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Systematic review and meta-analysis of the baseline concentrations and physiologic responses of gut hormones to food in eating disorders

¹ From King's College London, Nutritional Sciences Division, Franklin-Wilkins Building, London, United Kingdom (ACP); the Division of Psychological Medicine, Eating Disorders Research Unit, Institute of Psychiatry, King's College, London, United Kingdom (SJB and DS); and the Department of Psychiatry, Thomas Guy House, Guy's Hospital, London, United Kingdom (JT).

² Reprints not available. Address correspondence to AC Prince, King's College London, Nutritional Sciences Division, Franklin-Wilkins Building, 150 Stamford Street, London SE1 9NH, United Kingdom. E-mail: alexis.prince{at}kcl.ac.uk.

Background: Disturbances in gastrointestinal hormones have been widely identified in persons with eating disorders (EDs) and have been implicated in their clinical pathologies.

Objective: The objective was to identify, critically examine, and summarize studies investigating the short-term response of gastrointestinal hormones to food in persons with an ED, including the subtypes anorexia nervosa and bulimia nervosa.

Design: A priori inclusion and exclusion criteria were set and included a procedure in which a test meal or glucose load was given and blood hormone concentrations measured. All studies included a healthy control group for comparison. The outcome variable was defined as the mean difference between fasting plasma hormone concentrations and the maximum postprandial peak or nadir. The difference in baseline values between groups was also examined. Pooled standardized mean differences were calculated and analyzed where possible.

Results: A total of 28 studies were identified, including sufficient studies to perform a meta-analysis for ghrelin, peptide YY, cholecystokinin, insulin, and pancreatic polypeptide. Persons with an ED had higher baseline concentrations of ghrelin (large effect), peptide YY (medium effect), and cholecystokinin (medium effect for ED, large effect for anorexia nervosa). The response of insulin to food was decreased in persons with an ED (medium effect). No further differences were found in the release of gut peptides to a standardized test meal.

Conclusions: All of the studies had low power for the different subtypes of EDs. High heterogeneity among the studies was observed, and limitations are discussed. The findings suggest that the physiologic changes observed in patients with EDs are highly variable and subject to multiple confounding factors.