Impaired maturation of resting-state connectivity in anorexia nervosa from adolescence to adulthood: differential mechanisms of consummatory vs. anticipatory responses through a symptom provocation paradigm

This functional magnetic resonance imaging (fMRI) study examined resting-state (RS) connectivity in adolescent and adult patients with anorexia nervosa (AN) using symptom provocation paradigms. Differential food reward mechanisms were investigated through separate assessments of responses to food images and low-caloric/high-caloric food consumption. Thirteen young (≤ 21 years) and seventeen adult (> 21 years) patients with AN and age-matched controls underwent two stimulus-driven fMRI sessions involving RS scans before and after the presentation of food-related stimuli and food consumption. Graph theory and machine learning were used for analyzing the fMRI and clinical data. Healthy controls (HCs) showed widespread developmental changes, while young participants with AN exhibited cerebellum differences for high-calorie food. Young individuals with AN displayed increased connectivity during the consumption of potato chips compared to zucchini, with no differences in adults with AN. Multiparametric machine learning accurately distinguished young individuals with AN from healthy controls based on RS connectivity following food visual stimulation ("anticipatory") and consumption ("consummatory"). This study highlights the differential food reward mechanisms and minimal developmental changes in RS connectivity from youth to adulthood in individuals with AN compared to healthy controls. Young individuals with AN demonstrated heightened reactivity to high-caloric foods, while adults showed decreased responsiveness, potentially due to desensitization. These findings shed light on aberrant eating behaviors in individuals with AN and contribute to our understanding of the chronicity of the disease.