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Fortschr Neurol Psychiatr 2007; 75(7): 402-412
DOI: 10.1055/s-2006-944317
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Die Bedeutung von Cholin und verschiedenen Serumparametern für den Verlauf der Anorexia nervosa

The Importance of Choline and Different Serum Parameters for the Course of the Anorexia NervosaL.  Wöckel1, 2 , T.  Bertsch3 , S.  Koch4 , L.  Achtnichts5 , M.  Holtmann1 , N.  Gretz6 , M. H.  Schmidt2 , F.  Poustka1
  • 1Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Universität Frankfurt am Main (Direktor: Prof. Dr. F. Poustka)
  • 2Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, Mannheim (Direktor: Prof. Dr. Dr. M. H. Schmidt)
  • 3Institut für Klinische Chemie und Laboratoriumsmedizin, Klinikum Nürnberg (Chefarzt: PD Dr. T. Bertsch)
  • 4Abteilung Psychopharmakologie, Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, Mannheim (Leiter der Abteilung: Prof. Dr. R. Spanagel)
  • 5Neurologische Klinik, Universitätsspital Basel, Schweiz (Direktor: Prof. Dr. A. J. Steck)
  • 6Zentrum für Medizinische Forschung, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Mannheim (Direktor: Prof. Dr. N. Gretz)
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Publication History

Publication Date:
17 November 2006 (online)

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Zusammenfassung

In einer Starvationsuntersuchung wurde im Tierexperiment die Mangelernährung entsprechend einer Anorexia nervosa simuliert. Ratten im Alter von 11 bis 13 Wochen erhielten eine hypokalorische Diät in einer Standardzusammensetzung oder eine hypokalorische cholinreduzierte Diät. Die Dauer der Gewichtsreduktion betrug 12 bis 20 Wochen, das Ausmaß der Gewichtsreduktion lag zwischen 30 % bis 40 % vom Ausgangsgewicht. Bei einem Teil der Tiere erfolgte anschließend eine Wiederauffütterung (6 bis 12 Wochen) mit Standardnahrung oder cholinangereichert ad libitum. Untersucht wurden Blutparameter und die Membranfluiditäten im ZNS. Unter Gewichtsreduktion fand sich eine signifikante Abnahme vom Gesamteiweiß und der Triglyzeride (Z = -3,53 bzw. -3,42; p < 0,001) und eine Zunahme der Fluidität (Z = -2,83; p < 0,01). Nach langandauernder Gewichtsreduktion und anschließender Wiederauffütterung lag eine katabole Stoffwechsellage mit einem signifikant erhöhten Harnstoff/Kreatinin-Quotienten vor. Die cholinangereicherte Wiederauffütterung führte zu einer Normalisierung der Blutparameter und der Membranfluidität im ZNS. Bei Cholinanreicherung stieg das Gesamteiweiß signifikant (Z = -2,03; p < 0,01). Außerdem fanden wir eine negative Korrelation zwischen dem Gesamteiweiß und dem Harnstoff/Kreatinin-Quotienten (rS = -0,47; p < 0,001; n = 64), möglicherweise infolge eines verringerten Proteinkatabolismus oder eines erhöhten Proteinanabolismus. Darüber hinaus korrelierten Gesamteiweiß und Kreatinin mit den Membranfluiditäten des ZNS (rS = 0,65 bzw. 0,58 mit p < 0,001), so dass diese Parameter als potenzielle Prädiktoren für die Zellfunktion im mangelernährten Gehirn und zur Verlaufsuntersuchung einer Anorexie diskutiert werden können. Wir stellen die Hypothese auf, dass Cholinanreicherung der Nahrung zur Stabilität zerebraler Membranen beiträgt und den Verlauf der Stoffwechselveränderungen bei Anorexia nervosa günstig beeinflusst.

Abstract

Malnutrition in anorexia nervosa was simulated in an animal starvation study. Female rats aged 11 to 13 weeks received a hypocaloric standard diet or a hypocaloric choline reduced diet. Weight reduction lasted for 12 to 20 weeks and was between 30 % to 40 % of initial weight. Several animals were refed after weight reduction up to 6 to 12 weeks with a standard or a choline enriched diet ad libitum. Serum parameters and membrane fluidity of the CNS were measured after weight reduction or after refeeding. Weight reduction leads to a significant decrease of serum protein, triglycerides (Z = -3,53 resp. -3,42; p < 0,001) and an increase of membrane fluidity in the CNS (Z = -2,83; p < 0,001). Long-term diet with marked weight reduction and following refeeding causes a catabole metabolic situation with significant increase of urea/creatinine-ratio. Choline enriched refeeding after diet results in normalization of serum parameters and membrane fluidity of the CNS. Choline enrichment leads to a significant increase of serum protein (Z = -2,03; p < 0,01). Besides we found a negative correlation between serum protein and urea/creatinine-ratio (rS = -0,47; p < 0,001; n = 64). This is possibly caused by a reduced protein catabolism or an increased protein anabolism. Furthermore membrane fluidity in the CNS correlates with serum protein (rS = 0,65; p < 0,001; n = 41) and with serum creatinine levels (rS = 0,58; p < 0,001; n = 42). We conclude that these serum parameters are potential predictors for cell function in the starved brain and consequently for the course of anorexia nervosa. We furthermore hypothesize that choline enriched nutrition after starvation improves the stabilization of cerebral membranes and the metabolic situation in anorexia nervosa.

Schlüsselwörter

Anorexia nervosa - Cholin - Serumparameter - Fluidität

Key words

anorexia nervosa - choline - serum parameter - fluidity

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Dr. Lars Wöckel

Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters der Universitätsklinik Frankfurt/Main

Deutschordenstr. 50

60528 Frankfurt/Main

Email: woeckel@em.uni-frankfurt.de

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