently revealed in animal studies. For the first time we describe SPX expressing neurons in the supraoptic (SON) and paraventricular (PVN) nuclei of the human hypothalamus using immunohistochemical and fluorescent methods, key regions involved in the mechanisms of osmotic homeostasis, energy expenditure, consummatory behaviour, reproductive processes, social recognition and stress responses. The vast majority of neurons located in both examined neurosecretory nuclei show abundant SPX expression and this may indirectly implicate a potential contribution of SPX signalling to the hypothalamic physiology in the human brain., (Copyright © 2020 Elsevier B.V. All rights reserved.)

In recent years, attention has been paid to the co-occurrence of attention deficit hyperactivity disorder (ADHD) and obesity, but results in relation to dental caries outcomes differ. The study was conducted to determine obesity/overweight and dental caries in children suffering from ADHD and to draw comparisons with non-ADHD children. A total of 119 children under 11 years old (8.2 ± 1.2) were enrolled into a cross-sectional study: those with confirmed ADHD ( n = 39), and healthy controls ( n = 80). The behavioral evaluation included a parent interview directed at sweetened food/drink habits. The clinical evaluation included physical measurements (height, waist, hip circumference, body weight, body mass index (BMI), and dental examination (International Caries Detection and Assessment System-ICDAS). Results showed a higher prevalence of abnormal body weight, hip circumference, and BMI, and a higher frequency of caries (84.6%) in the ADHD group. Significant caries differences for primary (ICDAS 0, 1, 2, 5, 6 scores) and permanent teeth (ICDAS 1, 3 scores) were recorded. The questionnaire pinpointed interplays between sugar consumption and tooth decay, especially for primary dentition. It can be concluded that the consumption of sweetened foods/drinks among ADHD children may lead to an increased rate of overweight, but may also affect oral health. Limiting sugar consumption might be one of the important elements in prevention programmes against dental caries and overweight/obesity.

Eating disorders (ED) constitute the third most common group of chronic diseases among people aged 14-19 years after asthma and obesity, and one of their forms is binge eating disorder (BED). The purpose of the present review was to summarize new research findings on BED and overview the epidemiology, characteristics, criteria, etiopathogenesis, and treatment. Etiopathogenesis of BED is still poorly understood, and the current state of knowledge leads to the conclusion that the pathomechanism of the development and persistence of the symptoms of that disorder is very complicated - factors influencing these symptoms have a genetic, neurobiological, biochemical, cognitive, and emotional background. Treatment targeted at selected pathogenetic mechanisms - i.a., disturbance in the corticostriatal circuit, neurohormonal dysregulation or incorrect regulation of emotions - may be of help for people with binge eating disorder. Often comorbid mental, e.g., mood, anxiety and personality disorders, psychoactive substance abuse, suicidal ideation and suicide attempts, and somatic problems are particularly crucial in the context of primary care physicians and psychiatrists work and should encourage the expanding knowledge about BED and the creation of interdisciplinary therapeutic teams.

Obesity in children is becoming a global epidemic. Health and emotional consequences can threaten life and health both during childhood and adulthood. In this study, we aimed to assess the coexistence of overweight and obesity, binge eating disorder and detrimental attitudes toward nutrition among school-age children. We also aimed to determine the usefulness of the Children's Binge Eating Disorder Scale (C-BEDS) as a screening tool. We examined a group of over 550 healthy children aged 6-12. In all, 15% were overweight, and 6% were obese. A total of 12% of the children presented an increased risk of eating disorders. The examined group of children significantly differed in the number of positive C-BEDS responses compared with the authors of the test. Test reliability as measured by the Cronbach's alpha coefficient was .008. Preliminary results indicate that the problem of excessive body weight affects every fifth child, consistent with previous reports. The C-BEDS used in this study did not permit the identification of children, neither with the risk of Binge Eating Disorder (BED) nor subthreshold BED. This may be due to the relatively low internal consistency of the questions contained in the scale.

