Ukuphazamiseka kwindlela yokutya: INkqubo yeNdalo yokuzivelela kwezinto (Psychiary Psychoneuroimmunological Approach (2019)

Ukuphazamiseka kokutya kukuphazamiseka okukhulu kwengqondo kunye ne-biopsychosocial pathogenesis kunye neendleko malunga ne-1 yezigidigidi zeedola ngonyaka kwi-EU kuphela.Schmidt et al., 2016). Zinokungaguquki kwaye zibe buthathaka kwaye zinxulunyaniswa nokwanda kwamazinga okusweleka kwabantu (Schmidt et al., 2016). I-Anorexia nervosa, umzekelo, inezinga eliphezulu lokufa kuzo zonke izifo zengqondo (i-5.10 yokufa kwi-1,000 yabantu abachaphazelekayo: UArcelus et al., 2011). Kuyaziwa ukuba unyango lweengxaki zokutya alusebenzi xa luthelekiswa nonyango lwezinye iziphazamiso zengqondo (UArcelus et al., 2011; UMurray et al., 2019). Oku kungasebenzi kakuhle kugxininiswa kukuba unyango lwangoku lujolise ekunciphiseni iimpawu kunokunyanga unobangela (s) osisiseko wokuphazamiseka kokutya. Esona sizathu siphambili sokungasebenzi konyango olukhoyo kukuba, ngokungafihlisiyo, i-etiology yokuphazamiseka kokutya ayiqondwa kakuhle (van Furth et al., 2016; UFrank et al., 2019; UMurray et al., 2019). Inkqubela kulwazi lwenzululwazi yokuphazamiseka kokutya ifuneka ngokukhawuleza.

Uhlalutyo olupheleleyo lweempawu okanye indlela yokuziphatha ibonelelwa ngokufanelekileyo kumanqanaba amabini awohlukeneyo kodwa ahambelanayo: (1) yintoni indlela ekufutshane Isiseko sophawu: isebenza njani? kwaye (2) yintoni i esona sizathu yavela: yeyiphi inzuzo yokomelela, ukuba ikhona, ebonelela ngayo kumzimba? (Bateson kunye noLaland, ngo-2013; Rantala et al., 2018; uLuoto et al., 2019a). Sidibanisa la manqanaba mabini okuhlalutya kwaye sixoxa ukuba ngaphandle kokuqonda zombini iindlela ezisondeleyo kunye nezizathu zokugqibela, kulucelomngeni ukuthintela ukuphazamiseka kokutya kunye nokufumana unyango olusebenzayo kubo.

Uhlelo lwesihlanu lwe-Diagnostic and Statistical Manual of Mental Disorders (DSM-5) luchaza izifo ezintathu zokutya: i-anorexia nervosa (AN), i-bulimia nervosa (BN) kunye nokuphazamiseka kokutya (BED). Ukongeza kwezi ziphazamiso zintathu, i-DSM-5 iyakubona ukubaluleka kwe-subthreshold kunye neemeko ze-atypical ngokubiza amagama amahlanu akhethekileyo Okunye ukutya okucacisiweyo okanye i-Disorder Eating (OSFED) subtypes:

1. I-Atypical Anorexia Nervosa (oko kukuthi, iimpawu ze-anorexic ngaphandle kobunzima obuphantsi);

2. I-Bulimia Nervosa (ye-frequency ephantsi kunye / okanye ixesha elilinganiselweyo);

3. Ukuphazamiseka kokutya ngokutya (yezihlandlo eziphantsi kunye / okanye ixesha elilinganiselweyo);

4. Ukuhlanjululwa kokuphazamiseka;

5. I-Night Eating Syndrome.

I-DSM-5 ikwabandakanya udidi olubizwa ngokuba yi-Unspecified Feeding okanye i-Eating Disorder (UFED) ebandakanya abantu abangahambelaniyo nakweyiphi na kwezi ntlobo zintlanu, okanye apho kungekho lwazi lwaneleyo ukwenza ukuxilongwa kwe-OSFED ethile (Umbutho we-Psychiatric Association, i-2013).

Iingqikelelo ezininzi zendaleko ziye zacetyiswa ukuba zichaze ukuphazamiseka kokutya. Siphonononga ngokunzulu ezi ngqikelelo zenqanaba lokugqibela (icandelo elithi "Iingcamango ezikhoyo ze-Evolutionary Psychological Hypotheses for Eating Disorder") kwaye sidibanise nenoveli esondeleyo yenkcazo yeendlela zomzimba ezisisiseko sokuphazamiseka kokutya (icandelo "Imodeli ye-Psychoneuroimmunological ye-Eating Disorders"). Imodeli yethu ye-psychoneuroimmunological ibonisa ukuba ukuphazamiseka kokutya akuzona izifo ezihlukeneyo - endaweni yoko, zenza i-continuum. Ngokusekwe kukwahluka kwizigulana ze-biobehavioral state, imodeli eqhubekayo ichaza ukuba kutheni "ukuphazamiseka kokutya okungachazwanga" luxilongo oluqhelekileyo (11-50.8% yamatyala: Machado et al., 2013; Caudle et al., 2015; UMancuso et al., 2015) kwaye kutheni ukuxilongwa kwesigulane kunokutshintsha phakathi kokuphazamiseka kokutya ngexesha (icandelo "Imithombo yoMhluko ngamnye kwiiMpendulo zoKhuphiswano lwe-Intrasexual"). Imodeli inika inkcazo yokufumanisa ukuba ukuphazamiseka kokutya kuhlala kuhambelana nezinye iziphazamiso zengqondo (icandelo "I-Comorbidity of Eating Disorders"): ngokutsho kwemodeli yethu, oku kuhanjiswa okwabelwana ngako kulamlwa bubuthathaka kwi-neuroinflammation kunye nokuphendula koxinzelelo (icandelo "Iizinto zoMngcipheko". kwiZiphazamiso zokutya”). Imodeli yethu ye-psychoneuroimmunological isikhokelela ekucebiseni unyango (amacandelo "Ukutya okuNyango kweSifo sokuTyalwa okuSekwe kwi-Psychoneuroimmunology" kunye "neNqanaba lokugqibela loThintelo lweZiphazamiso zokutya") ukwaziswa ngokuqondwa kokwenziwa kwazo zombini iindlela ezisondeleyo kunye nezizathu zokugqibela. Olu nyango lunamandla okubonelela ngenkqubela phambili ebalulekileyo kunyango lwangoku lokuphazamiseka kokutya, oluhlaziywayo kwicandelo elithi "Unyango lwangoku lweSifo sokuTyila".

Imibono ekhoyo ye-Evolutionary Psychological Hypothes kwi-Eating Disorders

Kukho iingcamango ezintandathu ezikhoyo zendaleko zoyena nobangela wokuphazamiseka kokutya. I-hypothesis ehamba phambili ye-evolution ye-BN kunye ne-BED yile (1) i thrifty genotype hypothesis. Icebisa ukuba ukuzingxala ngokutya kukuziqhelanisa ngokwasengqondweni (bona umzekelo, Lewis et al., 2017 kwingxoxo yokulungelelaniswa kwengqondo) eyavela ngenxa yokuba izitolo zamandla ezongezelelweyo zazikhusela kwimbali yokuguquguquka kweentlobo zethu: zanceda ukuphepha ukungondleki, zanceda ukusinda ngexesha lendlala kunye nokuzala okulawulwayo (I-Chakravarthy kunye neBooth, 2004; Wells, 2006). Ukongezwa kolu qikelelo, i indawo yokungenelela kabini imodeli ibeka ukuba umzimba unamanqaku aphezulu kunye nangaphantsi kwinqanaba le-adiposity yomzimba; ukuba ezi zigqithisiwe, iindlela zengxelo yezendalo ziyapheliswa (Speakman et al., 2011; Isithethi, ngo-2018). Ubuncinci bokumisela i-adiposity iyadingeka ukuze ugweme indlala, ngelixa inqanaba eliphezulu lokumisela lichongwa ngumngcipheko wokuhlaselwa. Njengoko umngcipheko we-predation wehlile, iikhowudi zofuzo kwindawo ephezulu yokuseta ziye zaxhaphaka, kwaye abantu abambalwa banciphisa ukutya kwekhalori ukunqanda ukufumana ubunzima (Speakman et al., 2011).

(2) Ukhuphiswano lwe-intrasexual hypothesis (Abed, ngo-1998) icebisa ukuba oyena nobangela wokuphazamiseka kokutya lukhuphiswano olumandla phakathi kwamaqabane. Le ngcamango iyaqonda ukuba ubume bomzimba womfazi luphawu lwembali yakhe yokuzala, amandla okuzala kunye nexabiso leqabane, ngokuyinxalenye ebonakaliswe ngumlinganiselo we-waist-to-hip kunye ne-body mass index (BMI) (UAndrews et al., 2017; Del Zotto kunye nePegna, ngo-2017). Njengoko abafazi bebudala kunye / okanye bazala, badla ngokufumana ubunzima bomzimba kwaye baphulukane nokumila komzimba wehourglass (Butovskaya et al., 2017) oluluphawu olunqweneleka ngokwesondo emadodeni (umz., Bovet, 2019). Ifestile yokuzala yabasetyhini inomda, yiyo loo nto amadoda eguqukele ekukhetheni iindlela zokuzala kunye nolutsha (Sohn, ngo-2016; ILassek kunye neGaulin, ngo-2019). Oku kunokukhokelela ekubeni abasetyhini bakhuphisane omnye komnye ukuze bathathelwe ingqalelo yamadoda ngokubonakala bencinci ngobutsha: ixabiso lokuzala labasetyhini, emva kwayo yonke loo nto, linxulunyaniswa nobutsha, kwaye ubutsha bunxulunyaniswa nokubhitya ( slimness )Abed, ngo-1998; ILassek kunye neGaulin, ngo-2019).

