TY - JOUR

T1 - A systematic review and meta-analysis finds increased blood levels of all forms of ghrelin in both restricting and binge-eating/purging subtypes of anorexia nervosa

AU - Seidel, Maria

AU - Jensen, Signe Markmann

AU - Healy, Darren

AU - Dureja, Aakriti

AU - Watson, Hunna J.

AU - Holst, Birgitte

AU - Bulik, Cynthia M.

AU - Sjögren, Jan Magnus

PY - 2021

Y1 - 2021

N2 - Anorexia nervosa (AN) is a severe psychiatric condition associated with high mortality and chronicity. The hunt for state, trait, subtyping, and prognostic biomarkers is ongoing and the orexigenic hormone ghrelin and its different forms, acyl ghrelin and desacyl ghrelin, have been proposed to be increased in AN, especially in the restrictive subtype. A systematic literature search was performed using established databases up to 30 November 2020. Forty-nine studies met inclusion criteria for cross-sectional and longitudinal meta-analyses on total ghrelin, acyl ghrelin, and desacyl ghrelin. All forms of ghrelin were increased in the acute stage of anorexia nervosa during fasting compared to healthy controls. Previous notions on differences in ghrelin levels between AN subtypes were not supported by current data. In addition, a significant decrease in total ghrelin was observed pre-treatment to follow-up. However, total ghrelin levels at follow-up were still margin-ally elevated compared to healthy controls, whereas for acyl ghrelin, no overall effect of treatment was observed. Due to heterogeneity in follow-up designs and only few data on long-term recovered patients, longitudinal results should be interpreted with caution. While the first steps towards a biomarker in acute AN have been completed, the value of ghrelin as a potential indicator of treatment success or recovery status or its use in subtype differentiation are yet to be established.

AB - Anorexia nervosa (AN) is a severe psychiatric condition associated with high mortality and chronicity. The hunt for state, trait, subtyping, and prognostic biomarkers is ongoing and the orexigenic hormone ghrelin and its different forms, acyl ghrelin and desacyl ghrelin, have been proposed to be increased in AN, especially in the restrictive subtype. A systematic literature search was performed using established databases up to 30 November 2020. Forty-nine studies met inclusion criteria for cross-sectional and longitudinal meta-analyses on total ghrelin, acyl ghrelin, and desacyl ghrelin. All forms of ghrelin were increased in the acute stage of anorexia nervosa during fasting compared to healthy controls. Previous notions on differences in ghrelin levels between AN subtypes were not supported by current data. In addition, a significant decrease in total ghrelin was observed pre-treatment to follow-up. However, total ghrelin levels at follow-up were still margin-ally elevated compared to healthy controls, whereas for acyl ghrelin, no overall effect of treatment was observed. Due to heterogeneity in follow-up designs and only few data on long-term recovered patients, longitudinal results should be interpreted with caution. While the first steps towards a biomarker in acute AN have been completed, the value of ghrelin as a potential indicator of treatment success or recovery status or its use in subtype differentiation are yet to be established.

KW - Acyl ghrelin

KW - Anorexia nervosa

KW - Desacyl ghrelin

KW - Eating disorders

KW - Ghrelin

KW - Meta-analysis

KW - Systematic re-view

U2 - 10.3390/nu13020709

DO - 10.3390/nu13020709

M3 - Review

C2 - 33672297

AN - SCOPUS:85101191603

VL - 13

SP - 1

EP - 19

JO - Nutrients

JF - Nutrients

SN - 2072-6643

IS - 2

M1 - 709

ER -