Hunger and Satiety in Anorexia Nervosa
Hunger and Satiety in Anorexia Nervosa
Anorexia means loss of appetite. But there is disagreement about whether the appetite is
 changed by the disease anorexia nervosa (AN). Appetite is a subjective essential sense, which
 is regulated in a complex ensemble between brain, stomach - intestinal system and hormones.
 As a direct result of malnutrition, there are many somatic complications caused by the
 disease AN. Several of these complications may in itself affect hunger- and satiety
 perception. An example of this is delayed gastric emptying. Furthermore, changes in the
 hormone systems affects the biological "reward system" in the brain, which plays an important
 role in appetite regulation. There is clearly need for research that could lead to better
 treatments for AN. Hunger- and satiety perception has only been studied in a few small
 cross-sectional studies with no clear conclusion.

 The purpose of the study is to determine whether a visual analog scale measurement can detect
 changes in hunger- and satiety perception in a least 30 patients admitted to nutrition for
 life-threatening severe anorexia nervosa. It may lead to the first step in the development of
 a simple and inexpensive instrument which may prove to be useful in measuring the impact of
 new and ongoing treatments of the disease.
Appetite refers to the desire associated with eating. Both internal and external factors can
 stimulate appetite. Hunger and satiety are included in appetite regulation. Hunger is related
 to physiological needs and the commencement of eating. Satiety refers to a state without the
 urge to eat, where both the onset of satiety and post ingestion satiety are included.

 Anorexia is abnormal loss of appetite for food. Anorexia nervosa is an eating disorder
 characterized by food restriction, despite low weight, leading to speculation about the
 presence of appetite alterations by weight loss.

 AN is a syndrome of unknown etiology which has been well described since 1873, and which
 occurs most frequently in adolescent women. The syndrome is characterized by distorted body
 image, and fear of obesity, why low ideal weight is pursued. The disorder occurs in different
 degrees of severity with secondary endocrine and metabolic changes and disturbances. The
 symptoms may also include excessive physical activity, abuse of laxatives, or diuretics and
 self-induced vomiting.

 There are multiple medical complications due to the starvation and weight loss in AN, several
 of which directly may affect appetite, for instance, delayed emptying of the stomach and
 constipation. Furthermore, compression of duodenum has been observed causing nausea and early
 satiety.

 Hypothalamic hypogonadism is one of the well-known adaptive endocrine alterations in AN due
 to starvation and exaggerated exercise. Progesterone and testosterone is believed to
 stimulate appetite and eating, in a manner mediated centrally, selectively increasing the
 number of meals.

 Moreover, AN patients have significantly higher levels of ghrelin, growth hormone (GH) and
 cortisol and significantly lower leptin, compared with partially recovered AN patients and
 constitutionally thin subjects.

 Hunger and satiety are subjective sensations which may be influenced by sensory factors and
 palatability, including taste, smell and texture. A recent study suggested that patients with
 AN may have an altered perception of olfactory, gustatory stimuli, and reduced perception of
 bitter stimuli.

 Other physiological factors such as, hypothalamic and mesolimbic endocannabinoids, enhance
 appetite by stimulating neurochemical pathways underlying both homeostatic and rewarding
 aspects of food intake. Endocannabinoids are involved in food-related reward mechanisms, and
 there are increasing evidence that these mechanisms are dysregulated in AN patients.
 Moreover, functional neuroimaging studies have demonstrated decreased food-related stimuli in
 brain areas of the mesolimbic reward system in AN patients.
Inclusion Criteria:

 -  Patients with severe AN admitted to the specialized nutrition unit at Center for
 Eating disorders at Odense University Hospital are included.

 Exclusion Criteria:

 -  Patients admitted only for short-term water-electrolyte correction, are excluded.