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Genes related to psychiatric disorders and control of body sugar and fat stores have been linked to anorexia in the largest study ever done on the genetics of the devastating eating disorder.
The study examined the genomes of nearly 17,000 people of European descent with anorexia, who have the highest mortality rate of all mental illnesses. She compared their genetic makeup to more than 55,000 people without this disorder.
Under the direction of Cynthia Bulik, from the University of North Carolina at Chapel Hill, USA, researchers discovered eight genetic sites associated with the disease, some with links to more than 100 genes expressed in the US. brain.
"The genes associated with anorexia nervosa were enriched for expression in most brain tissues," the authors write.
One of the regions, the hippocampus, plays an important role in the feeding behavior of mice, particularly with regard to food motivation and reward, the authors note.
The extensive genetic database allowed researchers to test whether a genetic signature of anorexia overlapped that of other psychological disorders or metabolic changes.
Anorexia, which affects about one in 200 people, mostly girls and young women, is strongly related to obsessive-compulsive disorder and to weaker but significant links with depression, schizophrenia and anxiety.
The researchers also found positive correlations with years of schooling, completion of college education and, consistent with a common trait of the disorder, levels of physical activity.
But there were also links to two of the body's most important hormones involved in hunger and blood sugar control; leptin, which induces a feeling of satiety after eating, and insulin, which lowers the sugar level.
The findings could redefine the road map for the treatment of anorexia, which, according to the authors, is rutted.
"A low BMI has traditionally been considered a consequence of the psychological characteristics of anorexia nervosa (ie a tendency to thinness and body dissatisfaction). This perspective has not led to interventions that reliably lead to sustained weight gain and psychological recovery, "they write.
Indeed, death rates due to anorexia make a shocking reading. The mortality rate for almost exclusively female disease (the study included nearly 15,000 women but only 447 men) is 20% over 20 years.
The results lead the authors to ask for a change of framework in our approach to anorexia.
"A fundamental metabolic deregulation can contribute to the exceptional difficulty that people with anorexia nervosa have in maintaining a healthy BMI (even after a therapeutic renewal)," they write.
"Our findings encourage consideration of both the metabolic and psychological factors of anorexia nervosa as we explore new avenues to treat this often fatal disease," the authors conclude.
The study appears in the newspaper Nature Genetics.
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