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Hypothermia is frequently observed in anorexia nervosa (AN) but is often overlooked clinically. External heat application has been proposed as a supportive adjunct. We conducted a retrospective study to determine the frequency of hypothermia in a highly selected inpatient population with AN admitted to a specialized medical (somatic) unit because of low BMI and/or somatic complications, and to explore clinical correlates and implications. In this naturalistic clinical setting, we retrospectively reviewed routinely collected clinical and biochemical data from admissions. Hypothermia was defined as tympanic temperature < 35.8°C. Clinical and biochemical variables were compared between normothermic and hypothermic patients, and multivariable logistic regression was used to identify factors associated with hypothermia. Among 111 patients, 10.8% had tympanic temperature < 35.8°C. During short-term hospitalization with supported meals, fluid and electrolyte correction, and partial weight restoration, most hypothermic patients achieved normothermia. However, persistent hypothermia may represent an underrecognized treatment target; future studies should assess its impact on outcomes and evaluate whether adjunctive warming interventions improve recovery.

Anorexia nervosa (AN) is a severe mental disorder characterized by restrictive eating and disturbance in the way one’s body weight or shape is experienced, often accompanied by depression and anxiety. Current evidence-based treatments for AN have limited efficacy, with less than half of the patients achieving full recovery in long-term follow-up studies. Recent findings have identified gut microbiota (GM) dysbiosis as a potential contributor to AN pathology through the gut-brain axis. This open-label, non-randomized, feasibility trial (Clinicaltrials.gov Identifier: NCT05834010) evaluated the feasibility of utilizing fecal microbiota transplantation (FMT) to modify the GM and GM-associated signaling in females with AN and to examine biological effects following a single FMT procedure. Adult female participants diagnosed with AN were recruited. FMT was administered either orally via capsules or as rectal enema. Stool and blood samples were collected pre- and one week post-FMT to assess GM composition, hormonal changes, and biomarkers. Primary endpoints: Feasibility of FMT in individuals with AN and preferred route of FMT. Secondary endpoints: A single FMT treatment can alter GM composition in individuals with AN short term and relevant gut brain signaling in serum. 18/22 participants (81%) completed FMT and sampling and 19/22 participants chose oral capsules, with no serious adverse effects reported. GM analysis showed significant shifts toward donor composition 1-week post-FMT, with improved stool consistency. No significant changes were observed in psychopathology measures or appetite-related biomarkers. Oral FMT is a feasible intervention for adult women with AN, leading to changes in GM profile. Future studies should focus on placebo-controlled trials to assess the efficacy of repeated oral treatments and explore long-term effects on GM, appetite, body weight, sex hormones, disorder-specific symptoms, and overall well-being

Objectives: To investigate the incidence, prevalence and mortality of anorexia nervosa (AN) among individuals with childhood-onset type 1 diabetes (T1D) compared with matched controls in Sweden.

Design: Retrospective nationwide cohort study using linked registry data.

Setting: Nationwide, Sweden; population-based registers (covering the period 1977–2019).

Participants: 12202 individuals diagnosed with T1D before age 15 years (5618 females; 6584 males) and 48484 age-matched, sex-matched and municipality-matched controls without diabetes (23618 females; 24866 males).

Primary and secondary outcome measures: AN diagnoses (International Classification of Diseases-10 codes F50.0 and F50.1) identified via the National Patient Register. Outcomes were period prevalence, point prevalence at ages 15 and 20 years, 10-year incidence rates and proportional mortality ratios (PMR), stratified by sex. ORs and incidence rate ratios (IRR) with 95% CIs were estimated using Mantel-Haenszel methods; Kaplan-Meier analysis compared time to AN diagnosis between groups.

Results: The period prevalence of AN among females with T1D was 1.9% compared with 1.1% in controls (OR 1.64, 95%CI 1.31 to 2.06; p<0.001). The 10-year incidence rate for females with T1D was 74.7 per 100000 person-years vs 45.2 per 100000 person-years in controls (IRR 1.77, 95%CI 1.35 to 2.32). Point prevalence at age 15 years was 0.87% (T1D) vs 0.53% (controls) (IRR 1.65, 95%CI 1.16 to 2.35), and at age 20 years was 1.73% (T1D) vs 1.11% (controls) (IRR 1.55, 95%CI 1.20 to 1.99). The PMR for females with both T1D and AN compared with controls without either condition was 20.4 (95% CI 6.6 to 47.6). Male cases were few (n=4 in the T1D group; n=12 in controls).

Conclusions: Females with childhood-onset T1D in Sweden have an elevated risk of AN and markedly higher mortality when both conditions are present. Despite the increased relative risk, the absolute risk of AN in females with T1D remained below 2%. These findings support routine screening for eating disorders in the T1D population, particularly among adolescent and young adult females.

