Appetite Regulatory Hormone Dysregulation in Women with Anorexia Nervosa-Binge/Purge Type

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 649-675-Central Regulation of Appetite & Feeding/GI Regulatory Peptides
Bench to Bedside
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-651
Kamryn T. Eddy1, Elizabeth A Lawson2, Christina Meade2, Erinne Meenaghan2, Sarah Horton2, Madhusmita Misra2, Anne Klibanski2 and Karen Klahr Miller*2
1Harris Center, Massachusetts General Hospital, Boston, MA, 2Massachusetts General Hospital/Harvard Medical School, Boston, MA
Anorexia nervosa (AN) is a psychiatric illness of unknown etiology characterized by aberrant eating behaviors, low body weight, and body image disturbance. AN is further classified as binge/purge (ANBP) or restrictive (ANR) type, the former associated with increased chronicity. Peptide YY (PYY), brain-derived neurotrophic factor (BDNF) and leptin knock-out rodent models are characterized by hyperphagia, suggesting a possible role of these hormones in regulation of eating behavior relevant to the ANBP phenotype. Abnormalities in appetite regulatory hormone serum levels, including the anorexigenic hormones PYY, BDNF and leptin have been described in AN, but the interplay between eating behavior subtypes, specifically binge/purge behavior, and anorexigenic hormones has not been explored.

Methods:  Serum total and 3-36 PYY (RIA, Millipore), BDNF (ELISA, R&D Systems) and leptin (ELISA, Millipore) were measured in 75 women with AN (50 with ANR, and 25 with ANBP) (mean BMI 17.3 ± 0.1 [SEM] kg/m2) and 22 healthy control females (HC) (mean BMI 22.4 ± 0.4 kg/m2) of comparable mean age. Participants completed a validated self-report measure of eating disorder psychopathology (Eating Disorder Examination-Questionnaire [EDE-Q]).

Results:  Mean PYY 3-36 (80 ± 4 vs. 48 ± 2 pg/ml, p<0.0001) and total PYY (111 ± 5 vs. 79 ± 6 pg/ml, p=0.0004) levels were higher, leptin levels lower (1.44 ± 0.14 vs. 6.05 ± 0.58 ng/ml, p<0.0001) and BDNF levels similar (14.8 ± 0.8 vs. 14.6 ± 1.4 ng/ml, p=0.88) for the entire AN group compared with HC. ANBP were of comparable mean age but slightly lower mean weight (17.0 ± 0.2 vs. 17.5 ±0.1 kg/m2) than ANR.  Mean PYY 3-36 (65 ± 3 vs. 87 ± 5 pg/ml) was lower in ANBP compared with ANR (p=0.01), and increased in significance after controlling for BMI (p=0.002). There was a trend toward lower mean total PYY levels in ANBP than ANR (97 ± 5 vs. 116 ± 6 pg/ml, p=0.10), which became significant after controlling for BMI (p=0.01). Mean BDNF was higher in ANBP than ANR (17.2 ± 1.5 ng/ml vs. 13.6 ± 0.9 ng/ml, p=0.04) and remained a trend after controlling for BMI (p=0.06).  Mean leptin levels were lower in ANBP vs. ANR (1.07 ± 0.21 vs. 1.63 ± 0.18 ng/ml, p=0.03), and were not significant after controlling for BMI (p=0.21). BDNF was positively associated with purging frequency (r=0.21, p=0.04), and leptin was negatively associated with frequency of bingeing (r=-0.29, p=0.007) and purging (r=-0.31, p=0.004). PYY was positively (r=0.27, p=0.02), and leptin was negatively (r=-0.51, p<0.0001), associated with dietary restraint. BMI was negatively associated with PYY (r=-0.45, p<0.0001) and positively with leptin (r=0.64, p<0.0001), but not BDNF. 

Conclusion:  Among women with AN, the anorexigenic hormones PYY, BDNF and leptin are differentially regulated in women with the ANBP type. Whether these hormone pathways play etiologic roles with regard to AN behavioral subtypes or are compensatory merits further study.

Nothing to Disclose: KTE, EAL, CM, EM, SH, MM, AK, KKM

*Please take note of The Endocrine Society's News Embargo Policy at

Sources of Research Support: NIH grants R01 MH083657, R01 DK052625 and M01 RR-01066