R Bou Khalil1,2, N Risch3,4, G Sleilaty5, S Richa6, M Seneque3,4, P Lefebvre7, A Sultan8, A Avignon9, L Maimoun8,10, E Renard3,11, P Courtet3,4, S Guillaume3,4. 1. Department of Psychiatry, Saint Joseph University-Hôtel Dieu de France Hospital, Beirut, Lebanon. rami.boukhalil@usj.edu.lb. 2. Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France. rami.boukhalil@usj.edu.lb. 3. Institute of Functional Genomics, University of Montpellier, CNRS, INSERM, Montpellier, France. 4. Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU, 34295, Montpellier, France. 5. Clinical Research Center and Department of Cardiac and Thoracic Surgery, Saint Joseph University-Hôtel Dieu de France Hospital, Beirut, Lebanon. 6. Department of Psychiatry, Saint Joseph University-Hôtel Dieu de France Hospital, Beirut, Lebanon. 7. Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, University of Montpellier, Montpellier, France. 8. University of Montpellier, PhyMedExp, INSERM, CNRS UMR, CHRU Montpellier, Montpellier, France. 9. Desbrest Institute of Epidemiology and Public Health, Univ Montpellier, INSERM, CHU, Montpellier, France. 10. Département de Médecine Nucléaire, Hôpital Lapeyronie, CHU Montpellier, Montpellier, France. 11. Department of Endocrinology, Diabetes, Nutrition, CHU Montpellier, Montpellier, France.
Abstract
PURPOSE: Anorexia nervosa (AN) is a serious mental illness. It is frequently accompanied by a history of childhood maltreatment (CM) that may constitute a specific ecophenotype in patients with eating disorders necessitating special assessment and management. This retrospective study tested whether in patients with AN, CM-related chronic stress may manifest through low-grade inflammation reflected by an increase in white blood cell ratios (neutrophil-to-lymphocyte ratio, NLR, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio). METHODS: Participants (N = 206) were enrolled at an eating disorder daycare unit in Montpellier, France, from March 2013 and January 2020. CM was assessed using the childhood trauma questionnaire (CTQ). The Eating Disorder Examination Questionnaire (EDE-Q) and the MINI were used to assess AN severity and the other clinical characteristics, respectively. RESULTS: NLR was higher in patients with AN and history of CM (p = 0.029) and in patients with AN and history of emotional abuse (p = 0.021), compared with patients with AN without history of CM. In multivariate analysis, emotional abuse (β = 0.17; p = 0.027) contributed significantly to NLR variability. CONCLUSION: In patients with AN, NLR is a low-grade inflammation marker that is influenced by various sociodemographic, clinical and biological factors. It is more directly affected by some CM types, especially emotional abuse, than by the presence/absence of CM history. Future studies should focus on mediators between CM and increased inflammation, such as interoceptive awareness, emotional dysregulation, food addiction, and stress sensitization. LEVEL OF EVIDENCE: III. Evidence obtained from well-designed cohort or case-control analytic studies.
PURPOSE: Anorexia nervosa (AN) is a serious mental illness. It is frequently accompanied by a history of childhood maltreatment (CM) that may constitute a specific ecophenotype in patients with eating disorders necessitating special assessment and management. This retrospective study tested whether in patients with AN, CM-related chronic stress may manifest through low-grade inflammation reflected by an increase in white blood cell ratios (neutrophil-to-lymphocyte ratio, NLR, platelet-to-lymphocyte ratio, and monocyte-to-lymphocyte ratio). METHODS: Participants (N = 206) were enrolled at an eating disorder daycare unit in Montpellier, France, from March 2013 and January 2020. CM was assessed using the childhood trauma questionnaire (CTQ). The Eating Disorder Examination Questionnaire (EDE-Q) and the MINI were used to assess AN severity and the other clinical characteristics, respectively. RESULTS: NLR was higher in patients with AN and history of CM (p = 0.029) and in patients with AN and history of emotional abuse (p = 0.021), compared with patients with AN without history of CM. In multivariate analysis, emotional abuse (β = 0.17; p = 0.027) contributed significantly to NLR variability. CONCLUSION: In patients with AN, NLR is a low-grade inflammation marker that is influenced by various sociodemographic, clinical and biological factors. It is more directly affected by some CM types, especially emotional abuse, than by the presence/absence of CM history. Future studies should focus on mediators between CM and increased inflammation, such as interoceptive awareness, emotional dysregulation, food addiction, and stress sensitization. LEVEL OF EVIDENCE: III. Evidence obtained from well-designed cohort or case-control analytic studies.