I-hypothesis yokhuphiswano lwe-intrasexual ihambelana nezifundo ezibonisa ukuba ukhetho lwamadoda kwimizimba yabasetyhini lunokwahluka ukusuka kwindawo ethile kunye noluntu ukuya kwenye (cf. IFurnham neBaguma, ngo-1994; UTovee et al., ngo-2006). Ubumanzi busenokuba luphawu lokuchuma okuphezulu kumazwe apho ukungondleki kuxhaphakile; kubantu abondleke kakuhle, ngokuchaseneyo, ukutyeba okunxulumene nokwaluphala kunye nokuncipha kokuchuma (umz., UTovee et al., ngo-2006). I-hypothesis yokhuphiswano lwe-intrasexual icebisa ukuba ukwanda kokuxhaphaka kokuphazamiseka kokutya kuluntu lwaseNtshona kusisiphumo sokhuphiswano olwandisiweyo phakathi kwabasetyhini kunye / okanye intabalala yokutya (Abed et al., 2012; Baumeister et al., 2017; Nettersheim et al., 2018).

Kukho inani lezinto eziqinisa ukhuphiswano lwe-intrasexual (Abed et al., 2012): (a) ukuncipha kokuzala kukhokelela ekugcinweni okwandisiweyo kwenkangeleko yenubile kumabhinqa amadala; (b) kuluntu lwanamhlanje lwaseNtshona, abasetyhini banobuchule obuphezulu bokulawula indlela yokuziphatha kwabo kwenzala (ngophazamiseko olungephi oluvela kwizizalwane); (c) kukho inani eliphezulu ngokungaqhelekanga labasetyhini abasebatsha nabakhangeleka bebatsha, oko kukuthi, abasenokuba ngabakhuphisani, kwizixeko zanamhlanje xa kuthelekiswa neemeko zookhokho babantu; (d) amajelo eendaba abonelela ngemifanekiso yabantu abakhuphisanayo abanomtsalane; (e) ukutya kuninzi kwaye abantu bondlekile, ngoko ke ukutyeba kunye nokuwohloka kobume be-nubile zizinto eziqhelekileyo ezihambisana nokukhula; (f) ukwanda kokungazinzi kwemitshato kunye nokuxhaphaka koqhawulo-mtshato kukhokelele ekubeni amadoda nabafazi babuyele ngokuphindaphindiweyo kwimarike yokukhwelana; (g) ngenxa yokuvela kwamayeza ale mihla kunye nokwanda kwexesha lokuphila (okt, ukwanda kwenani labasetyhini abasemva kokuyeka ukuya exesheni), ulutsha luye lwaba sesinye sezona zigqibo ziphambili zexabiso leqabane lomfazi (lihlaziywe Abed et al., 2012; bona kwakho Baumeister et al., 2017; Saunders kunye ne-Eaton, ngo-2018; ILassek kunye neGaulin, ngo-2019; Luoto, 2019a).

Uphononongo olwenziwa kumazwe angama-26 anabathathi-nxaxheba abangaphezu kwe-7,000 bafumanisa ukuba ubume bomzimba obhityileyo bukhethwa kwiindawo ezinobume bentlalo noqoqosho kwaye ukuvezwa kwemithombo yeendaba kunonxulumano olubalulekileyo kunye nobunzima bomzimba.I-Swami et al., 2010). Ngapha koko, Swami et al. (2010) wafumanisa ukuba abafazi bahlala becinga ukuba amanani abhinqileyo abhityileyo anomtsalane ngakumbi kunokuba amadoda ayecinga. Baumeister et al. (2017) banike ingxelo yokuba okukhona abafazi bebona ukuba imarike yokukhwelana yasekuhlaleni inengxaki yokunqongophala kwamadoda, kokukhona befuna ukuba babhitye ngakumbi kwaye baba neempawu zokunganeliseki komzimba. Ezi ziphumo zixhasa uluvo lokuba ukhuphiswano lwe-intrasexual phakathi kwabasetyhini luqhuba ukufuna kwabasetyhini ukubhitya.

Inkxaso eyongezelelekileyo yendima ecingelwayo yokhuphiswano lwe-intrasexual emva kokuphazamiseka kokutya ivela kwi "reverse anorexia" echaphazela abakhi bomzimba besilisa (UPapa et al., 1993) kwaye inokuqhuba ukunganeliseki komzimba ngokubanzi kumakhwenkwe kunye namadoda (Karazsia et al., 2017). Abantu abachaphazelekayo bavakalisa inkolelo yokuba bancinane kakhulu nangona benezihlunu, ngenxa yoko banomfanekiso womzimba ogqwethekileyo. Izihlunu kunye nobukhulu bomzimba omkhulu zibonelela ngeenzuzo ezicacileyo kukhuphiswano lwendoda-yindoda ebantwini njengakwezinye izilwanyana ezincancisayo; I-muscularity inokuba yinto ekhangayo ngokwesondo kubasetyhini kwimbali yethu yokuziphendukela kwemvelo, kunye nokukhethwa kwezesondo okusebenza kulo mkhwa nakumadoda anamhlanje (UFrederick noHaselton, ngo-2007; Thengisa et al., 2017).

Ngenxa yokhuphiswano olwandisiweyo kunye nezinye izinto ezinoveli ezichazwe ngasentla, uninzi lwabasetyhini behlabathi laseNtshona abanelisekanga bubungakanani bemizimba yabo kunye nokumila, kunye nesiqingatha samantombazana akwishumi elivisayo azama ukulawula ubunzima babo (Neumark-Sztainer, 2005). Uphononongo lovavanyo lubonise ukuba nangona kungabikho umtsalane- kunye nokubhitya okunxulumene nokukhuphisana, iinjongo zesimo se-intrasexual ziyakwazi ukuqalisa izimo zengqondo zokutya ezifana nokuphazamiseka kokutya kwabasetyhini abancinci (Li et al., 2010; Castellini et al., 2017). Isiphumo esifanayo asibonakali kumadoda athandana nesini esahlukileyo (Li et al., 2010). Ngaphaya koko, ukuphazamiseka kokutya kuxhaphake kakhulu phakathi kwamadoda angamafanasini kunamadoda athandana nesini esahlukileyo (Li et al., 2010; Calzo et al., 2018). Ingcaciso enokubakho kwezi ziphumo kukuba ukhuphiswano lwe-intrasexual kumadoda athandana nesini esifanayo lugxile ekuthandeni ngokwasemzimbeni, kuba amadoda angamafanasini ayazi ukuba imiqondiso yolutsha kunye nomtsalane womzimba zizinto ezibalulekileyo ezikhethwa ngamaqabane kwamanye amadoda angamafanasini (Li et al., 2010). Amadoda angamafanasini nawo asabela kukhuphiswano lwesimo se-intrasexual kunye nezimo zengqondo zokutya kunye nemibono embi malunga nemizimba yabo (Li et al., 2010).

Ukuba ukhuphiswano lwe-intrasexual luyeyona nto ibalulekileyo ekukhuleni kokuphazamiseka kokutya, abantu abajolise ngakumbi ekufumaneni imeko yentlalo enxulumene nokukhwelana banokuba sengozini enkulu yokuphazamiseka kokutya. Enyanisweni, ukuphazamiseka kokutya kubangelwa rhoqo malunga nobudala xa ukhuphiswano lwe-intrasexual lunamandla (Li et al., 2010). Ukongeza, kubonisiwe ukuba amantombazana kwizikolo ezinobungakanani obuphezulu babafundi ababhinqileyo banamathuba aphezulu okuba nokuphazamiseka kokutya (Bould et al., 2016), ecebisa ukuba indawo ephezulu yokhuphiswano lwe-intrasexual yonyusa ukuxhaphaka kokuphazamiseka kokutya (cf. Baumeister et al., 2017; Saunders kunye ne-Eaton, ngo-2018).

Ukuphazamiseka kokutya kuhlala kosulela ekuhlaleni kumaqela obuhlobo kwaye kunokusasazeka kwimeko yesikolo (Bould et al., 2016). Umzekelo, ukuba abahlobo bomntu bane-BMI ephantsi ngenxa yokuphazamiseka kokutya, umntu unokuwuqonda umzimba wakhe ukuba mkhulu, nto leyo ekhokelela ekunganeliseki okuphezulu komzimba kunye namathuba aphezulu okuba nokuphazamiseka kokutya. Le etiology ye-sociodevelopmental etiology yokuphazamiseka kokutya ixhaswa kukufumanisa ukuba kwizikolo ezinomlinganiselo omkhulu wamantombazana angaphantsi komzimba, amanye amantombazana angazama ukunciphisa umzimba (Mueller et al., 2010).