Objective: Inpatient treatment aimed at weight restoration and psychiatric stabilization is often required for individuals with anorexia nervosa (AN). This study aimed to identify distinct trajectories of change in body mass index (BMI) and depressive symptoms during inpatient treatment, examine clinical predictors and outcomes, and test reciprocal associations between BMI and depressive symptom changes.

Method: Weekly BMI and depressive symptom data were collected from 156 inpatients with AN (mean treatment duration = 11.6 weeks). Growth mixture modeling identified trajectory classes. Baseline clinical variables were examined as predictors, and discharge outcomes were compared across classes. A joint Bayesian growth model was used to examine longitudinal associations between BMI and depressive symptoms.

Results: Three BMI trajectories were identified: steady increase (58.3%; higher baseline BMI with consistent gains), gradual weight gain (28.9%; low baseline BMI with steady gains), and rapid response (12.8%; low baseline BMI with early rapid gain followed by slowing or decline). Two depressive symptom trajectories emerged: severe-stable and moderate-improving. The severe-stable group was predicted by higher trauma-related comorbidity (OR 11.11, p = 0.009) and eating psychopathology (OR 3.23, p < 0.001). Depressive symptom class was associated with initial BMI but not BMI change, while BMI classes predicted the curvature of depressive symptom trajectories. No credible week-to-week associations emerged between BMI and depressive symptom changes.

Discussion: Findings highlight substantial heterogeneity in treatment response. Rapid early weight gain in patients with extremely low BMI and high severity may not indicate sustained improvement. Persistent depressive symptoms, especially in those with trauma histories, underscore the need for trauma-informed care alongside weight restoration.

Objectives: This World Federation of Societies of Biological Psychiatry (WFSBP) consensus paper aims to summarise and evaluate the published study results on objectively measurable biological markers associated with anorexia nervosa (AN).

Methods: The relevant literature was reviewed by the WFSBP Task Forces on Eating Disorders and on Biological Markers, and a consensus regarding the significance of the published evidence was reached.

Results: Candidate biological markers that have been associated with AN include clinical (e.g. body weight), molecular (e.g. genetic, epigenetic, hormonal, immunological, metabolomic), cellular (e.g. leukocytes), neuroimaging (e.g. structure, function, connectivity), digital, cardiac and neurophysiological parameters. Some clinical and laboratory parameters are risk markers in clinical practice. Biological markers have pathophysiological relevance in understanding the biological and metabolic pathophysiology of AN and its physical health consequences. Few studies have examined pharmacogenetics or therapeutic drug monitoring as tools to monitor and guide the treatment of AN.

Conclusions: Biological markers will hopefully soon enable clinicians to intervene earlier in a more targeted manner to mitigate treatment resistance. However, the current scientific basis for most biological markers are group comparisons only. Studies on sensitivity, specificity and the prognostic value of these markers are lacking.

Emotion regulation strategies, specifically expressive suppression (ES) and cognitive reappraisal (CR), are known to influence mental health outcomes in the general population and adult elite athletes. Young elite athletes, who face unique academic and athletic pressures, remain understudied in this regard. The main aim of this study was to examine the relationship between ES and CR and mental health in young elite athletes. This longitudinal study included 93 young elite athletes (aged 15–17) attending upper secondary education in Sweden. Participants completed the Emotion Regulation Questionnaire and the General Health Questionnaire at three time points over 12 months. Linear mixed models were used to examine associations between ES, CR, and mental health. Higher use of ES was significantly associated with poorer mental health (β = 0.34, p < 0.001), while greater use of CR predicted better mental health (β = −0.33, p < 0.001) across the study period. Expressive suppression and CR are both important for the mental health of young elite athletes, with CR being protective and ES conferring risk. Given the observed associations, future research could examine whether interventions aiming to enhance CR and reduce ES are linked to better mental health in young elite athletes.

Background: Case reports suggest an increased risk of both venous thromboembolism and arterial thromboembolism in patients with anorexia nervosa (AN), even in the absence of known risk factors. Population-based studies on thromboembolism in patients with AN are missing. This study aims to establish the association in a registry-based nation-wide data set from Denmark.

Methods: This nationwide, observational registry-based cohort study used mandatory health care registries to identify the risk of thromboembolism in a cohort of patients with AN and in population controls matched on date of birth, area of residence, and sex. Thromboembolic outcomes were validated using specific criteria. The two groups were compared using Fine-Gray regression models.

Results: In total, 12,676 patients (mean age 18.3 and 93.5% female) were matched with 63,049 controls. Median follow-up time was 9.5 years. For venous thromboembolism, the cumulative risk during the full follow-up period was 0.88% (n = 112) in the AN group and 0.12% (n = 79) in the control group with a subhazard ratio of 7.1 [5.3–9.5]. For arterial thromboembolism, the cumulative risk during the full follow-up period was 0.54% (n = 68) in the AN group and 0.05% (n = 36) in the control group (subhazard ratio 9.5 [6.4–14.1]).

Conclusions: Patients with AN have a substantially increased risk of both arterial and venous thromboembolism, compared to the background population.

