Fasten und (Über)-essen:
Abstract
Zusammenfassung.Theoretischer Hintergrund: Ergebnisse tierexperimenteller Studien lassen darauf schließen, dass Fastenperioden mit reduzierter sympathischer Aktivierung verbunden sind, während Zeiten der normalen Ernährung oder des Überessens mit einer erhöhten sympathischen Aktivierung einhergehen. Fragestellung: In der vorliegenden Studie wurden Parameter der kardialen sympatho-vagalen Balance zu endokrinologischen Variablen des Ernährungszustandes in Beziehung gesetzt. Methode: Sechzehn Frauen mit der Diagnose Bulimia nervosa wurden anhand ihres Serum-Profils in verschiedenen endokrinologischen Parametern (Glukose, Prä-Albumin, Somatomedin-C, TSH, Leptin) in zur Zeit mangelernährt (fastend) und nicht-mangelernährt (nicht-fastend) kategorisiert und mit 14 alters- und BMI-parallelisierten gesunden Frauen verglichen. Zur Bestimmung der sympatho-vagalen Erregungslage wurden die spektralanalytischen Komponenten der Herzfrequenzvariabilität mit autoregressiven Analysen von Ruhedaten berechnet. Ergebnisse: Wie erwartet war die Ruhepulsfrequenz bei fastenden Bulimikerinnen signifikant niedriger als bei nicht-fastenden Bulimikerinnen oder Kontrollpersonen. Nicht-fastende Bulimikerinnen zeigten die niedrigsten vagalen und die höchsten sympathischen Frequenzkomponenten in der Herzfrequenzvariabilität. Schlussfolgerungen: Diese Ergebnisse bestätigen die Hypothese kardialer sympathischer Hemmung während des Fastens und der erhöhten sympathischen Aktivierung bei normaler Ernährung oder Überessen.
Abstract.Background: Findings from animal studies suggest sympathetic inhibition during dietary restriction as opposed to increased sympathetic activity during re-feeding. Objective: The present study investigated sympathovagal balance in relation to endocrinological parameters of malnutrition status in women diagnosed with bulimia nervosa. Methods: Sixteen female volunteers diagnosed with bulimia nervosa were categorized according to their serum profile (glucose, prealbumin, insuline-like growth factor, TSH, leptin) into currently malnourished (i.e., fasting) versus non-malnourished (not fasting) and compared with fourteen controls without eating disorders matched for age and body mass index (BMI). Spectral components of heart rate variability (HRV) were calculated on resting heart rate data using autoregressive analysis. Results: As expected, fasting bulimic women displayed lower resting heart rates compared to non-fasting women and controls. Non-fasting bulimic women consistently showed lower results in the vagally mediated component and significantly higher results in the sympathetically mediated component of HRV. Conclusions: These results confirm the notion of cardiac sympathetic inhibition during caloric restriction and increased activity during periods of normal eating or bingeing.
Literatur
(1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Press.
(1997). Heart rate variability: origins, methods, and interpretive caveats. Psychophysiology , 34, 623–648.
(1993). Body weight change, all-cause mortality, and cause-specific mortality in the Multiple Risk Factor Intervention Trial. Annals of Internal Medicine , 119, 749–757.
(1994). Heart rate and heart variability as indexes of sympathovagal balance. American Journal of Physiology , 266, H1565–H1571.
(1994). Medical, metabolic, and psychological effects of weight cycling. Archives of Internal Medicine , 154, 1325–1330.
(1983). Reliability of DSM-III anxiety disorders categories using a new structered interview. Archives of General Psychiatry , 40, 1070–1074.
(1988). Refeeding hypertension in dietary obesity. American Journal of Physiology , 254, R47–R55.
(1996). Consequences of weight cycling in obese spontaneously hypertensive rats. American Journal of Physiology , 270, R864–R872.
(1994). Refeeding hypertension in obese SHR. Hypertension Dallas , 24, 699–705.
(1997). Serum leptin concentrations in patients with anorexia nervosa, bulimia nervosa and non-specific eating disorders correlate with the body mass index but are independent of the respective disease. Clinical Endocrinology , 46, 289–293.
(1986). Effect of experimental and pathological weight loss upon the hypothalamo-pituitary-adrenal axis. Psychoneuroendocrinology , 11, 295–305.
(1997). Psychological effects of weight cycling in obese persons: a review and research agenda. Obesity Research , 5, 474–488.
(1998). Differential relation of psychological functioning with the history and experience of weight cycling. Journal of Consulting and Clinical Psychology , 66, 646–650.