Objectives: Opiorphin is a salivary peptide with analgesic and antidepressant properties. Its relationship with the hypothalamic-pituitary-adrenal, autonomic nervous and immune systems may provide understanding of chronic stress, especially in anorexia nervosa (AN). This study investigated a possible correlation between opiorphin and stress/immune biomarkers, cortisol, salivary alpha-amylase (sAA) and secretory immunoglobulin A (sIgA), in saliva of patients with restrictive-type AN. Methods: A case-control clinical trial was conducted in 92 AN patients (+75 healthy controls). Unstimulated salivary samples were taken during the acute stage of AN, measurements of cortisol, sAA, sIgA and opiorphin were performed with a quantitative assay (enzyme-linked immunosorbent assay, P  < 0.05). Results: AN patients displayed an increase in cortisol ( P  < 0.001) and sIgA ( P  < 0.001) but not in sAA ( P =  0.279) levels. Distinct correlation between these two parameters and body-weight indexes were observed. Opiorphin levels were neither correlated to stress and immune biomarkers, nor to salivary flow rate. Conclusions: The effect of stress responses can be reliably assessed in saliva in AN patients. The difference between sIgA and cortisol indicate that they can both be used for mental stress assessment in saliva. Modulation of opiorphin by chronic stress was not confirmed. Unchanged sAA indicates a partial adaptation of human organism to severe condition during malnutrition.

Objectives: Opiorphin is a physiological inhibitor of peptidases inactivating endogenous opioids displaying strong analgesic properties without undesirable side effects, antidepressant properties or hormonal dependency. It might therefore play an important role in patients with painful diseases related to neuro-hormonal dysregulation of the nervous system, affecting saliva secretion and composition such as anorexia nervosa (AN). The main objective aim of this study was to compare the level of opiorphin in saliva of patients with AN to matched subjects free of eating disorders. Methods: A case-control clinical trial was conducted in 68 AN patients and 43 healthy matched control subjects. Depression symptoms were assessed with the self-scored questionnaire Beck Depression Inventory (BDI) and salivary samples were taken during the acute stage of AN (BMI <15 kg/m 2 ) for measuring opiorphin. Opiorphin levels were measured with a quantitative assay using a commercial immunoenzymatic Elisa kit (cat no. EH1927, Wuchan, Hubei, China). Results: No statistically significant difference was found in salivary opiorphin levels between the AN and control groups, ( P  = 0.499, Mann-Whitney U -test). Positive correlations to duration of the disease, BDI and bodyweight in AN patients were evidenced. Conclusions: Measurement of salivary opiorphin levels cannot be used as a marker of AN but may allow new perspectives in monitoring AN in its early stages.

Introduction: Brain-derived neurotrophic factor (BDNF), as well as oxytocin (OXY), are centrally secreted neuropeptides regulating a range of physiological processes, including food intake and metabolism. Moreover, numerous reports suggest their role in affective and cognitive symptoms of various psychiatric disorders. Thus, the study aimed to measure the serum level of BDNF and its receptor-tropomyosin-related kinase B (TrkB) and OXY in the malnourished anorexia nervosa patients and following partial weight-recovery. The correlations between levels of these proteins with the primary symptoms of the anorexia nervosa (AN) were also analyzed., Methodology: Eighty-four adolescent AN patients were recruited into the study, but only forty-two AN patients completed it. The control group comprises of thirty age- and height-matched girls (CG). Serum BDNF, TrkB, and OXY levels were measured in AN group in two time-points-at the beginning of the hospitalization in malnourished patients (AN-T1) and again after partial weight normalization, on the day of discharge (AN-T2). The severity of eating disorders, as well as depressive and obsessive-compulsive symptoms, were assessed at the same two-time points., Results: Body mass index (BMI) differed significantly between the AN-T1, AN-T2, and CG. BDNF levels for the AN-T2 increased significantly in comparison to the AN-T1, but at two-time points were significantly lower than in the CG. The OXY level did not change with weight gain and in both groups AN-T1 and AN-T2 were statistically significantly higher than in the CG. Statistically significant negative correlations between BDNF and the severity of eating disorders symptoms were found. Depressive and obsessive-compulsive symptoms did not show significant correlations with levels of studied proteins for either malnourished or partially weight recovered AN patients., Conclusions: BDNF serum levels were decreased in the malnourished AN patients and tended to normalize with partial weight recovery. OXY serum levels were found to be increased in the malnourished AN patients and did not normalize with partial weight recovery, confirming previous reports about its role in the etiopathogenesis of AN. BDNF can be related to aberrant eating behaviors occurring in AN. Our results do not support the role of serum levels of BDNF, TrkB, or OXY in the modulation of depressive or obsessive-compulsive symptoms., (Copyright © 2020 Tyszkiewicz-Nwafor, Rybakowski, Dmitrzak-Weglarz, Skibinska, Paszynska, Dutkiewicz and Słopien.)

