Anorexia nervosa is linked to reduced brain structure in reward and somatosensory regions: a meta-analysis of VBM studies

Olga E Titova, Olof C Hjorth, Helgi B Schiöth, Samantha J Brooks, Olga E Titova, Olof C Hjorth, Helgi B Schiöth, Samantha J Brooks

Abstract

Background: Structural imaging studies demonstrate brain tissue abnormalities in eating disorders, yet a quantitative analysis has not been done.

Methods: In global and regional meta-analyses of 9 voxel-based morphometry (VBM) studies, with a total of 228 eating disorder participants (currently ill with anorexia nervosa), and 240 age-matched healthy controls, we compare brain volumes using global and regional analyses.

Results: Anorexia nervosa (AN) patients have global reductions in gray (effect size = -0.66) and white matter (effect size = -0.74) and increased cerebrospinal fluid (effect size = 0.98) and have regional decreases in left hypothalamus, left inferior parietal lobe, right lentiform nucleus and right caudate, and no significant increases. No significant difference in hemispheric lateralization was found.

Conclusions: Global and regional meta-analyses suggest that excessive restrained eating as found in those with anorexia nervosa coincides with structural brain changes analogous to clinical symptoms.

Figures

Figure 1
Figure 1
Difference in GM volume between anorexia nervosa and control group. Forest plot depicting the difference in global grey matter volume between patients with AN and healthy controls. Authors of study are given on left, red line indicates median, blue boxes indicate separate studies; p value = statistical significance threshold; weight % as adjusted for study population size; CI = confidence intervals.
Figure 2
Figure 2
Difference in WM volume between anorexia nervosa and control group. Forest plot depicting the difference in global white matter volume between patients with AN and healthy controls. Authors of study are given on left, red line indicates median, blue boxes indicate separate studies; p value = statistical significance threshold; weight % as adjusted for study population size; CI = confidence intervals.
Figure 3
Figure 3
Difference in CSF volume between anorexia nervosa and control group. Forest plot depicting the difference in global cerebrospinal fluid volume between patients with AN and healthy controls. Authors of study are given on left, red line indicates median, blue boxes indicate separate studies; p value = statistical significance threshold; weight % as adjusted for study population size; CI = confidence intervals.
Figure 4
Figure 4
Activation likelihood estimation of reduced regional brain volumes. Showing clusters with significant ALE maxima (p < 0.05 for multiple comparisons, cluster size >100 mm3), Talairach coordinates are given for the respective slices. ALE clusters for the contrast AN < HC: (A) Hypothalamus; (B) L Inferior Parietal lobe. Brodmann area 39, (C) R Lentiform nucleus, (D) R Caudate.
Figure 5
Figure 5
Average T-Values across studies showing gray matter reduction in anorexia nervosa. T value intensity of VBM studies showing regional gray matter decrease in people with anorexia nervosa and healthy controls.
Figure 6
Figure 6
Number of studies demonstrating regional gray matter change in people with anorexia nervosa and healthy controls.
Figure 7
Figure 7
Regional grey matter change in people with anorexia nervosa in left and right hemispheres.

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