Neural activation of food reward and cognitive control regions in young females with anorexia nervosa and atypical anorexia nervosa versus healthy controls

Abstract

Abstract Anorexia nervosa (AN) and atypical AN (AtypAN) are complex neurobiological illnesses that typically onset in adolescence with an often treatment-refractory and chronic illness trajectory. Aberrant eating behaviors in this population have been linked to abnormalities in food reward and cognitive control, but prior studies have not examined respective contributions of clinical characteristics and metabolic state. Research is needed to identify specific disruptions and inform novel intervention targets to improve outcomes. Fifty-nine females with AN (n = 34) or AtypAN (n = 25), ages 10–22 years, all ≤ 90% expected body weight, and 34 age-matched healthy controls (HC) completed a validated neuroimaging food motivation paradigm pre- and post- standardized meal, and we used ANCOVA models to investigate main and interaction effects of Group and Appetitive State on blood oxygenation level-dependent (BOLD) activation. We found main effects of Group with greater BOLD activation in the dorsal anterior cingulate cortex (dACC), dorsolateral prefrontal cortex (DLPFC), hippocampus, caudate, and putamen for AN/AtypAN versus HC groups, and in the three-group model including AN, AtypAN, and HC groups, where differences were primarily driven by greater activation in AtypAN versus HC groups. We found a main effect of Appetitive State with increased premeal BOLD activation in the hypothalamus, amygdala, nucleus accumbens, and caudate for models that included AN/AtypAN and HC groups, and in BOLD activation in the nucleus accumbens for the model that included AN, AtypAN, and HC groups. There were no interaction effects of Group with Appetitive State for any of the models. Our findings suggest robust feeding-state independent group effects reflecting greater activation of reward-related brain regions as well as cognitive control regions across AN and AtypAN that may override observed increased activation of reward regions, in turn supporting the maintenance of a negative energy balance in this clinical population.