The aim of the study was to highlight the aspect of oral and cutaneous changes in anorexia nervosa (AN) as a purging type. On the basis of three clinical cases, a description has been made of the beginning and the possible course of the disease, teeth, oral mucosa, and skin changes resulting from the illness. The research method was based on the analysis of the available literature on AN supplemented by clinical experience of presented cases. On the basis of the interdisciplinary analysis, it was concluded that the appropriate diagnosis and treatment of AN are possible only with the collaboration of many specialists-psychiatrist or pediatric psychiatrist, general practitioner, dermatologist, dentist, and if necessary other medical specialists. In this context, psychotherapy is an integral aspect of treatment. Therefore, early intervention is essential to obtain good results of treatment., Competing Interests: None declared.

Objectives: Anorexia nervosa (AN) is a chronic illness where restriction of food intake results in decreased adipose tissue. The aim of this study was to measure the concentration of adiponectin and resistin in acute and partially weight-recovered anorectic inpatients. The associations of their levels with eating disorder symptoms were also assessed. Methods: A longitudinal study was conducted on 76 adolescent patients (ANG) and 30 age-matched healthy girls (CG). Selected adipokines serum levels, as well as the severity of depressive, obsessive-compulsive and disturbed eating behaviours, were analysed in the group of anorectic patients before (accAN) and after weight gain (recAN) and compared with the CG. Results: The concentration of adiponectin in the accAN was higher than in the CG ( P  = 0.05) and increased in recAN ( P  = 0.01). Resistin concentrations were lower in accAN and recAN than in the CG ( P =  0.00). A negative correlation between adiponectin and the scores in Yale-Brown Obsessive Compulsive Scale as well as positive between resistin and Beck Depression Inventory were found. Conclusions: In the acute AN, adiponectin and resistin levels are impaired and partial weight recovery fails to normalise them thus we suggest that they can be involved in the chronicity of certain symptoms. The level of adiponectin is associated with obsessive and compulsive symptoms and resistin with depressive symptoms, which indicates their potential contribution to the regulation of emotions and behaviours in AN.

Characterized primarily by a low body-mass index, anorexia nervosa is a complex and serious illness 1 , affecting 0.9-4% of women and 0.3% of men 2-4 , with twin-based heritability estimates of 50-60% 5 . Mortality rates are higher than those in other psychiatric disorders 6 , and outcomes are unacceptably poor 7 . Here we combine data from the Anorexia Nervosa Genetics Initiative (ANGI) 8,9 and the Eating Disorders Working Group of the Psychiatric Genomics Consortium (PGC-ED) and conduct a genome-wide association study of 16,992 cases of anorexia nervosa and 55,525 controls, identifying eight significant loci. The genetic architecture of anorexia nervosa mirrors its clinical presentation, showing significant genetic correlations with psychiatric disorders, physical activity, and metabolic (including glycemic), lipid and anthropometric traits, independent of the effects of common variants associated with body-mass index. These results further encourage a reconceptualization of anorexia nervosa as a metabo-psychiatric disorder. Elucidating the metabolic component is a critical direction for future research, and paying attention to both psychiatric and metabolic components may be key to improving outcomes.