Kukwakho nezinye iingqikelelo ezifumene inkxaso engaphantsi ngokwasemoyeni, njenge (3) the i-hypothesis yoxinzelelo lokuzala, ecebisa ukuba i-AN yinzame yokulungelelanisa ekunciphiseni inzala ngabasetyhini abachaphazelekayo (UWasser noBarash, ngo-1983; Ukuthobela, i-1987; IVoland kunye neVoland, ngo-1989). (4) I ingqikelelo yokukhohlisa yabazali icebisa ukuba i-AN igcinwa ngokukhethwa kwezihlobo: abazali bakhohlisa inzala yabasetyhini ukuququzelela utshintsho olucwangcisiweyo kutyalo-mali lokuzala phakathi kwabantakwabo (IVoland kunye neVoland, ngo-1989). (5) I ukunyanzeliswa kokuzala ngombono obalaseleyo wabasetyhini ibeka ukuba i-AN yimbonakaliso yokucinezelwa kwenzala yabasetyhini abangaphantsi ngabasetyhini abalawulayo ngexesha lenkqubo yokhuphiswano lwabasetyhini kunye nebhinqa (Mealey, 2000). (6) I zilungelelaniselwe ukubaleka indlala icebisa ukuba iimpawu ze-AN (ezifana nokuxhatshazwa kunye nokuthintelwa kokutya) zenza ukuba ukufuduka ngexesha lendlala kufikelele kwiindawo ezinokutya okuninzi.UGuisinger, ngo-2003).

Ezi ngcamango zijolise kwi-AN, zishiya ezinye iingxaki zokutya, ngakumbi i-BED, ngaphandle kwengcaciso. I-hypotheses 3-5 iyasilela ngokupheleleyo ukucacisa ukuba kutheni ukuphazamiseka kokutya kwenzeka nakumadoda. Kananjalo bayasilela ukucacisa ukuba kutheni ukuziqhelanisa ngokwesondo kuphembelela ukubakho kokuphazamiseka kokutya (Li et al., 2010; Calzo et al., 2018). Uphando olukhoyo alunikezeli nkxaso kwingcamango yokuba abantu abane-anorexia nervosa baya kuba ngabantu abangaphantsi kwentlalo abasebenzisa "iqhinga lokulahlekelwa" (UFaer et al., ngo-2005). Uninzi lweengqikelelo ezidweliswe ngasentla zisekelwe kwingcamango yokuba ukuphazamiseka kokutya kukuziqhelanisa nokuziqhelanisa.

Ngokwahlukileyo kwezinye iingqikelelo, i-hypothesis yokhuphiswano lwe-intrasexual ayicingi ukuba ukuphazamiseka kokutya kukulungelelaniswa. Ngaphezu koko, ayisebenzi kuphela kwi-AN, kodwa ibona yonke i-spectrum yokuphazamiseka kokutya njengesiphumo se-pathological sokungahambelani phakathi kokulungelelaniswa kwabasetyhini kukhuphiswano lwe-intrasexual kunye nemeko yanamhlanje apho ezo zilungelelaniso zihamba kakubi. Ngaphandle kwamandla enkcazo ye-hypothesis yokhuphiswano lwe-intrasexual, umsebenzi wangaphambili kwi-hypothesis awulungiswanga ngokwaneleyo ukunika ingxelo epheleleyo yemvelaphi yendalo yokuphazamiseka kokutya. Ngoko ke siyayandisa kunye ne ingcamango engafanelekanga yokuphazamiseka kokutya.

I-Mismatch Hypothesis yokuphazamiseka kokutya

Ukutyeba kakhulu yinto entsha yendaleko. Ukuziphendukela kwenkcubeko yabantu kuye kwakhokelela kwimeko apho inani elikhulu xinene ngamandla kwaye ivuza ngokumangalisayo Ukutya kufumaneka lula kubantu abaninzi kumazwe athuthukileyo (Lindeberg, ngo-2010; Amandla, ngo-2012; Rozin kunye noTodd, ngo-2015; Corbett et al., 2018). Ukukhupha amandla okusingqongileyo akubandakanyi iindleko ezinkulu zamandla kuninzi lwabantu bale mihla abahlala kuluntu oluphuhlileyo. Ubuninzi bamandla obukhoyo obubonwa ngabantu abaphuhlileyo bale mihla buyinto entsha: abantu ookhokho banyanzelwa (ngokomndilili) ukuba bachithe amandla aphezulu okufumana imithombo yokutya kunokuba kunjalo ngabantu bale mihla. Oku kungasebenzi kakuhle kwamandla (iikhalori kwi > iikhalori eziphumayo) kukhokelele kubhubhani wokutyeba ngokugqithiseleyo kunye neengxaki zempilo zanamhlanje (Lindeberg, ngo-2010; Amandla, ngo-2012; Corbett et al., 2018), kubandakanywa nempilo yengqondo (Milaneschi et al., 2018; Rantala et al., 2018).

Abantu bane-suite ephucukileyo yeendlela zengqondo (iimodyuli) ezinoxanduva lokutya (Kumkani, 2013; Al-Shawaf, 2016; Imiqulu, i2017; Uthando kunye neSulikowski, ngo-2018) kunye nolunye uluhlu lweendlela (iimodyuli) ezinoxanduva lokukhwelana (Iiveki-eShackelford kunye neShackelford, ngo-2014; Luoto, 2019a, b). Iimeko ezingqongileyo zangoku zobuninzi bamandla anxulumeneyo (Lindeberg, ngo-2010; Amandla, ngo-2012) yenze ingxabano yenoveli phakathi kweemodyuli zengqondo ezinoxanduva lokutya kunye nokukhwelana. Kwelinye icala, abantu baveliswa ukuba basebenzise ngokupheleleyo ubukho bokutya (I-Chakravarthy kunye neBooth, 2004; Kumkani, 2013; Al-Shawaf, 2016); kwelinye icala, abantu baveliswa ukubonisa amandla abo okuzala ngokusebenzisa imihombiso yesondo ye-phenotypic (Sugiyama, 2015; ILassek kunye neGaulin, ngo-2019). Ukuziphendukela kwemvelo kwenkcubeko okokuqala ngqa kwimbali yokuzivelela kwabantu kwadala imeko apho olu lungelelwaniso lwengqondo luphikisana kakhulu. Ngoko ke, i ingcamango engafanelekanga yokuphazamiseka kokutya iqaphela imeko yenoveli apho iindlela zengqondo ezilungelelanisiweyo ngaphambili zokuthatha ukutya kunye nokukhwelana zichase. Olu tshaba ludala imeko apho umntu aqhawukene phakathi kweenkuthazo ezichaseneyo: imbuyekezo yokutya kunye nemivuzo yokukhwelana. Unikezelo lwangaxeshanye lweengxaki eziguqukayo eziphikisanayo zenza i i-adaptive metaproblem (Al-Shawaf, 2016). Uchaso olusisiseko lokuba ubuninzi bokutya okuxineneyo kunye nokuvuza okunemvakalelo (Lindeberg, ngo-2010; Rozin kunye noTodd, ngo-2015) ibangele phakathi kweenjongo zokukhwelana kunye nembuyekezo yokutya iqhuba enye ingxaki eguqukayo kubantu banamhlanje, ebonakala ekugqibeleni kwiingxaki zokutya ezahlukeneyo.

Ingqikelelo engafaniyo inokwenziwa bubuxoki ngokubonisa ukuba ukuphazamiseka kokutya kuxhaphake ngokulinganayo kuluntu lwabazingeli nabaqokeleli bemveli njengoko lukho kuluntu oluphuhlileyo. Izitayile ze-Hunter-gatherer subsistence ngandlel' ithile zithelekiseka neemeko zemo engqongileyo yoluntu zokuziqhelanisa nendaleko (umz., Al-Shawaf, 2016; Lewis et al., 2017). Asazi nabuphi na ubungqina malunga nobukho be-AN, BN kunye ne-BED kuluntu lwabazingeli-abaqokeleli - ngokuchaseneyo, indlala ibonakala iyinto exhaphakileyo yemibutho yanamhlanje yokuzingela (ihlaziywe kwi Al-Shawaf, 2016).

I-hypothesis engafaniyo ixhaswa ngokungathanga ngqo kuphando lwezilwanyana ezingezozamntu oluye lwabonisa ukuba ukutyeba kakhulu kuba yingxaki enkulu kuphela xa abantu begcina izilwanyana ekuthinjweni (Amandla, ngo-2012). Ukuthinjwa kubonisa imeko efana nendalo yezilwanyana ezingengobantu njengoko ubomi banamhlanje bokuhlala busenzela abantu (Williams, ngo-2019), okukhokelela ekwandeni okukhulu kokuxhaphaka kweephenotypes ezityebileyo phantsi kweemeko zombini (Amandla, ngo-2012). Ezi ziphumo ziqaqambisa ukusetyenziswa kokuqulunqa ukuphazamiseka kokutya kumxholo we-hypothesis engafanelekanga yokuvela, esiyiphakamisa njengolwandiso oluyimfuneko kwi-hypothesis yokhuphiswano lwe-intrasexual. Ngaphandle kokuphazamiseka kokutya, i-hypothesis engafaniyo ikwachaza ubhubhani wale mihla wezifo ezininzi ezingasuleliyo, ezinje nge-2 yeswekile, isifo se-coronary artery (Corbett et al., 2018) kunye nezinye iingxaki ezininzi zempilo yengqondo (Li et al., 2018; Rantala et al., 2018).

Imodeli ye-Psychoneuroimmunological ye-Eating Disorders

Ukhuphiswano lwe-intrasexual lokubhitya kunye nemetaproblem eguqukayo evela kubuninzi bokutya okunemivuzo kunye nekhalori exineneyo (Kumkani, 2013; Rozin kunye noTodd, ngo-2015) kubonakala ngathi kunika ingcaciso yokugqibela ebambekayo yokusukela ukubhitya kwabasetyhini abahlala kuluntu oluphuhlileyo. Noko ke, ezi ngqikelelo azisichazi isizathu sokuba liqaqobana nje labasetyhini kunye namadoda angamafanasini abe nokuphazamiseka kokutya. Ukongezelela, ezi ngcamango azisichazi isizathu sokuba abanye abantu babe nomnqweno onamandla wokunciphisa umzimba kangangokuba bazilambele de bafe, ngoxa abanye bezintyintya ngokutya baze batyebe ngokugqithiseleyo. Iingcamango nazo ziyasilela ukucacisa ubukho be-non-fat-phobic AN (jonga icandelo elithi "Autoimmunity and Eating Disorders").