(1998). Autonomic balance revisited: panic anxiety and heart rate variability. Journal of Psychosomatic Research , 44, 133–151.
(1997). Persistence of binge-eating patterns after a history of restriction with intermittent bouts of refeeding on palatable food in rats: implications for bulimia nervosa. International Journal of Eating Disorders , 22, 411–420.
(2003). Central and autonomic nervous system integration in emotion. Brain and Cognition , 52, 79–87.
(1989). Large fluctuations in body weight during young adulthood and twenty-five-year risk of coronary death in men. American Journal of Epidemiology , 129, 312–318.
(1991). Development and validation of a scale for measuring state self-esteem. Journal of Personality and Social Psychology , 60, 895–910.
(1996). Does weight cycling present a health risk?. American Journal of Clinical Nutrition , 63, 452S–455S.
(1997). Mangelernährung in Hämodialysepatienten. Medizinische Klinik , 92, 13–17.
(1995). Biological and psychological correlates of intermittent dieting behavior in young women. A model for bulimia nervosa. Physiology & Behavior , 60, 1–5.
(1998). Nutritional and endocrine-metabolic aberrations in women with functional hypothalamic amenorrhea. The Journal of Clinical Endocrinology and Metabolism , 83, 25–32.
(1992). Change in body weight and longevity. A 27-year follow-up of middle-aged men. Journal of the American Medical Association , 268, 2045–2049.
(1990). Autonomic interactions in cardiac control. Annals of the New York Academy of Sciences , 601, 209–221.
(1991). Variability of body weight and health outcomes in the Framingham population. New England Journal of Medicine , 324, 1839–1844.
(1987). Heart rate variability as an index of sympathovagal interaction after acute myocardial infarction. American Journal of Cardiology , 60, 1239–1245.
(1995). Vagal tone in generalized anxiety disorders and the effects of averse imaging and worrisome thinking. Behavior Therapy , 26, 457–466.
(1993). Components of heart rate variability - what they really mean and what we really measure. American Journal of Cardiology , 72, 821–822.
(1994). Physiology and clinical implications of variability of cardiovascular parameters with focus on heart rate and blood pressure. American Journal of Cardiology , 73, 3C–9C.
(1994). Mini-DIPS. Diagnostisches Kurzinterview bei psychischen Störungen. Berlin: Springer.
(1994). Power spectral analysis of heart rate variability to assess the changes in sympathovagal balance during graded orthostatic tilt. Circulation , 90, 1826–1831.
(1995). Is weight cycling detrimental to health? A review of the literature in humans. International Journal of Obesity , 19 (Suppl 3), S46–S50.
(1998). The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. Archives of General Psychiatry , 55, 580–592.
(1994). Weight cycling. Journal of the American Medical Association , 272, 1196–1202.
(1995). Spectral analysis of blood pressure and heart rate variability in evaluating cardiovascular regulation. Hypertension , 25, 1276–1286.
(1996). Central and peripheral noradrenalin regulation in eating disorders. Psychiatry Research , 62, 43–49.
(1990). Analyses of periodic processes in psychophysiological research. In J. T. Cacioppo & L. G. Tassinary (Eds.), Principles of psychophysiology: Physical, social, and inferential elements (pp. 708-753). New York: Cambridge University Press.
(2000). Severe depression is associated with markedly reduced heart rate variability in patients with stable coronary heart disease. Journal of Psychosomatic Research , 48, 493–500.
(1996). Heart rate variability: Standards of measurement, physiological limitations, and clinical use. Circulation , 93, 1043–1065.
(1998). The heart of anxiety: a dynamical systems approach. In A. Vingerhoets (Ed.), The (Non)Expression of Emotions in Health and Disease. Amsterdam: Springer.
(1996). Autonomic characteristics of generalized anxiety disorder and worry. Biological Psychiatry , 39, 255–266.
(2000). Phasic heart period to cued threat and non-threat stimuli in generalized anxiety disorder. Psychophysiology , 37, 361–368.
(2000). A model of neurovisceral integration in emotion regulation and dysregulation. Journal of Affective Disorders , 61, 201–216.
(1998). Heart period variability and depressive symptoms: gender differences. Biological Psychiatry , 44, 304–306.
(2003). Psychological responses to body shape exposure in patients with bulimia nervosa. Behaviour Research and Therapy , 41, 573–586.
(1997). Intentional weight loss: patterns in the general population and its association with morbidity and mortality. International Journal of Obesity , 21 (Suppl 1), S14–S19.
(1995). A prospective study of weight cycling on cardiovascular risk factors. Archives of Internal Medicine , 155, 1416–1422.