Letizia Maria Affaticati

Background: Anorexia nervosa (AN) has the highest mortality rate among psychiatric disorders, making early diagnosis and tailored management crucial. This study aimed to evaluate the impact of age at onset (AAO)—childhood/adolescence versus adulthood—on the clinical course and associated biochemical parameters. Methods: Seventy-six female patients with AN were divided into two groups based on AAO (t-tests for continuous variables and χ² tests for categorical variables. Correlation analyses assessed associations between AAO and continuous variables. Significant findings were entered into regression models, including a binary logistic regression with AAO as the dependent variable and a linear regression with significant correlations as predictors. Results: The early-onset group showed significantly higher potassium levels and a lower sodium/potassium ratio (Na⁺/K⁺) compared with the late-onset group (potassium: t = 0.93, p < 0.01; Na⁺/K⁺: t = 3.39, p < 0.01). AAO was strongly inversely correlated with potassium levels (r = −0.75, p < 0.01) and positively correlated with cholesterol (r = 0.574, p < 0.01) and Na⁺/K⁺ (r = 0.78, p = 0.01). Binary logistic regression correctly classified 87% of cases, showing that lower Na⁺/K⁺ was associated with earlier onset (OR = 2.23, p = 0.03). Linear regression confirmed significant associations of AAO with cholesterol levels (B = 0.07, p = 0.02) and Na⁺/K⁺ (B = 1.68, p < 0.01). Conclusions: AAO in AN is strongly associated with specific biochemical parameters. Early-onset patients exhibit more severe electrolyte imbalances, while late-onset cases show higher cholesterol levels, suggesting increased cardiovascular risk. These findings emphasize the importance of personalized treatment approaches according to AAO, although further studies are warranted to confirm these results.

Anorexia nervosa (AN) has the highest mortality rate among psychiatric disorders, mak-ing early diagnosis and appropriate management essential. This study aims to investigate the impact of age at onset (AAO) - childhood/adolescence vs adulthood - on the course of the disorder and associated biochemical parameters. A total of 76 female patients were in-cluded and divided into two groups based on AAO (< 18 years versus ≥ 18 years). Com-parisons between groups were made using t-tests for continuous variables and χ² tests for categorical variables. Correlation analyses were performed to evaluate the relation be-tween AAO and continuous variables. Significant variables at univariate analyses were then entered into two regression models with AAO as dependent variable: a binary lo-gistic regression model with significant continuous variables at t tests as predictors, and a linear regression model with significant correlations as independent variables. The ear-ly-onset group showed significantly higher potassium levels and a lower sodi-um/potassium ratio (Na+/K+) compared to the late-onset group (potassium: t=0.93, p< 0.01; Na+/K+: t=3.39, p< 0.01). Pearson correlations revealed a strong inverse relationship be-tween AAO and potassium levels (r = -0.75, p < 0.01). Cholesterol levels (r = 0.574, p < 0.01) and Na+/K+ (r = 0.78, p = 0.01) were positively correlated with AAO. Binary logistic re-gression correctly classified 87% of cases, with a lower Na+/K+ associated with earlier on-set (OR = 2.23, p = 0.03). Linear regression confirmed that cholesterol levels (B = 0.07, p = 0.02) and Na+/K+ (B = 1.68, p < 0.01) were significantly associated with AAO. This study highlights a strong association between AAO of AN and some clinical/biochemical pa-rameters. Early-onset patients show more severe electrolyte imbalances. Late-onset cases tend to have higher cholesterol levels, suggesting increased cardiovascular risk. These findings underscore the need for personalized treatment approaches according to AAO of AN. Further studies are needed to confirm the findings reported in the present article,

The aim of the present study was to investigate the potential associations between clinical/socio-demographic variables and the presence of purging/binge-eating episodes in eating disorders (EDs). Clinical/socio-demographic variables and psychometric scores were collected. Groups of patients were identified according to the presence or absence of purging or objective binge-eating episodes (OBEs) and compared through t-test and chi-square tests. Binary logistic regression analyses were run. A sample of 51 ED outpatients was recruited. Patients with purging behaviors had a longer duration of untreated illness (DUI) (t = 1.672; p = 0.019) and smoked a higher number of cigarettes/day (t = 1.061; p = 0.030) compared to their counterparts. A lower BMI was associated with purging (OR = 0.881; p = 0.035), and an older age at onset showed a trend towards statistical significance (OR = 1.153; p = 0.061). Patients with OBEs, compared to their counterparts, were older (t = 0.095; p < 0.001), more frequently presented a diagnosis of bulimia or binge-eating disorder (χ² = 26.693; p < 0.001), a longer duration of illness (t = 2.162; p = 0.019), a higher number of hospitalizations (t = 1.301; p = 0.012), and more often received a prescription for pharmacological treatment (χ² = 7.864; OR = 6.000; p = 0.005). A longer duration of the last pharmacological treatment was associated with OBE (OR = 1.569; p = 0.046). In contrast to purging, OBE was associated with a more complicated and severe presentation of ED. A lower BMI and a later age at onset, as well as long-lasting previous pharmacological treatments, may predict the presence of purging/binging. Further research is needed to thoroughly characterize ED features and corroborate our preliminary findings.