Inkqubela phambili yezenzululwazi ixhomekeke ekulungelelaniseni kakuhle kwethiyori kunye nobungqina obubambekayo (UMathot noFrankenhuis, ngo-2018). Oku kuhambelana okwangoku akukho phakathi kwethiyori evela kwingqondo yendalo kunye nobungqina bekliniki malunga nokuphazamiseka kokutya. Ngoko ke sibeka ubukho beendlela ezisondeleyo ezichaza phakathi komntu kunye nokwahluka komntu ngamnye kwingxaki yokutya, ukuphucula ngakumbi ukulingana phakathi kwethiyori kunye neziphumo zobungqina. Siphakamisa imodeli entsha echaza iziphumo ezithi (1) ukhuphiswano lwangaphakathi lwe-intrasexual lukhokelela ekuphazamisekeni kokutya kwinxalenye encinci yabasetyhini; (2) le nxalenye yabasetyhini inokuthi ivelise ukuphazamiseka kokutya okwahlukileyo okubandakanya iziphumo ezichaseneyo zokubhitya okugqithisileyo kunye nokutyeba; kunye (3) nokuxilongwa kwesigulane kunokutshintsha phakathi kokuphazamiseka kokutya ekuhambeni kwexesha.

Ukuphazamiseka kokutya kunye ne-Obsessive Compulsive Disorder

Ngokweendlela zokuxilonga, ukunyamezela ngokuzivocavoca umzimba, inkangeleko kunye nokutya kuxhaphakile kukuphazamiseka kokutya (Umbutho we-Psychiatric Association, i-2013). Olu tshintsho lukhokelela ekungakhululeki ngokweemvakalelo kunye nophuhliso lweendlela zokuziphatha ezinje ngokujonga ubunzima, ukwenza umthambo, ukucoca okanye ukuzila ukutya. Ukongeza kwezi zibonakaliso zeklasi zokuphazamiseka kokutya, ezinye iimpawu ezininzi ezinyanzelisayo, njengokungabaza, ukujonga kunye nesidingo sokulinganisa kunye nokuchaneka zixhaphake kakhulu kwizigulane ze-BN kunye ne-AN kunamaqela okulawula ingqondo (ingqondo)UCassidy et al., 1999). Ezinye izigulana ezinengxaki yokutya zineendlela zokujonga izinto ezibonwayo okanye ezibambekayo, ezinje ngokuchukumisa amalungu omzimba ngokuphindaphindiweyo okanye ukubukela ubume bomzimba womntu esipilini (Legenbauer et al., 2014). Ke, iindlela zokuziphatha kwezigulana ezinengxaki yokutya zinokufana okuninzi nokuziphatha kwe-OCD (Bastiani et al., 1996; UGarcia-Soriano et al., ngo-2014). Kwintsapho yaseSweden yamazwe amaninzi kunye nophononongo lwamawele olubandakanya abathathi-nxaxheba be-19,814 abanokuxilongwa kwe-OCD kunye ne-8,462 kunye ne-AN (i-6.4% yamadoda), kwafunyaniswa ukuba abafazi abane-OCD babenokuxilongwa kwe-16-fold ye-AN, kanti amadoda ane-OCD ane-37 -phinda ukwanda komngcipheko (Cederlof et al., 2015). I-AN kunye ne-BN nazo zidibene neempawu zobuntu ezinxulumene ne-OCD, ezifana nokugqibelela kunye ne-neuroticism (UCassidy et al., 1999; UAnderluh et al., ngo-2003; UHalmi et al., ngo-2005; Altman kunye noShankman, ngo-2009). Ukongeza, i-AN ixhaphake kakhulu kwizizalwane ezingachaphazelekiyo zabantu abane-OCD, xa kuthelekiswa nezalamane zolawulo oluhambelanayo, ecebisa ukuba kubekho imingcipheko yemfuza ekwabelwana ngayo.Kaye et al., 1993). Ngokufanelekileyo, uhlalutyo lwemeta ye-GWAS lufumene ulungelelwaniso lwemfuza phakathi kwe-AN kunye ne-OCD phenotypes (uAntila et al., ngo-2018).

Uphando olutshanje lwe-positron emission tomography (PET) lufumene i-neuroinflammation kwizigulane ze-OCD; ngokukodwa, baye baphakamisa umsebenzi we-microglia kwiingqondo zabo (Attwells et al., 2017). Uxinzelelo olunxulumene nokuthintela ukuziphatha okunyanzelekileyo kuhambelana kakhulu ne-neuroinflammation kwi-cortex ye-orbitofrontal (Attwells et al., 2017). Kusenokwenzeka ukuba i-neuroinflammation ibangela i-cascade yeziganeko ze-biochemical ezikhokelela kukungasebenzi kakuhle kwe-neurohormones, neuropeptides kunye ne-neurotransmitters ebangela iimpawu ze-OCD. Nangona kunjalo, uphando lwangaphambili (Attwells et al., 2017) ayikwazanga ukuchaza ukuba kutheni izigulane ze-OCD zine-neuroinflammation.

Nangona ukunyanzeliswa kwe-OCD kubangela uxinzelelo olukhulu kwizigulana, uxinzelelo ngokwalo lubonakala ludlala indima ebalulekileyo nasekuqalekeni kwe-OCD (Toro et al., 1992; Behl et al., 2010; I-Adams et al., 2018). Uxinzelelo lubangela iimpawu ze-OCD kwaye zonyuse amaxesha azo kunye nobunzima (Findley et al., 2003). Izifundo zovavanyo kwizilwanyana ezingezozabantu zibonise ukuba uxinzelelo lonyusa i-neuroinflammation kwaye luphakamisa umsebenzi we-microglia (uhlaziyo Calcia et al., 2016). Ke, uxinzelelo olungapheliyo lunokuba ngumthombo we-neuroinflammation eyenzeka kwi-OCD phenotype. Ekubeni uxinzelelo kunye nokusebenza kwe-axis ye-HPA kunendima ebalulekileyo kwi-OCD (USousa-Lima et al., 2019), umntu unokulindela unxulumano olufanayo noxinzelelo kunye neempawu zokuphazamiseka kokutya.

Ukuphazamiseka kokutya kunye noxinzelelo

Abantu abane-BN kunye ne-AN bazama ukunciphisa umzimba ukuze bahlangabezane "nobuhle obufanelekileyo" kwaye bazingise kukhuphiswano lwe-intrasexual ngenxa yokubhitya (cf. Abed, ngo-1998). Izigulana ze-AN kunye ne-BN zisabela kukhuphiswano ngamanqanaba aphezulu ehomoni yoxinzelelo oluhlala luhlala ixesha elide (bona Soukup et al., 1990; Rojo et al., 2006). Uxinzelelo lunokubangelwa luxinzelelo loontanga kunye noluntu ukuba lube "nohlobo olugqibeleleyo lomzimba" (Castellini et al., 2017), ngoxa ukuziva uneentloni nokuziva unetyala ngenkangeleko kabani kunokubangela ukuba abantu baqhubeke nomjikelo okhohlakeleyo woxinezeleko. Ezinye izigulana ezine-AN zichonge emva kokuba izimvo ezingalunganga malunga nobunzima bomzimba zibe sisiganeko esibangela i-AN (Dignon et al., 2006). Ngokukodwa kwimidlalo apho ubunzima bomzimba obuphantsi buyinto ekhuphisanayo, iimfuno zokuncinci zingabangela ukuphazamiseka kokutya (Uvuyo et al., 2016; Arthur-Cameselle et al., 2017). Kunjalo nakwilizwe lefashoni, umdaniso kunye neballet (UMarquez, ngo-2008). Imfuno yokunciphisa umzimba kwimidlalo nakwifashoni inokubangela ukungoneliseki komzimba kunye noxinzelelo lwentlalo (cf. Castellini et al., 2017).

Uphando olubuyela emva kwizigulane ezine-AN kunye ne-BN zichonge ezinye iziganeko ezintandathu ezibangela ukuphazamiseka kokutya: (1) utshintsho lwesikolo, (2) ukufa kwelungu lentsapho, (3) utshintsho lobudlelwane, (4) ikhaya kunye nokutshintshwa komsebenzi, (5) ukugula/ukulaliswa esibhedlele kunye (6) nempatho-gadalala, uhlaselo ngokwesondo okanye umbulo (Berge et al., 2012). Okuqhelekileyo kuzo zonke ezi ziganeko ezibangela ukuba ziyaziwa ngokunyusa uxinzelelo. I-DSM-5 ke ngoko ithi ukuqala kwe-AN kuhlala kunxulunyaniswa neziganeko zoxinzelelo zobomi.Umbutho we-Psychiatric Association, i-2013).

