Elzbieta Paszynska

Salivary alpha-amylase, secretory IgA and free cortisol as neurobiological components of the stress response in the acute phase of anorexia nervosa

Abstract Objectives One novel hypothesis of the pathogenesis of anorexia nervosa (AN) is the possible role of mental stress in hyperactivity of the autonomic nervous system (ANS) and of the hypothalamic–pituitary–adrenal (HPA) axis. Two components of stress response – salivary alpha-amylase (sAA) and free cortisol – have been proposed. They can be determined in saliva, which closely reflects their concentrations in plasma. The purpose of this study was to measure salivary free cortisol, sAA and their correlation to secretory IgA (sIgA) of patients with AN in comparison to the average population. Methods A controlled clinical trial was designed for a matched group of 47 AN patients and 54 healthy individuals. After clinical examination, unstimulated salivary samples were taken during the acute stage of AN (BMI < 15 kg/m2) in the first week of hospitalisation. An enzyme-linked immunosorbent assay (ELISA) suitable for measuring sAA, sIgA and free cortisol were used. Results Anorexic patients exhibited disturbances in sAA secretion, and significantly increased cortisol and sIgA levels with a distinct correlation between these two parameters. Conclusions The behaviour of cortisol, sAA and sIgA levels can be assessed as an effect of stress reaction among AN patients with hyperactivity of the HPA axis and ANS dysregulation. The effect of stress response can be assessed reliably in saliva.

Salivary and serum insulin-like growth factor (IGF-1) assays in anorexic patients

Objectives. The purpose of this study was to measure the salivary and serum free IGF-1 concentration of patients with anorexia nervosa (AN) in comparison to an average population. Methods. A controlled clinical trial was designed for an age- and gender-matched group of 121 AN patients and 77 healthy individuals. A clinical examination was made and blood and salivary samples were taken during the acute stage of AN (BMI < 15 kg/m2) in the first week of hospitalization. An enzyme immunoassay (ELISA) suitable for measuring free IGF-1 was used. Results. Anorexic patients had significant reductions in salivary unstimulated flow rate (UFR), pH and free IGF-1 levels in their saliva and serum. Significant correlations between serum IGF-1 and BMI; salivary IGF-1 and UFR and pH were detected. Conclusions. Salivary and serum IGF-1 analyses appear to be a reliable biochemical indicator of malnutrition in AN patients. Measurement of salivary IGF-1 levels would allow new perspectives in monitoring AN in its early stages.

Parotid salivary parameters in bulimic patients - a controlled clinical trial

OBJECTIVES The aim of this study was to determine whether patients with purging-type bulimia and/or non-bulimic patients, treated with serotonin reuptake inhibitor SI-5-HT (fluoxetine), have dental erosion and changes in selected buffer components of parotid saliva (bicarbonates, phosphates, urea), compared with the healthy population. METHODS A controlled clinical trial was designed for three, age-matched, female groups of 94 patients: 1) bulimic patients treated with fluoxetine 40 mg/day (n = 25), 2) non-bulimic patients diagnosed with bipolar affective disorder, treated with fluoxetine 20mg/day (n = 25), and 3) healthy controls (n = 44). Parotid saliva was collected from the subjects by means of Lashley cup at rest and stimulated chemically with a 3% citric acid solution. In clinical examination the dental erosion was determined as non-carious tooth substance loss using the Tooth Wear Index (TWI). The concentrations of inorganic phosphates, bicarbonate, urea and pH in saliva were measured. RESULTS In the bulimic subjects higher TWI (24%) and lower levels of pH, bicarbonates and phosphates compared with controls were observed. There were no significant differences in urea concentration. CONCLUSIONS Erosive-abrasive tooth surface loss seems to be a significant diagnostic tool of bulimia nervosa. The presence of pathological changes in teeth structure indicates the loss of protective properties of saliva, which is proved by pH value and concentration of buffer ions. It is advisable to monitor salivary parameters, such as salivary flow rate, pH and the concentration of buffer ions in long-term treatment with SI-5-HT drugs in case of patients with purging-type bulimia. There is also a need for regular dental check-ups of the oral cavity tissues.