A strong interplay exists between sleep and dietary habits, and sleep disturbances have been repeatedly documented in individuals with eating disorders (EDs). The orexin system – implicated in sleep regulation, energy homeostasis, and food reward - may represent a mechanist link between sleep alterations and disordered eating behaviors. Daridorexant is a dual orexin receptor antagonist (DORA) recently approved for the treatment of insomnia, with demonstrated efficacy and tolerability. Owing to its action on orexin neurons, the compound represents an intriguing option for addressing both sleep-related and core symptoms of EDs. By inhibiting motor hyperactivity, daridorexant may reduce excessive physical exercise in individuals with anorexia nervosa (AN) restricting type. Additionally, the compound may exert anti-binge effects, suggesting broad applicability in binge ED, bulimia nervosa, and binge/purging AN. In this framework, daridorexant emerges as a promising therapeutic option, offering a multifaceted approach to improving circadian rhythms, energy balance, and overall quality of life in individuals with diverse ED subtypes.

Severe forms of Anorexia Nervosa (AN) are characterized by medical complications, psychiatric comorbidity, and high mortality. This study investigated potential associations between clinical/biological factors and the severity of AN, measured by the Body Mass Index (BMI). Red and white blood cells, hemoglobin, platelets, iron, vitamins D and B12, folate, and total cholesterol were measured in a mixed sample of 78 inpatients and outpatients. Linear regressions and one-way analyses of variance (ANOVAs) were carried out to evaluate the relationship between BMI and clinical/biochemical variables. BMI was significantly lower in hospitalized patients (F = 4.662; p = 0.034) and in those under pharmacological treatment (F = 5.733; p = 0.019) or poly-therapy (F = 5.635; p = 0.021). Higher vitamin B12 (β = −0.556, p < 0.001), total cholesterol (β = −0.320, p = 0.027), and later age at onset (with a trend towards significance) (β = −0.376, p = 0.058) were associated with a lower BMI. Increased total cholesterol and vitamin B12, later age at onset, current pharmacological treatment, and poly-therapy might be distinctive in patients with a lower BMI. In clinical practice, these findings may contribute to the early identification of AN patients at higher risk of developing complicated or chronic forms of the disorder. Further studies on larger samples are needed to identify potential predictive factors of AN severity in the framework of precision medicine.

The aim of this systematic review was to synthesise the impact of the COVID-19 pandemic on binge eating disorder (BED) the new onset and course. Inclusion criteria: original articles and BED diagnosis; and the main outcomes: relationships between the COVID-19 pandemic and the new onset/clinical changes in BED, and specific results for BED. Exclusion criteria: mixed/inaccurate diagnoses and articles not written in English. We searched four databases and one registry until 5 May 2023. The quality appraisal was conducted using the Effective Public Health Practice Project (EPHPP) tool. Twelve studies with 4326 participants were included. All studies were observational with nine cross-sectional and three longitudinal. Four of the included studies investigated new-onset BED, while eight examined the BED clinical course of patients with a previous diagnosis. With the exception of one study, the available literature indicates both an increase in BED diagnoses and a clinical worsening during COVID-19. Major limitations include study quality (weak-to-moderate) and high heterogeneity in terms of pandemic phase, population, geographical areas, and psychometric tools. Our findings indicate that BED patients are particularly vulnerable to events characterised by social distancing and over-worry, and should be, therefore, carefully monitored. Further studies are needed to corroborate our findings, implement preventive strategies, and promote personalised treatments. PROSPERO registration number: CRD42023434106

Anorexia Nervosa (AN) is a disabling disorder characterized by extreme weight loss and frequent chronicization, especially in its most severe forms. This condition is associated with a pro-inflammatory state; however, the role of immunity in symptom severity remains unclear. Total cholesterol, white blood cells, neutrophils, lymphocytes, platelets, iron, folate, vitamin D and B12 were dosed in 84 female AN outpatients. Mildly severe (Body Mass Index—BMI ≥ 17) versus severe (BMI < 17) patients were compared using one-way ANOVAs or χ² tests. A binary logistic regression model was run to investigate the potential association between demographic/clinical variables or biochemical markers and the severity of AN. Patients with severe anorexia (compared to mild forms) were older (F = 5.33; p = 0.02), engaged in more frequent substance misuse (χ² = 3.75; OR = 3.86; p = 0.05) and had a lower NLR (F = 4.12; p = 0.05). Only a lower NLR was predictive of severe manifestations of AN (OR = 0.007; p = 0.031). Overall, our study suggests that immune alterations may be predictive of AN severity. In more severe forms of AN, the response of the adaptive immunity is preserved, while the activation of the innate immunity may be reduced. Further studies with larger samples and a wider panel of biochemical markers are needed to confirm the present results.

Social anxiety disorder (SAD) is a common psychiatric condition associated with a high risk of psychiatric comorbidity and impaired social/occupational functioning when not promptly treated. The identification of biological markers may facilitate the diagnostic process, leading to an early and proper treatment. Our aim was to systematically review the available literature about potential biomarkers for SAD. A search in the main online repositories (PubMed, ISI Web of Knowledge, PsychInfo, etc.) was performed. Of the 662 records screened, 61 were included. Results concerning cortisol, neuropeptides and inflammatory/immunological/neurotrophic markers remain inconsistent. Preliminary evidence emerged about the role of chromosome 16 and the endomannosidase gene, as well as of epigenetic factors, in increasing vulnerability to SAD. Neuroimaging findings revealed an altered connectivity of different cerebral areas in SAD patients and amygdala activation under social threat. Some parameters such as salivary alpha amylase levels, changes in antioxidant defenses, increased gaze avoidance and QT dispersion seem to be associated with SAD and may represent promising biomarkers of this condition. However, the preliminary positive correlations have been poorly replicated. Further studies on larger samples and investigating the same biomarkers are needed to identify more specific biological markers for SAD.