Uxinzelelo olungapheliyo luyaziwa ngokunyusa amajoni omzimba (ihlaziywe kwi Stanton et al., 2018; Rohleder, 2019). Uphononongo ebantwini nakwezinye izilwanyana lubonise ukuba uxinzelelo lwezentlalo zizinto ezibangela ukuveliswa kwee-cytokines ezine-proinflammatory ezinokukhuthaza ukudumba kweperipheral ephantsi kunye ne-neuroinflammation. Ukulahlwa kwezentlalo ebantwini kuhambelana namanqanaba okwanda kwe-tumor necrosis factor-α (TNF-α) kunye ne-interleukin-6 (IL-6) (Slavich et al., 2010). Ngako oko, uhlalutyo lwe-meta olubandakanya izifundo ze-23 lufumene ukuba izigulane ze-AN ziye zanda kakhulu amanqanaba e-TNF-α kunye ne-IL-6, ebonisa ukuba izigulane ze-AN zine-immune system (Dalton et al., 2018). Nangona kunjalo, izifundo azikwazanga ukungabandakanyi ukuba kungenzeka ukuba ukunyuka kwe-IL-6 kwenzeka ngenxa yokuncipha kobunzima. Ekubeni i-IL-6 ivuselela i-lipolysis (UWedell-Neergaard et al., 2019), akucaci ukuba amanqanaba okwanda kwe-IL-6 abangelwa ukungondleki okanye ukuvuvukala, okanye zombini. Nangona kunjalo, Dalton et al. (2018) bafumanise ukuba izigulane ezine-AN nazo zinezinga eliphezulu le-IL-15. I-IL-15 idibene ne-neuroinflammation (I-Pan et al., 2013), ecebisa ikhonkco phakathi kwe-AN kunye neuroinflammation.

Njengakwizigulane ze-AN (USolmi et al., 2015; Dalton et al., 2018), abantu abane-OCD nabo baye banyusa amanqanaba e-TNF-α kunye ne-IL-6 (Konuk et al., 2007). Kuba izigulana ze-AN kunye ne-BN zihlala zifunyaniswa zine-OCD (kwaye oko ukwehla kobunzima kuba yinto eyomeleleyo kubo), siqikelela ukuba i-neuroinflammation ebangelwa luxinzelelo olungapheliyo iphantsi kwe-AN kunye ne-BN - njengoko isenza nge-OCD (cf. Attwells et al., 2017). Ubungqina obungathanga ngqo kule ngcamango buvela ekubonweni ukuba i-74% yezigulane ezine-AN kunye ne-BN zihlushwa yi-migraine (UBrewerton noGeorge, ngowe-1993; UBrewerton et al., 1993; UD'Andrea et al., ngo-2009), isifo se-neuroinflammatory (UMalhotra, ngo-2016). Kuba indlala iyaziwa ngokunyusa amanqanaba ehomoni yoxinzelelo (uNaisbitt noDavies, ngo-2017), kubonakala ukuba indlala yokuzimela ngokwayo inokomeleza ukunyanzeliswa koxinzelelo lokunciphisa umzimba kwizigulane ze-AN. Olu luvo lwempendulo lunokudala umjikelo okhohlakeleyo onokuba nzima ukuwuyeka kwaye onokunyukela kumanqanaba abeka ubomi esichengeni. Okubangela umdla kukuba, ihomoni yoxinzelelo i-cortisol elawulwa kwizigulana ze-AN (bona Soukup et al., 1990; Rojo et al., 2006) yenye yeehomoni ezandisa igluconeogenesis ebantwini. IGluconeogenesis yinkqubo yokwenza iswekile emzimbeni isuka kwiprotheyini okanye kumafutha, ukuze isetyenziswe njengamandla ngumzimba.UKhani noTayek, ngo-2001). Ngokunyusa amanqanaba ehomoni yoxinzelelo, i-gluconeogenesis inokonyusa i-neuroinflammation ngexesha lokutya kunye nendlala kwizigulana ze-AN.

Izifundo zovavanyo ebantwini nakwezinye izilwanyana zibonise ukuba i-proinflammatory cytokines iyanciphisa umdla wokutya kwaye inokubangela ukugula okubangelwa yi-anorexia (Dantzer, ngo-2009). Inkqubo yomvuzo we-mesolimbic, eqhuba inkuthazo kunye nexabiso le-hedonic lokutya, ayisebenzi ngokufanelekileyo kwizigulana ze-AN njengolawulo olusempilweni okanye ezo zinokuphazamiseka kokutya.Ceccarini et al., 2016). Ke, ukutya akunakwenza amava e-hedonic alinganayo kwizigulana ze-AN njengoko zenza kubantu abangachaphazelekanga (cf. Stanton et al., 2018). Oku kwehla kwe-hedonic kunokuba negalelo ekusebenzeni kokutya kwezigulane ze-AN, ngelixa uninzi lwe-dieters olunempilo lusilela kwimizamo yabo (bona Mann et al., 2007).

Ukuzingxala ngokutya kunye noxinzelelo

Njengakwi-BN kunye ne-AN, siqikelela ukuba kwiimeko ezininzi, ne-BED iqalwa lukhuphiswano lwe-intrasexual lokubhitya. Ubungqina obungathanga ngqo bale ngcamango bunikezelwa ngeziphumo ezibonisa ukuba izigulane ze-BED zinokuzithemba okuphantsi, ukunganeliseki komzimba jikelele (Pearl et al., 2014) kunye noxinzelelo lwengqondo oluphakamileyo (Castellini et al., 2017; Mustelin et al., 2017). Batyekele ekugqithiseni ubunzima babo kwaye babone ukumila kwemizimba yabo ngokukhanya okungalunganga (Pearl et al., 2014). Nangona iinjongo zokunciphisa umzimba, izigulane ze-BED ziphela ngokutya ngokutya kunye nokufumana ubunzima obuninzi, obusoloko bukhokelela ekutyebeni. Castellini et al. (2017) Ixelwe ukuba ukutya ngokuzinkcinkca kunxulunyaniswa nokungasebenzi kakuhle komfanekiso womzimba kunye noxinzelelo olukhulu lwezesondo kubantu abangekho kliniki yabasetyhini, ixhasa ngakumbi i-hypothesis yethu yokuba i-BED ibangelwe lukhuphiswano lwe-intrasexual ngenxa yokubhitya. Le ngcamango inokucelwa umngeni ngokubonisa ukuba iimpawu ze-BED ziyimpembelelo ye-BED kunokuba imbangela yayo. Nangona kunjalo, uphando oluthelekisa abantu abanobunzima obuqhelekileyo be-BED kunye nabantu abatyebe kakhulu be-BED bafumanisa ukuba abo banobunzima obuqhelekileyo babenomnqweno onamandla wokunciphisa umzimba kunabo batyebe kakhulu.Goldschmidt et al., 2011). Kwakungekho ntlukwano phakathi kweqela ekugqithiseni ubume okanye ubunzima, ebonisa ukuba ezi mpawu azibangelwa kukukhuluphala kwe-comorbid (Goldschmidt et al., 2011).

Ngelixa abantu abaninzi bephelelwa ngumdla xa beziva becinezelekile kakhulu, nokuba uxinzelelo lwengqondo oluncinci okanye isiqendu esingathandekiyo sinokubangela ukutya kakhulu kwi-BED okanye kwizigulane ze-BN (Masheb et al., 2011). Ngokuqhelekileyo uxinzelelo lusebenza inkqubo ye-nervous enovelwano kunye nempendulo yomzimba yokulwa-okanye-indiza. Ngaphantsi kwezi meko, i-corticotropin-releasing factor (CRF) icinezela ukutya ngokuchaphazela inkqubo yokugaya kunye nokunciphisa ingqondo yendlala. Yiyo loo nto abantu abane-BED bengenamava okuzingxala kunye nokutya kakhulu ngexesha loxinzelelo olunzima, kodwa ngasese kumakhaya abo kwaye xa bebodwa ixesha elide emva kokuba uxinzelelo olukhulu luphelile (Masheb et al., 2011). Ukutya ngokugqithisileyo kunokubonwa njengendlela "yokuphuncuka" kwimeko yeemvakalelo engalunganga (Burton kunye noAbbott, ngo-2019).

Izigulane ze-BED kunye ne-BN zinomnqweno ocacileyo wokunciphisa umzimba, kwaye ke kubalulekile ukuqonda ukuba kutheni kunzima kangaka kubo ukuxhathisa ukutya ngokutya. Isizathu sisenokuba kukuziqhelanisa nedayethi. Kwiigundane ezinqatshelwe ngekhalori, uxinzelelo lwengqondo luye lwaboniswa ukuba luqalise iziqendu zokutya ezidliwayo ukuba izifundo zinethuba lokutya izinto zokutya ezinoshukela kunye namafutha (UHagan et al., 2002, 2003). Ngokunjalo, uxinzelelo lwe-footshock kunye nothintelo lwekhalori lukhokelela iigundane ukuba zitye kabini inani eliqhelekileyo lokutya (I-Boggiano et al., 2005). Iigundane ezithintelwe kukutya ezicinezelekileyo zovavanyo ziphuhlisa ukudumba kwimimandla yobuchopho elawula ngokuthe ngqo okanye ngokungathanga ngqo ukutya; ezimpuku zikwaphuhlisa iindlela zokuziphatha ezifana nokutya (Alboni et al., 2017). Ngokuhambelana nezifundo zabantu, uxinzelelo lwengqondo lunokubangela ukutya ngokutya kwi-dieters enempilo ukuba kukho ukutya okunencasa kakhulu (Oliver noWardle, ngo-1999; bona kwakho Castellini et al., 2017; Klatzkin et al., 2018).

