Modifications of gastric inhibitory polypeptide (GIP) secretion in man by a high-fat diet

1. Five healthy volunteers (usual fat intake 103 (SE 9) g/d and energy intake 9855 (SE 937) kJ/d were given on two separate occasions (a) 100 g oral glucose and (b) sufficient intravenous (IV) glucose to obtain similar arterialized plasma glucose levels to those after oral glucose. 2. Subjects increased their fat intake by 68 (SE 9.6)% for 28 d by supplementing their diet with 146 ml double cream/d (fat intake on high-fat diet (HFD) 170 (SE 8) g/d; energy intake 12347 (SE 770)). 3. The 100 g oral glucose load was repeated and IV glucose again given in quantities sufficient to obtain similar arterialized blood glucose levels. Immunoreactive plasma insulin, C-peptide and gastric inhibitory polypeptide (GIP) were measured. 4. Plasma GIP levels were higher following oral glucose after the HFD (area under plasma GIP curve 0-180 min 1660 (SE 592) v. 2642 (SE 750) ng/l.h for control and HFD respectively; P less than 0.05). Both insulin and C-peptide levels were significantly higher after oral than after IV glucose (P less than 0.01) but neither were affected by the HFD. Glucose levels were lower following the HFD after both oral and IV glucose (area under plasma glucose curve 0-180 min, following oral glucose 6.7 (SE 0.3) mmol/l.h for control and 4.2 (SE 0.6) mmol/l.h for HFD; P less than 0.01). 5. Glucose-stimulated GIP secretion was thus enhanced by the HFD. Insulin secretion in response to oral glucose was unchanged, in spite of an improvement in glucose tolerance. 6. The improvement in glucose tolerance post-HFD could possibly be due to a GIP-mediated inhibition of hepatic glycogenolysis, or a decreased rate of glucose uptake from the small intestine.     

Gastric dilatation in a girl with former obesity and atypical anorexia nervosa

OBJECTIVE: This case report describes a 16 year-old girl of normal weight with acute gastric dilatation due to binge eating habits. METHOD AND RESULTS: Psychiatric assessment revealed a history of obesity and later atypical anorexia nervosa, but no current diagnosis of a typical eating disorder. After one month of daily binges a food excess was followed by an acute massive gastric dilatation which led to a laparotomy. DISCUSSION: Clinicians should be aware that abnormal eating habits may cause severe somatic complications even in patients of normal weight who are not currently diagnosed as having a typical eating disorder. Careful investigation of eating habits might have resulted in therapeutic gastric emptying at an earlier stage, thus avoiding the need for surgery in our patient.     

Thymulin (Zn-facteur thymique serique) activity in anorexia nervosa patients

Thymulin (or FTS-Zn) a well-defined thymic hormone was studied in fifteen female patients hospitalized for anorexia nervosa. The circulating hormone was measured together with the plasma levels of thyroid hormones, cortisol and zinc. Thymulin activity determined by the rosette assay was significantly reduced in the anorexia nervosa patients compared to sex- and age-matched healthy control subjects. The patients were characterized by very depressed plasma levels of triiodothyronine (T3) but exhibited normal concentrations of thyroxine (T4), thyroxine-binding globulin (TBG), cortisol and zinc. The distribution of their peripheral lymphocyte cells into several subsets was not affected. The observed decrease of thymulin activity in this illness might be the consequence of thymic atrophy secondary to malnutrition and/or hormonal disturbances. Our results suggested that the fall in thymulin level might explain the variability of cellular immune responses in anorexia nervosa patients and occurrence of energy when their weight loss is far advanced.     

Perfectionism in anorexia nervosa

Although it is well accepted that most patients with anorexia nervosa are perfectionistic, little work has been done in characterizing this behavior. Anorexics were assessed by two new multidimensional instruments that were designed to measure multiple aspects of perfectionism. Both scales confirm that underweight, malnourished patients with anorexia nervosa are perfectionistic. Importantly, elevated perfectionism scores persisted after weight restoration. Anorexics experienced their perfectionism as selfimposed, and not as a response to other's expectations. Perfectionism is a dimension of the rigid, obsessive behaviors that may contribute to resistance to treatment and relapse in anorexia nervosa. Thus, these scales may be of value in assessing response to treatment. © 1995 by John Wiley & Sons, Inc.     

Osteoporosis in anorexia nervosa

Anorexia nervosa is a disorder characterized by low body weight and amenorrhoea (in females). These features lead to a risk of osteoporosis, a condition in which bone loss leads to weakening of bone structure and increased fracture risk.     

