Pre-meal anxiety and food intake in anorexia nervosa

Abstract

Anorexia nervosa (AN) is a serious mental illness characterized by reduced caloric intake that often persists after acute weight restoration. This preliminary study assesses the relationship between pre-meal anxiety and food intake in recently weight-restored individuals with AN. We hypothesized that pre-meal anxiety is inversely related to caloric intake in AN. Caloric intake and pre-meal anxiety were measured in three laboratory-based assessments (yogurt snack, multi-item lunch, macaroni and cheese lunch). Anxiety was measured by Spielberger State-Trait Anxiety Inventory (STAI-S) administered prior to the meal. Acutely weight-restored patients with AN were compared with healthy controls (HCs). Associations between anxiety and intake were analyzed first within each meal type separately and then using a model to combine the sample. In the multi-item lunch and the macaroni and cheese lunch, AN ate significantly less than HC (p=0.01, p<0.001). Pre-meal anxiety was significantly correlated with intake among AN, but not HC. In the yogurt snack, there was no significant association between anxiety and intake among patients or controls, and the groups did not differ in caloric intake. The association between pre-meal anxiety and intake among weight-restored individuals with AN suggests a potential target for relapse prevention treatment.

Trial registration: ClinicalTrials.gov NCT00627341 NCT00755820.

Figures

Figure 1

Pre-meal anxiety and caloric intake in patients with AN across 3 laboratory test meals. Pre-meal anxiety was measured by Spielberger State-Trait Inventory, State version (STAI-S). Pearson correlations: (A) Yogurt Snack (r=−0.44, p=0.21), Multi-item Lunch (r=−.26, p=0.23), Macaroni & Cheese Lunch (r = −.64, p=0.03). Using statistical modeling procedures (GEE analysis) to pool data and increase power, STAI-S was significantly associated with caloric intake in the Macaroni & Cheese Lunch (C) and the Multi-Item Lunch (B), but not in the Yogurt Snack (A).