Uvavanyo lwemeko ye-psychophysiological yezigulane lubonelela ngokuqonda ngakumbi kwi-BED. Izigulana ze-BED zinokuphendula okuphezulu koxinzelelo kunolawulo (Klatzkin et al., 2018). Izigulana ze-BED zinokuguqukela ekutyeni ngokutya ngokulula ngakumbi kunolawulo ngokuchanekileyo ngenxa yokusabela kwabo kuxinzelelo oluphezulu (cf. Klatzkin et al., 2018). Esinye isizathu sokuphendula kwabo kuxinzelelo oluphezulu kunokuba kukuvuvukala okubangelwa yi-visceral fat tissue (Izihlangu et al., 2017; Krams et al., 2018; Rohleder, 2019). Nangona uxinzelelo lwengqondo lukhona kubomi babantu abaninzi, amandla okuzilawula akhusela abantu kwiziphumo zempilo ezimbi ezihlala zibangelwa luxinzelelo (Evans kunye noFuller-Rowell, ngo-2013; Izihlangu et al., 2017). Ubungqina obuninzi bubonisa, nangona kunjalo, ukuba ukuvuvukala kunokubangela ukuba kubekho utshintsho olubanzi lwe-biobehavioral olukhuthaza ukusilela ukuzilawula (Izihlangu et al., 2017). Izigulana ze-BED zinama-88% amaxabiso aphezulu e-CRP kunolawulo oluhambelana nobunzima bomzimba, ebonisa ukuba izigulane ze-BED zinokuvuvukala okukhulu emzimbeni wazo.Succurro et al., 2015). Ukudumba kweperipheral ke ngoko kunokunciphisa amandla okuzilawula (Izihlangu et al., 2017) kwizigulana ze-BED kwaye zandise ngakumbi ukuphendula koxinzelelo. Oku kungenxa yokuba i-cytokines ene-proinflammatory eveliswa ngamaseli omzimba okanye i-adipocytes iyaziwa ukuba ivuselele i-axis ye-HPA.I-Yau kunye nePotenza, 2013). Eli khonkco lobuchule linokubangela umjikelo okhohlakeleyo, okhokelela ekutyebeni (cf. Izihlangu et al., 2017; Milaneschi et al., 2018) kwaye, njengoko sicebisa, ukuya kwi-BED. Ukudumba kwe-peripheral yeyona nto inokuba ngunobangela ochaza ukuba kutheni ukuphazamiseka kwemo yengqondo kuxhaphake kakhulu phakathi kwezigulana ze-BED: ukudumba, umzekelo, kwandisa amathuba okuba utshintsho lwemo eguqukayo lujike lube kukudandatheka okungalunganga kweklinikhi (cf. uLuoto et al., 2018; Rantala et al., 2018). Izinto ze-Genetic zinokwandisa ngakumbi ukuxhatshazwa phakathi kwezi ngxaki (njengoko kuhlaziywa kwicandelo elithi "Imiba yoMngcipheko weZiphazamiso zokutya").

I-Neurochemistry ye-Anorexia Nervosa kunye ne-Bulimia Nervosa

I-Serotonin (i-5-hydroxytryptophan) yaziwa ngokuchaphazela ulawulo lwempembelelo, ukunyanzeliswa, imo kunye nomdla wokutya (Bailer kunye noKaye, ngo-2011; UDalley noRoiser, ngo-2012; I-Garcia-Garcia et al., 2017). Unyango oluphakamisa umsebenzi we-serotonergic luthambekele ekunciphiseni ukusetyenziswa kokutya, ngelixa unyango oluthoba umsebenzi we-serotonergic lonyusa ukutya kunye nokukhuthaza ukunyuswa kobunzima (uhlaziyo Bailer kunye noKaye, ngo-2011; bona kwakho U-Alonso-Pedrero et al., 2019). Izifundo kwizigulana ze-AN zichaze ukungasebenzi kakuhle kwenkqubo ye-serotonergic (kuphononongwe kwi Bailer kunye noKaye, ngo-2011; Riva, ngo-2016). Okubangela umdla kukuba, i-IL-15 ilawulwa kwizigulane ze-AN (Dalton et al., 2018), kunye nezifundo kwiigundane zibonise ukuba i-IL-15 ilawula inkqubo ye-serotonergic (Wu et al., 2011; I-Pan et al., 2013).

Kwinqanaba elibukhali le-AN (xa abantu bengaphantsi komzimba), izigulane zinezinga eliphantsi kakhulu le-serotonin metabolites kwi-cerebrospinal fluid yabo kunokulawulwa okunempilo.Kaye et al., 1984, 1988). Baye bane-blunted prolactin impendulo kwiziyobisi kunye nomsebenzi we-serotonin kunye nokunciphisa ³Ukubopha i-H-imipramine, iphakamisa ngakumbi ukunciphisa umsebenzi we-serotonergic (Bailer kunye noKaye, ngo-2011). Ekubeni i-serotonin yenziwe kwi-amino acid ebizwa ngokuba yi-tryptophan, i-amino acid ebalulekileyo ekufuneka ifunyenwe ekutyeni, inkcazo ecacileyo ye-serotonin ephantsi ye-metabolism kwizigulane ze-AN ngexesha lesigaba esinzima sokugula kukuba ibangelwa yindlala / ukutya.Kaye et al., 2009; Haleem, ngo-2012). Ngokwahlukileyo, abantu abaye bafumana i-AN baye baphakamisa amanqanaba e-serotonin.Kaye et al., 1991). Uphononongo oluvavanyayo lufumanise ukuba ukuncitshiswa kwe-tryptophan yokutya kunciphise ixhala kunye nomoya ophakamileyo kubasetyhini abane-AN, kodwa kwakungekho futhe kulawulo lwabasetyhini.Kaye et al., 2003).

Izigulana ze-AN zaziwa ngokuba namanqanaba aphezulu okuxhalaba, ukunyanzeliswa kunye nokuphepha ukwenzakaliswa kwangaphambili nasemva kokuchacha. Banokuba namanqanaba aphezulu e-serotonin ngaphambili, okukhokelela kwimeko ye-dysphoric (Bailer kunye noKaye, ngo-2011). Kaye et al. (2009) icebise ukuba ukutya/ukulamba kwenza izigulane ze-AN zizive ngcono ngokunciphisa umsebenzi we-serotonergic engqondweni. Aba bantu banokufumana ingxelo eyakhayo koontanga babo malunga nenkangeleko yabo ebhityileyo, nto leyo ebakhuthaza ngakumbi ukuba baqhubeke nendlala. Ngenxa yokuncipha kwe-tryptophan okubangelwa yindlala, ingqondo iphendula ngokunyusa inani le-serotonin receptors ukusebenzisa i-serotonin eseleyo ngokufanelekileyo (Kaye et al., 2009). Oku kukhokelela kumjikelo okhohlakeleyo we-homeostatic (Umzobo 1), ngenxa yokuba ukuze uzive ungcono, izigulane ze-AN zifuna ukunciphisa i-tryptophan ngakumbi, okukhokelela ekunciphiseni ukusetyenziswa kokutya (Kaye et al., 2009). Ukuba isigulana siqala ukutya ukutya okune-tryptophan kuyo, amanqanaba e-serotonin aphakama ngokukhawuleza abangela unxunguphalo olugqithisileyo kunye nesiphithiphithi seemvakalelo.Kaye et al., 2009). Oku kwenza ukubuyiswa kwezigulane ze-AN kube nzima kakhulu (Kaye et al., 2009). Ukwehla kwamanqanaba e-serotonin ngexesha lesigaba esinzima sokugula ngenxa yokunqongophala kwe-tryptophan (Riva, ngo-2016) inokuchaza ukuphazamiseka okumandundu kwembonakalo yomzimba okuqhelekileyo kwi-AN. Nangona eyona ndlela ichanekileyo ye-neurophysiological ebangela ukuphazamiseka okunjalo ingaziwa, indlela yokusebenza iyafana nokungazithembi okuhlala kubonwa kuxinzelelo (cf. Orth kunye noRobins, ngo-2013).

Kaye et al. (2009) kucingelwa ukuba abantu abane-AN banesiphako esingaphakathi kwinkqubo yabo ye-serotonergic kunye nokuba i-gonadal steroid iyatshintsha ngexesha lokuya exesheni okanye imiba enxulumene noxinzelelo ekukhuleni komntu ofikisayo inokutshintsha ngakumbi umsebenzi wenkqubo ye-serotonergic. Nangona kunjalo, le ngcaciso ayinako ukuphendula ngokunyuka kwe-AN kuluntu lwanamhlanje okanye ukwenzeka kokuphazamiseka kokutya emadodeni. Ukunxulumanisa iindlela ezisondeleyo kunye nezizathu zokugqibela, kubalulekile ukuqwalasela ixesha lokuqalisa kwe-AN kwi-mearche kunye nokuba ngumntu omdala onokuthi ubangelwe lukhuphiswano olwandisiweyo lwe-intrasexual lokubhitya malunga neli xesha liphakathi ekuphuhliseni inzala. Ukhuphiswano lwe-Intrasexual lunokubangela uxinzelelo olungapheliyo kubantu abakhuphisana kakhulu (cf. I-Vaillancourt, ngo-2013). Okubalulekileyo, uxinzelelo olungapheliyo lwaziwa ngokunyusa amanqanaba e-serotonin ebuchosheni ebantwini (kujongwe kwakhona Hale et al., 2012) nakwezinye izilwanyana (umz., uAdell et al., ngo-1988; Keeney et al., 2006; Vindas et al., 2016). Izifundo zovavanyo kwiimpuku zibonise ukuba ukuzila ukutya kunciphisa amanqanaba e-serotonin ebuchosheni (UHaleem noHaider, ngo-1996). Kwale ndlela inye inokuthi yenzeke kubantu abacinezelekileyo abanenkqubo ye-serotonergic elawulwayo xa beqala ukutya ukuze banciphise imeko yedysphoric. Kwi-aggregate, ezi ziphumo zichaza enye inxalenye yekhonkco lomatshini phakathi koxinzelelo olungapheliyo kunye nokutya okungahambi kakuhle (Umzobo 1).