Objectives: Patients with anorexia nervosa (AN) are primarily at high risk of multiple somatic complications, including oral diseases. In recent years, a number of new molecules that may play a potentially important role in AN progress and prognosis have been identified in saliva, but their exact roles are still poorly understood. Two such group of substances are antioxidants and vaspin. The purpose of this observational, cross-sectional study was to measure both the salivary and serum total antioxidant status (TAS), and vaspin (VASP) concentrations of patients with AN in comparison to an average population., Material and Methods: Ninety subjects participated (30 patients with AN, 60 matched healthy control subjects). A clinical examination was made, and blood and salivary samples were taken during the acute stage of AN (BMI < 15 kg/m 2 ) in the first week of hospitalization. Enzyme immunoassay (ELISA) suitable for measuring VASP and colorimetric assay for TAS were used., Results: Anorexic patients had significant reductions in salivary flow, TAS, and an elevation in VASP levels in their saliva and serum. Significant correlations between TAS, VASP, salivary flow, and nutritional status were detected., Conclusion: Determination of TAS and VASP in combined biological material confirmed that saliva might be a reliable non-invasive source of information for potent nutritional biomarkers., Clinical Relevance: Our findings suggest that VASP cannot be excluded, as its increased concentration in saliva is an adaptive mechanism in reduced TAS, one resulting from diminished salivary secretion. It is therefore worth conducting further research aimed at recognizing the role of TAS and VASP in the saliva of underweight patients.

Introduction: The aim of the study was to assess the correlation between the levels of neuropeptide B (NPB), neuropeptide W (NPW), vaspin (VAS), and the total antioxidant status (TAS) in the blood, as well as nutritional status of patients with anorexia nervosa (AN)., Materials and Methods: The study covered a cohort of 76 female teenagers, including 46 females with extreme AN and 30 healthy peers (CONTR) aged 12-17., Results: AN persons were characterized by higher (in comparison to CONTR) NPB and VAS concentrations and lower values of TAS levels, body weight, and anthropometric values. Positive correlations between NPB and VAS levels were noted in the AN group (R=0.33; p<0.001) as well as between concentrations of NPW and VAS in the same group (R=0.49; p<0.001). Furthermore, positive correlations existed between NPB and NPW concentrations across the whole studied population (AN+CONTR; R=0.75; p<0.000001), AN (R=0.73; p<0.000001) and CONTR (R=0.90; p<0.0005)., Conclusions: In detailed diagnostics of AN it is worth considering testing NPB and VAS levels.

Introduction: The aim of the study was to evaluate the correlation between the nutritional status of patients with anorexia nervosa (AN) and levels of vaspin (VASP), neuropeptide B (NPB), neuropeptide W (NPW) and total antioxidant status (TAS)., Material and Methods: Ninety serum samples collected from 30 teenage female patients during the acute stage of AN and 30 healthy persons (CONTR) were subjected to biochemical analysis; patients with AN were examined at the beginning of the study (AN-I) and after hospitalization (AN-II), as a result of which partial stabilization of anthropometric measurements was achieved (an increase of body mass index (BMI) by 3.5 kg/m 2 )., Results: Vaspin levels dropped at the end of the hospitalization (compared to AN-I, p < 0.05), achieving values comparable to the CONTR; moreover there was a positive correlation between VASP level and the achieved body weight in AN-II ( p < 0.05). Positive correlations were also noted with regard to VASP vs. NPB in AN-I ( p < 0.02) (and AN-II, p < 0.013), as well as in the case of VASP vs. NPW in the same groups ( p < 0.02 and p < 0.015, respectively). NPB concentration was higher in AN-I ( p < 0.05) and AN-II ( p < 0.018) than in CONTR, whereas there were no differences ( p > 0.05) with regard to levels of VASP, NPW, or TAS., Conclusions: The high level of NPB despite treatment and normalization of VASP level may suggest that there are chronic neuroendocrine disorders at play in anorexia nervosa., Competing Interests: The authors declare no conflict of interest., (Copyright: © 2018 Termedia & Banach.)

The aim of this study was to determine the characteristic features which contribute to inappropriate eating attitudes in people suffering from anorexia nervosa, based on an analysis of recent data. Factors influencing these attitudes have a genetic, neurobiological, biochemical, affective-motivational, cognitive, and behavioral background. Another important issue addressed in the paper is a description of the mechanism leading to continuous dietary restrictions. The altered activity of neurotransmitters modulating patients' moods after the consumption of food and a disturbed responsiveness to enterohormones enhance affective-motivational and cognitive aspects which, in turn, impede the improvement of eating behaviors. An understanding of the mechanisms behind the factors affecting the maintenance of inappropriate eating attitudes may contribute to greater effectiveness in the treatment of anorexia nervosa.