Parotid gland flow activity and inorganic composition in purging bulimic patients treated with fluoxetine

Abstract Objectives. The purpose of this study was to establish whether vomiting bulimic and/or non-bulimic depressive patients, both treated with the serotonin reuptake inhibitor SI-5-HT (fluoxetine), have differing proportions of inorganic components (specifically, sodium, potassium and calcium) in their parotid salivary gland secretions, than in the average population. Methods. A controlled clinical trial was designed for three age-matched female groups: bulimic patients receiving fluoxetine 40 mg/day (n = 33), non-bulimic patients diagnosed with bipolar affective disorder (fluoxetine 20 mg/day, n = 25) and healthy controls (n = 51). Parotid saliva was collected using a Lashley cap while the subjects were at rest. Stimulation was obtained chemically using a 3% citric acid solution, and physically by instructing the subjects to chew on wax pellets. The concentrations of sodium, potassium and calcium ions were measured using the colorimetric photometry method. Results. The bulimic patients had a reduction in flow and sodium and potassium ions in the parotid saliva and non-bulimic patients had a reduction in flow. Deficits in certain components of saliva were shown to be directly related to salivary flow rate. Conclusions. The data suggest that detection of inorganic deficits in parotid saliva might serve as a reliable confirmation of reduction in flow amongst purging bulimic patients treated with fluoxetine.

Flow rates and inorganic composition of whole saliva in purging bulimic patients treated with a fluoxetine

Abstract Objectives. The current study established whether vomiting bulimic and/or non-bulimic depressive patients, both treated with a serotonin reuptake inhibitor (fluoxetine), have changes in their whole salivary secretion and inorganic components: Na+, K+, Ca2+. Methods. From 108 female subjects, namely bulimics (Group B) (fluoxetine: 40 mg/day) (n = 33), non-bulimic depressives (Group D) (fluoxetine: 20 mg/day) (n = 25) and a Group C of 50 healthy controls, unstimulated and stimulated saliva was collected. The concentrations of Na+, K+, Ca2+ were determined by colorimetric photometry method (Effox 5053, Eppendorf, Germany). Results. The bulimic group reported significant lower output in salivary flow and sodium concentration. In the group (D) only flow was lower than in healthy controls but not significant. Conclusion. This study supports the hypothesis that salivary flow is an unreliable indicator of bulimia, the lack of increase in sodium level in stimulated saliva in bulimic subjects could be a more reliable confirmation of the eating disorder.

Neurobiochemical and psychological factors influencing the eating behaviors and attitudes in anorexia nervosa

The aim of this study was to determine the characteristic features which contribute to inappropriate eating attitudes in people suffering from anorexia nervosa, based on an analysis of recent data. Factors influencing these attitudes have a genetic, neurobiological, biochemical, affective-motivational, cognitive, and behavioral background. Another important issue addressed in the paper is a description of the mechanism leading to continuous dietary restrictions. The altered activity of neurotransmitters modulating patients’ moods after the consumption of food and a disturbed responsiveness to enterohormones enhance affective-motivational and cognitive aspects which, in turn, impede the improvement of eating behaviors. An understanding of the mechanisms behind the factors affecting the maintenance of inappropriate eating attitudes may contribute to greater effectiveness in the treatment of anorexia nervosa.

Salivary opiorphin levels in anorexia nervosa: a case control study

Abstract Objectives: Opiorphin is a physiological inhibitor of peptidases inactivating endogenous opioids displaying strong analgesic properties without undesirable side effects, antidepressant properties or hormonal dependency. It might therefore play an important role in patients with painful diseases related to neuro-hormonal dysregulation of the nervous system, affecting saliva secretion and composition such as anorexia nervosa (AN). The main objective aim of this study was to compare the level of opiorphin in saliva of patients with AN to matched subjects free of eating disorders. Methods: A case–control clinical trial was conducted in 68 AN patients and 43 healthy matched control subjects. Depression symptoms were assessed with the self-scored questionnaire Beck Depression Inventory (BDI) and salivary samples were taken during the acute stage of AN (BMI <15 kg/m2) for measuring opiorphin. Opiorphin levels were measured with a quantitative assay using a commercial immunoenzymatic Elisa kit (cat no. EH1927, Wuchan, Hubei, China). Results: No statistically significant difference was found in salivary opiorphin levels between the AN and control groups, (P = 0.499, Mann–Whitney U-test). Positive correlations to duration of the disease, BDI and bodyweight in AN patients were evidenced. Conclusions: Measurement of salivary opiorphin levels cannot be used as a marker of AN but may allow new perspectives in monitoring AN in its early stages.