Kukho ubungqina bokungasebenzi kakuhle kwinkqubo ye-serotonergic kwi-bulimia nervosa (ihlaziywe Sjögren, 2017), kodwa ngendlela eyahlukileyo kune-AN. Amanqanaba e-serotonin kwizigulane ze-BN ehla ngaphezu kokulawula okunempilo nangexesha elifutshane lokuzila ukutya (umzekelo, ngexesha lokulala), okukhokelela ekucaphukeni kwemizwelo kunye neziqendu zokutya ngokugqithisileyo (Steiger et al., 2001). Ezi ziphazamiso ekusebenzeni kwenkqubo ye-serotonergic ziyaqhubeka emva kokuchacha, zicebisa ukuba zinokuba sele zikhona ngaphambi kokuqala kwe-BN (Kaye et al., 2001). Ngokwahlukileyo kwizigulana ze-AN, ukuncipha kwe-tryptophan kwizigulana ze-BN kunciphisa imo kwaye kubangela umnqweno wokutya kakhulu (ihlaziywe Sjögren, 2017). Uphononongo lwe-neuroimaging lufumene ukwanda kwe-5-HT1A yokubopha kwizigulana ze-BN xa kuthelekiswa nolawulo olusempilweni (Galusca et al., 2014). Ukusebenza kwe-serotonin receptor 5-HT_2CR ukunciphisa ukutya ngokutya okunencasa kwimodeli yeempuku (UMartin et al., 1998; UFletcher et al., 2010; Higgins et al., 2013; Ixabiso et al., 2018). Ngokunjalo, amayeza e-SSRI anciphisa umnqweno wokutya kakhulu (uhlaziywe kwakhona Tortorella et al., 2014). Ezi ziphumo zixhasa i-hypothesis yokuba izigulane ze-BN ziye zanciphisa ukuveliswa kwe-serotonin kwinkqubo ye-nervous central.

Imithombo yoMahluko ngamnye kwiiMpendulo zoKhuphiswano lwe-Intrasexual

Kukho iiyantlukwano ezinkulu zomntu ngamnye kwiimpendulo kukhuphiswano lwabasetyhini kunye ne-intrasexual: abanye abantu bazintyintya ngokutya ngelixa abanye bebulawa yindlala (Umzobo 2). Uninzi lwabasetyhini abasebatsha bachanabeke kukhuphiswano lwe-intrasexual ngenxa yokubhitya, kodwa liqaqobana nje labo eliba nengxaki yokutya. Isizathu solu tshintsho lubonakala luhambelana nokungafani komntu ngamnye ekuphenduleni uxinzelelo kunye nokusebenza kwenkqubo ye-serotonergic. Ukuqonda i-etiology yokuphazamiseka kokutya, omnye umbuzo ophambili ngulo: yeyiphi eyona mithombo iphambili yokuphendula uxinzelelo kunye nokungasebenzi kakuhle kwenkqubo ye-serotonergic kubantu abanengxaki yokutya?

Into enokuthi iqhube lo mahluko womntu ngamnye inokuba yi-dysbiosis yamathumbu (cf. UTemko et al., 2017). Ubungqina obuninzi bobungqina kwezinye izilwanyana bucebisa ukuba i-gut microbiota inefuthe ekuphenduleni uxinzelelo, ukuziphatha okufana nexhala kunye nendawo emiselweyo yokusebenza kwe-neuroendocrine hypothalamic-pituitary-adrenal (HPA) i-axis yoxinzelelo (ihlaziywe Ukunyanzelwa et al., 2017; bona kwakho UMolina-Torres et al., 2019). Utshintsho kwi-physiology enxulumene noxinzelelo kunye nokuziphatha okumodareyithwa yi-gut dysbiosis kunokukhokelela ekuguqulweni kokwakheka kwe-microbial ngokuvezwa ngamayeza okubulala iintsholongwane, ukutya okungalunganga, ukunqongophala kokuncancisa, ukuzalwa ngokutyalwa, usulelo, ukuvezwa koxinzelelo kunye nezinye izinto ezininzi zokusingqongileyo (zihlaziywe kwakhona Ukunyanzelwa et al., 2017).

Ubungqina obubalulekileyo bendlela ecingelwayo phakathi kokuphazamiseka kokutya kunye ne-microbiota ibonelelwa kukufumanisa ukuba i-64% yabantu abaneengxaki zokutya baye bafumanisa ukuba bane-syndrome ye-bowel syndrome.Perkins et al., 2005). Uphononongo lwakutsha nje lufumene ukuba izigulana ze-AN ziyatenxa kulawulo kubuninzi, iyantlukwano kunye nokwakheka kwe-microbial ye-fecal microbiota (ihlaziywe Schwensen et al., 2018), ezihlala zahluke kakhulu kwezo zolawulo olusempilweni nasemva kokutyiswa (Kleiman et al., 2015; UMack et al., ngo-2016). Nangona ezinye zeetenxa kwi-microbiota zinokubangelwa kukutya - ngokutya okulinganiselweyo kuthintela iyantlukwano yeentsholongwane (njengoko kufunyenwe kwizifundo zezinambuzane kunye nabantu: Krams et al., 2017; UStevens et al., ngo-2019) -kusenokwenzeka ukuba aba bantu baye bane-microbiota etenxileyo ngaphambili. Uphononongo lwakutsha nje lubonise ukuba uxinzelelo luphazamisa i-gut microbiota (UGao et al., 2018; Partrick et al., 2018; UMolina-Torres et al., 2019). Ke, uxinzelelo olungapheliyo oluye lwabangela ukuphazamiseka kokutya lunokuthi lutshintshe i-microbiota kwizigulana ezinokuphazamiseka kokutya (cf. Seitz et al., 2019). Ngelishwa, izifundo malunga nokwakhiwa kwe-microbial yezigulane ezine-BED kunye ne-BN okwangoku zinqongophele. Uphononongo oluvavanya i-premorbid microbiota yezigulana ezinengxaki yokutya ziya kuba luncedo ngakumbi. Okubangela umdla kukuba, isifundo esikhulu saseSweden (UHedman et al., ngo-2019) wafumanisa ukuba umngcipheko wesifo se-celiac unyuswe ngu-217% kunyaka wokuqala emva kokuxilongwa kwe-AN. Ngokufanayo, isifo sikaCrohn sasiphindwe kathathu kwi-AN kunye ne-ulcerative colitis ngamaxesha angama-2.3 aqhelekileyo kwi-AN kunokulawula (Wotton et al., 2016). Ekubeni ezi zifo zibangelwa yi-dysbiosis (umz., Ni et al., 2017), ukwanda kwabo kwizigulane ze-AN kunika inkxaso eyongezelelweyo kwikhonkco phakathi kwe-dysbiosis kunye ne-AN.

Uphononongo kwiimpuku ezingenazo iintsholongwane lubonise ukuba ukungabikho kwe-microbiota yobomi bokuqala kukhokelela ekonyukeni koxinzelelo lwe-tryptophan kwiplasma kunye nokwanda komsebenzi we-serotonergic kwingqondo (Clarke et al., 2013). Olu tshintsho lunokuthi luqheleke ngokubonelela ngeempuku ngeebhaktheriya zeprobiotic ezaziwa ngokuba nefuthe kwi-tryptophan metabolism (Clarke et al., 2013). Kumdibaniso, uphononongo oluphononongwe ngasentla lubonisa ukuba ukungaqhelekanga kumsebenzi we-serotonergic kukuphazamiseka kokutya kunokubangwa ngokuyinxenye kukutenxa kwi-gut microbiota. Sikholelwa ukuba le yindlela ebalulekileyo kwizifundo zexesha elizayo (cf. Seitz et al., 2019), nangona umsebenzi obalulekileyo usafuneka ngaphambi kokuba sibe kwindawo yokuphuhlisa unyango olusekelwe kwi-microbiome yokuphazamiseka kokutya.

Iziphazamiso zokutya njengoQoqosho

Kubalulekile kodwa ngokwethiyori nangokwekliniki ukufumanisa ukuba ngaphezu kwe-50% yabasetyhini abafunyaniswa bene-AN baphuhlisa i-BN (Bulik et al., 1997). Isizathu esinye sokuba kutheni i-AN itshintshe kwi-BN inokuba njengoko imeko yesondlo yomntu iphucuka, i-gut microbiota yabo iyatshintsha, enokuthi yona ibe nefuthe ekuphenduleni kwabo kuxinzelelo kunye nokusebenza kwenkqubo ye-serotonergic. Olu qikelelo luxhaswa ziziphumo ezibonisa ukuba i-bulimic AN subtypes (AN-B) ihluke kuhlobo lokukhawulela i-AN (AN-R) kwi-microbial community composition (UMack et al., ngo-2016), ngelixa ukondla kutshintsha i-gut microbiota (Kleiman et al., 2015). Ukongeza, emva kokuba ukondla kunyuse ukugxila kwe-tryptophan, iimpendulo ze-homeostatic kwinkqubo ye-serotonergic zinokukhokelela ekuhambeni kwexesha kwindawo apho amanqanaba e-serotonin ehla ngokugqithisileyo, nto leyo ebangela umnqweno wokutya kakhulu (cf. Steiger et al., 2001).