Psychotherapy in anorexia nervosa

The long term psychotherapeutic treatment of anorexia nervosa is discussed. Questions are raised ragarding how early disturbances among these patients can be recongnized, how anorexia nervosa patients express theur understanding of their mental attitude and behavior, and what they consider the reasons and causes behind it. A case study is used to illustrate these points.     

Primary anorexia nervosa: Gastric emptying and antral motor activity in 53 patients

In 53 consecutive patients with primary anorexia nervosa, gastric emptying of a semisolid meal was significantly slower than in 24 healthy subjects. Slow emptying tended to be associated with low serum potassium, low body weight, and long illness duration. Antral contraction amplitudes were lower than in healthy subjects and failed to increase postcibally, whereas contraction frequency and rhythmicity seemed unaffected. After the gastric prokinetic agent, cisapride, 8 mg intravenously administered double-blind, emptying was significantly faster than after placebo. The recognition of impaired gastric motility may be important in the management of anorexia nervosa.     

Melatonin disturbances in anorexia nervosa and bulimia nervosa

The pineal gland releases melatonin into the blood stream in response to sympathetic noradrenergic stimulation of pinealocytes. This process is inhibited by light via the retino-hypothalamic-pineal pathway. Hence melatonin is predominantly released in darkness. Because serotonin is a precursor of melatonin, the intake of dietary tryptophan may also influence melatonin levels. Although the exact physiological role of melatonin in humans is unclear, it appears to be implicated in reproductive physiology, especially in terms of the onset of menarche. Low levels of melatonin also occur in depression. In this review, studies of melatonin in patients with anorexia nervosa and bulimia nervosa are considered in relation to potential abnormalities of noradrenergic function and circadian rhythm. The influence of weight loss, binging and purging, and depression on melatonin is discussed. Other studies involving the assessment of melatonin in relation to menstrual function are required. © 1994 by John Wiley & Sons, Inc.     

Body images in anorexia nervosa and bulimia nervosa

This study extends earlier research on body image disturbance in anorexia nervosa to the reactions of patients with bulimia nervosa. “Natural” procedures were employed, and normal comparison groups as well as those with anorexia nervosa or bulimia nervosa used adjective scales to rate “the self,” mirror images of themselves that were veridical, exaggerated for fatness or for thinness and adjusted to their ideal, and a television image they had adjusted to show how they feel and then how they think their body is. The different adjustments and ratings that were made in each condition question the validity of any single estimates of body size. Nevertheless, this multimethod approach to the cognitive and affective components of body image shows that those with anorexia nervosa and bulimia nervosa consistently emphasize their feelings of fatness.     

Dietary patterns in anorexia nervosa

The effect of high nitrogen Criticare and Vivonex on nutritional repletion was evaluated in 12 patients with malnutrition secondary to pancreatic insufficiency. The patients were randomized to receive either Criticare HN or Vivonex HN for a total period of 9 days. Each patient received 3000 kcal/day of either preparation, in addition to 1000 kcal of solid food. A significant weight gain was encountered in the group of patients receiving Criticare HN. Increased blood urea nitrogen was encountered in both groups of patients. All patients tolerated both diets well without evidence of relapse of their pancreatitis. No significant complications were encountered. Our results indicate that Criticare HN is of superior nutritional value, but both preparations resulted in increased blood urea nitrogen retention.     

The electrocardiogram in anorexia nervosa

Anorexia nervosa claims the highest mortality rate of all psychiatric illnesses; death is often sudden, suggesting a primary cardiac arrhythmic etiology. We analyzed the admission electrocardiograms from 67 consecutive inpatients with anorexia nervosa to determine the prevalence and clinical associations of EKG repolarization abnormalities, known to increase the likelihood of ventricular arrhythmias. QT interval prolongation was present in 20 patients (29.9%), and large U waves were present in 12 patients (17.9%). Large U waves were independently associated with serum potassium level (p = .02) but not with degree of weight loss or clinical symptoms. The corrected QT interval showed a nonsignificant trend toward association with serum potassium concentration (p = .08) but not with other variables. These findings differ from previous studies which concluded that EKG abnormalities in anorexia were secondary to weight loss.     

Dopaminergic regulation in anorexia nervosa

An endocrine study that showed a lack of response of growth hormone to L-DOPA in weight-restored anorectics indicated that dopaminergk regulation may be impaired in anorexia nervosa. We studied another indirect as- sessment of dopaminergk activity by measuring the prolactin response to the dopamine antagonist, chlorpromazine, in six female anorectic normal- weight, recently recovered patients. Two of these patients had no response to chlorpromazine, another three patients had a minimal response, and only one patient had a normal prolactin response to chlorpromazine. Our findings suggest that anorexia nervosa patients have a defect in the negative feedback system in dopamine synthesis, such as an impairment at the dopamine post-synaptic receptor site.