Anorexia nervosa (AN) is a complex and serious mental disorder, which may affect individuals of all ages and sex, but primarily affecting young women. The disease is characterized by a disturbed body image, restrictive eating behavior, and a lack of acknowledgment of low body weight. The underlying causes of AN remain largely unknown, and current treatment options are limited to psychotherapy and nutritional support. This paper investigates the impact of Fecal Microbiota Transplants (FMT) from patients with AN on food intake, body weight, behavior, and gut microbiota into antibiotic-treated mice. Two rounds of FMT were performed using AN and control (CO) donors. During the second round of FMT, a subset of mice received gut microbiota (GM) from a different donor type. This split-group cross-over design was chosen to demonstrate any recovery effect of FMT from a non-eating disorder state donor. The first FMT, from donors with AN, resulted in lower food intake in mice without affecting body weight. Analysis of GM showed significant differences between AN and CO mice after FMT1, before cross-over. Specific bacterial genera and families Ruminococcaceae, Lachnospiraceae, and Faecalibacterium showed different abundances in AN and CO receiving mice. Behavioral tests showed decreased locomotor activity in AN mice after FMT1. After FMT2, serum analysis revealed higher levels of appetite-influencing hormones (PYY and leptin) in mice receiving AN-GM. Overall, the results suggest that AN-GM may contribute to altered food intake and appetite regulation, which can be ameliorated with FMT from a non-eating disorder state donor potentially offering FMT as a supportive treatment for AN.

Objective: Anorexia nervosa (AN) is a condition characterized by chronic malnutrition. This study aims to determine the frequency of hypoalbuminemia in individuals with severe, medical unstable AN and its associations with inflammation and mortality.

Method: Data were collected from electronic health records on patients admitted to a specialized, medical unit in Denmark between 2017 and 2021. A total of 159 records were initially registered, with 127 meeting the inclusion criteria. Clinical characteristics, laboratory values and vital signs were analyzed. Patients were divided into groups based on their plasma albumin (PA) levels, being hypoalbuminemic (<36 g/L), normoalbuminemic (36–50 g/L), and hyperalbuminemic (>50 g/L), respectively. Statistical analyses were made using Welches t-test, Fisher's exact and a multivariable logistic regression was performed to assess the association between albumin status and mortality, adjusting for BMI and illness duration.

Results: 78.6 % of patients exhibited normoalbuminemia, 7.1 % were hypoalbuminemic, and 14.3 % were hyperalbuminemic. The hypoalbuminemic group had higher mean body temperature (p = 0.041), higher mean platelet count (p = 0.046), and a lower mean hemoglobin level (p = 0.046). Mortality was strikingly higher in the hypoalbuminemic group with 4 (44 %) deceased, compared to 5 (5.1 %) in the normoalbuminemic group (p = 0.012) during the 2017–2021 period, with no statistically significant difference in age between the two groups (p = 0.067). Logistic regression revealed a significantly increased risk of death in the hypoalbuminemic group (OR = 6.39, p = 0.038).

Discussion: Despite the severity of the illness, most patients with AN maintained normal PA levels, probably due to adaptive physiological mechanisms. PA level assessments could aid in identifying high-risk patients, as hypoalbuminemia was associated with inflammation and increased mortality.

Conclusion: Despite significant nutritional restrictions, even individuals with severe and extreme AN maintain normal PA levels. Hypoalbuminemia was associated with increased mortality.

Background: Plasma lipid concentrations in patients with anorexia nervosa (AN) seem to be altered.

Methods: We conducted a naturalistic study with 75 adult female patients with AN and 26 healthy female controls (HC). We measured plasma lipid profile, sex hormones and used self-report questionnaires at admission and discharge.

Results: Total cholesterol (median (IQR): 4.9 (1.2)) and triglycerides (TG) (1.2 (0.8)) were elevated in AN at admission (BMI 15.3 (3.4)) compared with HC (4.3 (0.7), p = 0.003 and 0.9 (0.3), p = 0.006) and remained elevated at discharge (BMI 18.9 (2.9)) after weight restoration treatment. Estradiol (0.05 (0.1)) and testosterone (0.5 (0.7)) were lower in AN compared with HC (0.3 (0.3), p = < 0.001 and 0.8 (0.5), p = 0.03) and remained low at discharge. There was no change in eating disorder symptoms. Depression symptoms decreased (33 (17) to 30.5 (19), (p = 0.007)). Regression analyses showed that illness duration was a predictor of TG, age was a predictor of total cholesterol and LDL, while educational attainment predicted LDL and TG.

Conclusion: Lipid concentrations remained elevated following weight restoration treatment, suggesting an underlying, premorbid dysregulation in the lipid metabolism in AN that persists following weight restoration. Elevated lipid concentrations may be present prior to illness onset in AN.

Level of evidence: III: Evidence obtained from well-designed cohort or case–control analytic studies.