Cerebral gray matter and white matter volume deficits in adolescent girls with anorexia nervosa

doi:10.1016/S0022-3476(96)70021-5

The Journal of Pediatrics

Volume 129, Issue 6, December 1996, Pages 794-803

https://doi.org/10.1016/S0022-3476(96)70021-5 Get rights and content

Abstract

OBJECTIVES: This study was undertaken to determine whether the increased cerebrospinal fluid (CSF) volumes found in anorexia nervosa (AN) are the result of differences in gray matter or white matter volumes or both. METHODS: Thirteen adolescent girls with AN who were receiving inpatient care at a tertiary-care university children's hospital and eight healthy female control subjects were studied by using magnetic resonance imaging. Images were processed by means of software developed to classify all pixels as either CSF, gray matter, or white matter. Pixels of each class were then summed across all sections. RESULTS: The AN group had larger total CSF volumes in association with deficits in both total gray matter and total white matter volumes. Lowest reported body mass index was inversely correlated with total CSF volume and positively correlated with total gray matter volume. Urinary free cortisol levels were positively correlated with total CSF volume and inversely correlated with central gray matter volume. CONCLUSIONS: These findings add support to the view that the brain abnormalities found in AN are in large part the result of the effects of the illness. The extent to which these differences in gray matter and white matter volumes are reversible with recovery remains to be established. (J Pediatr 1996;129:794-803)

Section snippets

Subjects

We studied 13 adolescent girls who were receiving inpatient treatment for AN at the Hospital for Sick Children in Toronto, Canada (mean age, 15.2 years; SD, 1.2 years; range, 13.3 to 17.0 years). Twelve of the subjects were white and one subject was of Asian origin; all subjects were right-handed. Patients were included if they met the criteria for AN, restricting type, as defined by the Diagnostic and Statistical Manual of Mental Disorders (third revised edition, 1987).¹² Exclusion criteria

RESULTS

Descriptive data for the AN and control groups are shown in Table I.

. Clinical characteristics

Empty Cell	Control group (n = 8)	AN group (n = 13)
Age at MRI (yr)	15.4 ± 1.5	15.2 ± 1.2
	13.4-17.3	13.3-17.0
Weight at MRI (kg)	60.2 ± 10.2	40.8 ± 6.6*
	42.8-74.2	32.4-54.4
Height at MRI (cm)	161.7 ± 8.3	161.6 ± 7.4
	147.0-175.5	151.0-180.0
BMI at MRI (kg/m²)	22.9 ± 2.3	15.6 ± 1.7*
	18.7-25.0	12.7-17.8
Lowest reported BMI (kg/m²)	NA	14.3 ± 1.7
		10.5-17.2
Menarche (yr)	12.4 ± 1.0	12.6 ± 0.8
	11.0-14.0	11.0-13.5
Duration of amenorrhea (mo)	NA	9.5 ± 4.7

DISCUSSION

This study clearly established that structural brain abnormalities are present in adolescents with AN. These abnormalities include larger CSF volumes in ventricles and sulci and reduced volumes of both gray matter and white matter. Larger CSF volumes and smaller gray matter volumes were significantly correlated with the severity of weight loss (as reflected by BMI) and with increased cortisol production. These abnormalities are present within months of the patients' having fulfilled diagnostic

Acknowledgements

We acknowledge the assistance of Cynthia Kirsh, the staff of the Eating Disorders Program at the Hospital for Sick Children, and the staff of the MRI Centre at the Toronto Hospital-Western Division. We also thank Allan L. Reiss for making Brain Image (National Institute of Child Health and Human Development, Human Brain Project, HD31715) available to us and Edmond Chong for his assistance with all facets of image processing. This article was prepared with the assistance of the Hospital for Sick

References (34)

S. Theander
Outcome and prognosis in anorexia nervosa and bulimia
J Psychiatr Res
(1985)
H Lankenau et al.
Cranial CT scans in eating disorder patients and controls
Compr Psychiatry
(1985)
TL Jernigan et al.
Cerebral structure on MRI. 1. Localization of age-related changes
Biol Psychiatry
(1991)
J Krieg et al.
Endocrine, metabolic, and cranial computed tomographic findings in anorexia nervosa
Biol Psychiatry
(1988)
S Schlegel et al.
Computerized brain tomography measures compared with spontaneous and suppressed plasma cortisol levels in major depression
Psychoneuroendocrinology
(1989)
NH Golden et al.
Reversibility of cerebral ventricular enlargement in anorexia nervosa, demonstrated by quantitative magnetic resonance imaging
J Pediatr
(1996)
JM Eagles et al.
Increasing incidence of anorexia nervosa in the female population of Northeast Scotland
Am J Psychiatry
(1995)
AR Lucas et al.
50-year trend in the incidence of anorexia nervosa in Rochester, Minnesota: a population based study
Am J Psychiatry
(1991)
RH Ratnasuriya et al.
Anorexia nervosa: outcome and prognostic factors after 20 years
Br J Psychiatry
(1991)
PF. Sullivan
Mortality in anorexia nervosa
Am J Psychiatry
(1995)

DS Goldbloom et al.

Medical complications of anorexia nervosa

B Palla et al.

Medical complications of eating disorders in adolescents

Pediatrics

(1988)

JO. Hagman

Brain imaging and eating disorders

RJ Dolan et al.

Structural brain changes in patients with anorexia nervosa

Psychol Med

(1988)

J-C Krieg et al.

Hormonal metabolic mechanisms in the development of cerebral pseudoatrophy in eating disorders

Psychother Psychosom

(1987)

American Psychiatric Association

Diagnostic and statistical manual of mental disorders

(1987)

RL Spitzer et al.

Structured clinical interview for DSM-III-R patient edition (with psychotic screen)

(1990)

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^☆: From the Hospital for Sick Children; Clarke Institute of Psychiatry; The Toronto Hospital—Western Division; and the Departments of Pediatrics, Psychiatry, and Medical Imaging, University of Toronto School of Medicine, Toronto, Ontario, Canada

^☆☆: Supported by the Ontario Mental Health Foundation and the Deans Fund, University of Toronto School of Medicine.

^★: Reprint requests: Robert B. Zipursky, MD, Clarke Institute of Psychiatry, 250 College St., Toronto, ON M5T 1R8, Canada.

^★★: 0022-3476/96/$5.00 + 0 9/21/75817

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Cerebral gray matter and white matter volume deficits in adolescent girls with anorexia nervosa☆,☆☆,★,★★

Abstract

Section snippets

Subjects

RESULTS

DISCUSSION

Acknowledgements

J Psychiatr Res

Compr Psychiatry

Biol Psychiatry

Biol Psychiatry

Psychoneuroendocrinology

J Pediatr

Increasing incidence of anorexia nervosa in the female population of Northeast Scotland

Am J Psychiatry

50-year trend in the incidence of anorexia nervosa in Rochester, Minnesota: a population based study

Am J Psychiatry

Anorexia nervosa: outcome and prognostic factors after 20 years

Br J Psychiatry

Mortality in anorexia nervosa

Am J Psychiatry

Medical complications of anorexia nervosa

Medical complications of eating disorders in adolescents

Pediatrics

Brain imaging and eating disorders

Structural brain changes in patients with anorexia nervosa

Psychol Med

Hormonal metabolic mechanisms in the development of cerebral pseudoatrophy in eating disorders

Psychother Psychosom

Diagnostic and statistical manual of mental disorders

Structured clinical interview for DSM-III-R patient edition (with psychotic screen)