199 - Associations between Nutritional Intake, Stress and Hunger Hormones, and Anxiety and Depression during the Treatment of Anorexia Nervosa in Adolescents and Young Adults

Poster Number: 199
Publication Number: 199.400

Jessica A. Lin, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Catherine Stamoulis, Boston Children's Hospital/Harvard University, Boston, MA, United States; Amy Divasta, Boston Children's Hospital, Boston, MA, United States

Background: Adolescents and young adults (AYA) with anorexia nervosa (AN) frequently have co-occurring anxiety and depression, which can negatively impact prognosis and recovery.

Objective: To inform the treatment of co-occurring anxiety/depression, we assessed the association of nutritional intake, stress hormones, and hunger hormones on anxiety/depression using a six-month longitudinal study of 50 AYA females receiving care for AN.

Design/Methods: At baseline and six months, we measured anxiety (using the Spielberger State/Trait Anxiety Inventory [STAI]), depression (using the Beck Depression Inventory [BDI]), body mass index (BMI), 3-day dietary intake (i.e., total calories and the proportion of fat, carbohydrate, and protein), and serum cortisol, leptin, and adiponectin. We performed mixed effects linear regression analyses, adjusting for age, duration of AN, and percentage of median BMI (%mBMI).

Results: At baseline, median age was 16.3 (interquartile range [IQR]=2.5) years and %mBMI was 87.2(IQR=10.5)%. About a-third (30.0%) had clinically significant depression and 56.0% had anxiety (Table 1). Over 6 months, participants had significant improvements in their median %mBMI (+2.2[IQR=9.2]%, p< 0.01), BDI score (‑5.0[IQR=13.8], p< 0.01), and STAI score (‑9.0[IQR=25.0], p< 0.01) (Figure 1). Patients with larger increases in caloric intake had statistically lower STAI (p=0.03) and BDI scores (p=0.04). Change in STAI was not associated with changes in fat, carbohydrate, or protein intake. However, increased fat intake was significantly associated with improved BDI (p < 0.01), although not carbohydrate or protein intake. Changes in concentrations of cortisol, leptin, or adiponectin were not associated with changes in BDI or STAI.Conclusion(s): Increased caloric intake may augment treatment of co-morbid anxiety and depression, and increased fat intake may improve co-morbid depression for AYA females with AN. During eating disorder treatment, increasing caloric intake and specifically increasing fat intake may more effectively treat co-morbid psychiatric disorders and lead to a better chance for our patients to reach recovery.
Table 1. Participant demographics and clinical characteristics at study entry (Nf50)Note. IQR = interquartile range; BMI = body mass index; AN = anorexia nervosa;
BDI = Beck Depression Inventory, a score ≥ 20 indicates clinically significant depression;
STAI = Spielberger State/Trait Anxiety Inventory, a score ≥ 65 indicates clinically significant anxiety.
Figure 1. Changes in BMI, anxiety, and depression over 6 months.Fig. 2A = Change in percentage of median BMI (p < 0.01)
Fig. 2B = Change in anxiety score (p < 0.01)
Fig. 2C = Change in depression score (p < 0.01)
Note. BMI = body mass index; STAI = Spielberger State/Trait Anxiety Inventory; BDI = Beck Depression Inventory.