Neuropeptide B and Vaspin as New Biomarkers in Anorexia Nervosa

Introduction The aim of the study was to assess the correlation between the levels of neuropeptide B (NPB), neuropeptide W (NPW), vaspin (VAS), and the total antioxidant status (TAS) in the blood, as well as nutritional status of patients with anorexia nervosa (AN). Materials and Methods The study covered a cohort of 76 female teenagers, including 46 females with extreme AN and 30 healthy peers (CONTR) aged 12-17. Results AN persons were characterized by higher (in comparison to CONTR) NPB and VAS concentrations and lower values of TAS levels, body weight, and anthropometric values. Positive correlations between NPB and VAS levels were noted in the AN group (R=0.33; p<0.001) as well as between concentrations of NPW and VAS in the same group (R=0.49; p<0.001). Furthermore, positive correlations existed between NPB and NPW concentrations across the whole studied population (AN+CONTR; R=0.75; p<0.000001), AN (R=0.73; p<0.000001) and CONTR (R=0.90; p<0.0005). Conclusions In detailed diagnostics of AN it is worth considering testing NPB and VAS levels.

Vaspin (but not neuropeptide B or neuropeptide W) as a possible predictor of body weight normalization in anorexia nervosa

Introduction: The aim of the study was to evaluate the correlation between the nutritional status of patients with anorexia nervosa (AN) and levels of vaspin (VASP), neuropeptide B (NPB), neuropeptide W (NPW) and total antioxidant status (TAS). Material and methods: Ninety serum samples collected from 30 teenage female patients during the acute stage of AN and 30 healthy persons (CONTR) were subjected to biochemical analysis; patients with AN were examined at the beginning of the study (AN-I) and after hospitalization (AN-II), as a result of which partial stabilization of anthropometric measurements was achieved (an increase of body mass index (BMI) by 3.5 kg/m2). Results: Vaspin levels dropped at the end of the hospitalization (compared to AN-I, p < 0.05), achieving values comparable to the CONTR; moreover there was a positive correlation between VASP level and the achieved body weight in AN-II (p < 0.05). Positive correlations were also noted with regard to VASP vs. NPB in AN-I (p < 0.02) (and AN-II, p < 0.013), as well as in the case of VASP vs. NPW in the same groups (p < 0.02 and p < 0.015, respectively). NPB concentration was higher in AN-I (p < 0.05) and AN-II (p < 0.018) than in CONTR, whereas there were no differences (p > 0.05) with regard to levels of VASP, NPW, or TAS. Conclusions: The high level of NPB despite treatment and normalization of VASP level may suggest that there are chronic neuroendocrine disorders at play in anorexia nervosa.

Enzyme activities in parotid saliva of patients with the restrictive type of anorexia nervosa

OBJECTIVE In patients with anorexia nervosa (AN) specific signs may occur in the oral cavity, but there are conflicting reports about their significance, especially concerning changes in salivary composition. The aim of this clinical study was to evaluate the resting parotid flow rate (PFR) and the activity of the following enzymes in parotid saliva: amylase, aspartate amino transferase (AST), lysozyme, peroxidase, serine and acidic proteases in the acute phase of the restrictive type of AN and to compare the findings with those in healthy controls. DESIGN Forty-one subjects participated (20 patients with AN, 21 matched healthy controls), parotid saliva was collected using a modified Lashley cap at rest. Enzyme activities were measured with fluorimetric and photometric assays. RESULTS The unstimulated PFR was significantly lower than in the controls, lysozyme and AST activity was significantly lower, and amylase showed a high inter-individual variability. A positive correlation for amylase and lysozyme and negative ones for lysozyme and BMI, lysozyme and IBW%, serine protease and salivary flow were observed. CONCLUSIONS The reduced PFR and enzyme activities levels suggest that AN does not only affect the quantity of the saliva but also its quality and, its biological functions. The results obtained should help to provide a better understanding of the effect of AN disease on the pathogenesis of at least some oral diseases. Further research is needed on any possible role of reduced lysozyme and transaminase activity in maintaining oral protection against external toxic agents and bacteria.