Altered Insula Response to Sweet Taste Processing After Recovery From Anorexia and Bulimia Nervosa

Tyson A. Oberndorfer · Guido Frank · Alan N. Simmons · Angela Wagner · Danyale McCurdy · Julie L. Fudge +3 more

198 citations0/0 files storedAmerican Journal of Psychiatry

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Eating Disorders and Behaviors Nutrition, Health and Food Behavior Regulation of Appetite and Obesity

Abstract

OBJECTIVE: Recent studies suggest that altered function of higher-order appetitive neural circuitry may contribute to restricted eating in anorexia nervosa and overeating in bulimia nervosa. This study used sweet tastes to interrogate gustatory neurocircuitry involving the anterior insula and related regions that modulate sensory-interoceptive-reward signals in response to palatable foods. METHOD: Participants who had recovered from anorexia nervosa and bulimia nervosa were studied to avoid confounding effects of altered nutritional state. Functional MRI measured brain response to repeated tastes of sucrose and sucralose to disentangle neural processing of caloric and noncaloric sweet tastes. Whole-brain functional analysis was constrained to anatomical regions of interest. RESULTS: Relative to matched comparison women (N=14), women recovered from anorexia nervosa (N=14) had significantly diminished and women recovered from bulimia nervosa (N=14) had significantly elevated hemodynamic response to tastes of sucrose in the right anterior insula. Anterior insula response to sucrose compared with sucralose was exaggerated in the recovered group (lower in women recovered from anorexia nervosa and higher in women recovered from bulimia nervosa). CONCLUSIONS: The anterior insula integrates sensory reward aspects of taste in the service of nutritional homeostasis. One possibility is that restricted eating and weight loss occur in anorexia nervosa because of a failure to accurately recognize hunger signals, whereas overeating in bulimia nervosa could represent an exaggerated perception of hunger signals. This response may reflect the altered calibration of signals related to sweet taste and the caloric content of food and may offer a pathway to novel and more effective treatments.

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References

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2014Are Extremes of Consumption in Eating Disorders Related to an Altered Balance between Reward and Inhibition?2015Altered interoceptive awareness in anorexia nervosa: Effects of meal anticipation, consumption and bodily arousal 2013Food related processes in the insular cortex 2014Hunger Does Not Motivate Reward in Women Remitted from Anorexia Nervosa 2017Neuroendocrinology and brain imaging of reward in eating disorders: A possible key to the treatment of anorexia nervosa and bulimia nervosa

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