Objectives: The purpose of this study was to measure the salivary and serum free IGF-1 concentration of patients with anorexia nervosa (AN) in comparison to an average population., Methods: A controlled clinical trial was designed for an age- and gender-matched group of 121 AN patients and 77 healthy individuals. A clinical examination was made and blood and salivary samples were taken during the acute stage of AN (BMI < 15 kg/m 2 ) in the first week of hospitalization. An enzyme immunoassay (ELISA) suitable for measuring free IGF-1 was used., Results: Anorexic patients had significant reductions in salivary unstimulated flow rate (UFR), pH and free IGF-1 levels in their saliva and serum. Significant correlations between serum IGF-1 and BMI; salivary IGF-1 and UFR and pH were detected., Conclusions: Salivary and serum IGF-1 analyses appear to be a reliable biochemical indicator of malnutrition in AN patients. Measurement of salivary IGF-1 levels would allow new perspectives in monitoring AN in its early stages.

Objectives One novel hypothesis of the pathogenesis of anorexia nervosa (AN) is the possible role of mental stress in hyperactivity of the autonomic nervous system (ANS) and of the hypothalamic-pituitary-adrenal (HPA) axis. Two components of stress response - salivary alpha-amylase (sAA) and free cortisol - have been proposed. They can be determined in saliva, which closely reflects their concentrations in plasma. The purpose of this study was to measure salivary free cortisol, sAA and their correlation to secretory IgA (sIgA) of patients with AN in comparison to the average population. Methods A controlled clinical trial was designed for a matched group of 47 AN patients and 54 healthy individuals. After clinical examination, unstimulated salivary samples were taken during the acute stage of AN (BMI < 15 kg/m(2)) in the first week of hospitalisation. An enzyme-linked immunosorbent assay (ELISA) suitable for measuring sAA, sIgA and free cortisol were used. Results Anorexic patients exhibited disturbances in sAA secretion, and significantly increased cortisol and sIgA levels with a distinct correlation between these two parameters. Conclusions The behaviour of cortisol, sAA and sIgA levels can be assessed as an effect of stress reaction among AN patients with hyperactivity of the HPA axis and ANS dysregulation. The effect of stress response can be assessed reliably in saliva.

Objectives: Anorexia nervosa (AN) often presents with comorbid depressive symptoms and is characterized by low levels of neuroimmunomodulatory hormone - leptin. Treatment-induced weight gain tends to normalize those variables. The aim of the study was the longitudinal assessment of the relationship between leptin levels and depressive symptoms in patients with AN, since previous cross-sectional studies in different populations brought conflicting results., Methods: Thirty AN inpatients were assessed twice - at admission and after mean body mass index (BMI) increase of 3.2 kg/m(2). Physical parameters were measured, blood samples for leptin levels drawn and depression evaluated with both clinician - (Hamilton Depression Rating Scale - HDRS) and self - (Beck Depression Inventory - BDI) rated scales at the same morning. Correlation coefficients between changes in assessed variables, and linear regression for changes in depression scores were calculated., Results: BMI and leptin levels showed significant increase after treatment, respectively 14.45±0.90 vs. 17.61±0.87 and 1.87±1.14 vs. 7.47±4.65, whereas severity of depressive symptoms measured with BDI and HDRS was significantly reduced: 18.69±12.65 vs. 11.62±11.59; 12.76±6.90 vs. 5.66±4.91, respectively. In linear regression analysis decrease of the clinician-rated depression score (HDRS) was directly associated with decrease in the self-assessed depressive symptoms (BDI) (standardized Beta=0.45; t=2.60; p<0.05) and inversely related to the increase in leptin level (standardized Beta=-0.33; t=-2.08; p<0.05)., Conclusions: These results may suggest, that increase in leptin levels during weight recovery in patients with AN is associated with objectively measured depressive symptoms. Longitudinal studies in other populations are warranted to establish whether this relationship is valid across the weight spectrum.