Kuyathakazelisa ukuba ngelixa i-meta-analysis ifumene ukuba izigulane ze-AN ziye zandisa i-cytokine concentration kwi-plasma (ingakumbi i-IL-6 kunye ne-TNF-α), amanqanaba e-cytokine kwizigulane ze-BN awazange ahluke kulawulo.Dalton et al., 2018). Izifundo zovavanyo kwizilwanyana ezingezozabantu ziye zafumanisa ukuba ukulawulwa kwe-IL-6 cytokines kwandisa amanqanaba e-serotonin kwaye kunciphisa amanqanaba e-dopamine kwi-accumbens yenyukliya, umphumo owandiswa luxinzelelo (Ingoma et al., 1999). Ngokusekwe kwezi ziphumo, siqikelela ukuba amanqanaba e-cytokine ehla kwizigulane ze-AN-R, kunokubangela ukunciphisa amanqanaba e-serotonin ukuya kuthi ga kwinqanaba lokuba umnqweno wokutya kakhulu uvele, ngaloo ndlela utshintshe ukuxilongwa kokuphazamiseka kokutya kwesigulana ukuya kwi-AN-B. . Le ngcamango ixhaswa kukufumanisa ukuba izigulane ze-AN-B zinezinga eliphantsi lokuvuvukala kunezigulane ze-AN-R (USolmi et al., 2015).

Ngokubanzi, ezi ndlela zokwabelwana ngazo ezibangela ukuphazamiseka kokutya zibonisa ukuba ukuphazamiseka kokutya ayizizo iingxaki ezahlukeneyo. Kunoko, zibonakala zenza i-continuum, kunye ne-BED kwelinye icala le-spectrum kunye ne-AN-R kwelinye icala. I-BN kunye ne-bulimic-type AN (AN-B) zibekwe phakathi kwezinto ezigqithisileyo (Umzobo 2). Ngaphambili, umbono we-transdiagnostic wokuphazamiseka kokutya wawubuzwa (Birmingham et al., 2009), ngokuyinxenye ngenxa yokuba indima yoxinzelelo, i-neuroinflammation kunye ne-gut dysbiosis kwi-etiology yeengxaki zokutya ayizange iqondwe. Imodeli eboniswe kweli nqaku (Iimpawu ze1, 2) icebisa ukuba utshintsho oluguquguqukayo lokudumba, uxinzelelo, amanqanaba e-serotonin, ukugxila kwe-tryptophan kunye ne-microbiota kubangela utshintsho kwindlela yokuziphatha engalunganga. Xa iindlela ezisondeleyo ezixutyushwa ngasentla zidityaniswe kwimodeli eqhubekayo yokuphazamiseka kokutya, sikwimeko engcono kakhulu yokuchaza ukuba kutheni iimpawu zomntu zihlala zitshintsha ngexesha lokuphazamiseka kokutya kunye nokuba kutheni izigulane zinokufunyaniswa ukuba zinenye ingxaki yokutya.

I-Autoimmunity kunye nokuphazamiseka kokutya

Zonke iimeko zemiyalelo yokutya azibangelwa kukhuphiswano lwe-intrasexual lokubhitya. Ngokomzekelo, kukho izigulane ze-AN ezingenalo uloyiko olunzulu lokufumana ubunzima okanye ukutyeba. I-DSM-V (Umbutho we-Psychiatric Association, i-2013) yazisa ukuxilongwa kwe-ARFID (i-Avoidant/Restrictive Food Intake Disorder) ukuchaza izigulane ezingaphantsi kobunzima obungenalo ukuphazamiseka komfanekiso womzimba (okt non-fat-phobic AN). I-ARFID ibonakala ixhaphake kakhulu kumazwe asakhasayo kune-fat-phobic AN, exhaphake kakhulu kumazwe athuthukileyo (ihlaziywe Becker et al., 2006). Ngokunjalo, nangona i-AN kunye nezinye iingxaki zokutya zixhaphake kakhulu phakathi kwabantu abathandana besini esifana nesabo kunamadoda athandana nesini esahlukileyo (Li et al., 2010; Calzo et al., 2018), iingxaki zokutya ziyenzeka kwamanye amadoda athandana nesini esahlukileyo. Oku kunokuba nzima ukukuchaza kuphela ngokhuphiswano lwe-intrasexual lokubhitya kuba ukubhitya akubalulekanga njengokuthanda iqabane kubafazi njengoko kunjalo ngamadoda (Li et al., 2010).

Ukuba i-neuroinflammation idlala indima ebalulekileyo kwi-AN, umbuzo obalulekileyo kukuba yintoni ebangela i-neuroinflammation kwezi meko? Ngokwendalo, uxinzelelo olungapheliyo olukhokelela kwi-neuroinflammation inokubangelwa zezinye izinto ngaphandle kokhuphiswano lwe-intrasexual. Oku kunokuba yinyani ngakumbi kwizigulana ezingatyibilikiyo ze-AN. Ngaphandle koxinzelelo olungapheliyo, i-neuroinflammation inokubangelwa zizifo ze-autoimmune kunye ne-autoinflammatory (Najjar et al., 2013). Ngokuhambelanayo, kukho iingxelo ezininzi zeemeko apho i-AN iqhutywe zizifo: ezi meko zichazwe njenge "autoimmune anorexia nervosa" (i-autoimmune anorexia nervosa).I-Sokol kunye neGrey, ngo-1997; Sokol, 2000). Kwezinye iimeko, i-OCD iye yabonwa ukuba ilandele usulelo (Umbutho we-Psychiatric Association, i-2013), ukubonelela ngenkxaso engakumbi kwintlangano phakathi kokusebenza kwe-immune system kunye nokuqala kwe-OCD kunye ne-AN (Umzobo 1). Kanye njengezigulane ezine-fat-phobic AN, izigulana ezingezizo i-fat-phobic AN zinokufunda ukunciphisa ixhala ngokutya. Oku kunokukhokelela kuxinzelelo olubi / umjikelo wendlala njengakwi-fat-phobic AN (Umzobo 1). Ngaphaya koko, imodeli yethu ye-psychoneuroimmunological ibonelela ngengcaciso kwezo zehlo zembali ze-non-fat-phobic anorexia nervosa ezazikho kuluntu lwembali olwalungenabo ubuhle obuncinci (cf. UArnold, ngo-2013).

Kuphononongo olukhulu lwabantu kwisizwe ngokubanzi olwenziwe eDenmark, UZerwas et al. (2017) ifumene ukuba izifo ezizenzekelayo okanye izifo ezizimele zonyusa ingozi ye-AN nge-36%, ingozi ye-BN nge-73% kunye nokuphazamiseka kokutya okungachazwanga ngenye indlela (EDNOS) ingozi nge-72%. Esi siphumo sasinamandla kumakhwenkwe kunamantombazana (Zerwas et al., 2017). Kumakhwenkwe, ukuba nayiphi na i-autoinflammation kwandisa ingozi ye-EDNOS nge-740%. Uphononongo olukhulu lwaseSweden luxele ukuba naziphi na izifo ezandulelayo zonyusa umngcipheko we-AN ngama-59% (UHedman et al., ngo-2019). Olunye uphononongo olukhulu oluhlalutya unxibelelwano lwemfuza phakathi kokuphazamiseka kokutya kunye nezifo ezizimelayo azizange zichonge naluphi na ukudibana kofuzo phakathi kwe-anorexia nervosa kunye nezifo ezizimelayo (autoimmune disease).Tylee et al., 2018). Oku kuphakamisa ukuba imeko yendalo endaweni yemfuzo ibangela umanyano phakathi kwe-AN kunye nezifo ezizimelayo.

Sitolika ezi ziphumo njengokubonelela ngenkxaso ebanzi kwimodeli yethu ye-psychoneuroimmunological yokuphazamiseka kokutya ngenxa yezizathu ezine: (1) uxinzelelo olungapheliyo luyaziwa ngokubangela izifo ezizimele (i-autoimmune)Ingoma et al., 2018), (2) izifo ezininzi ezizimeleyo kunye nezifo ezizimele ziyaziwa ngokunyusa i-neuroinflammation (Najjar et al., 2013), (3) ukusebenza kwe-immune system kwaziwa ngokunyusa ukuphendula koxinzelelo (I-Yau kunye nePotenza, 2013), kunye (4) i-dysbiosis kwi-gut microbiota inokukhokelela ekuqaliseni kwezifo ezizenzekelayo (Lukens et al., 2014). Njengoko kuhlaziywe kwicandelo elithi "I-Neurochemistry ye-Anorexia Nervosa kunye ne-Bulimia Nervosa", i-dysbiosis nayo ixhaphake kwiingxaki zokutya.

Ke, kwimeko ye-ARFID (non-fat-phobic AN), abantu abane-neuroinflammation banokufunda ukuba ukutya kunye nokuzila ukutya kunokunciphisa ixhala kunye ne-dysphoria kuba ukutya kunye nokuzila ukutya kunciphisa iimpendulo ze-autoimmune (cf. Hafstrom et al., 1988) kunye nokulawula inkqubo ye-serotonergic (cf. Kaye et al., 2009), ekhokelela kumjikelezo wokutya okukhohlakeleyo kwaye ekugqibeleni kwi-AN. Le ndlela ye-psychoneuroimmunological inokuchaza ukuba kutheni amadoda athandana nabantu besini esahlukileyo kunye nabangakholwayo ngamanye amaxesha bephathwa yi-AN (cf. UCarlat et al., ngo-1997) naxa ukhuphiswano olunamandla lwe-intrasexual malunga nokubhitya lungekho kwinqanaba elifanayo njengakwabasetyhini abathandana nesini esahlukileyo (cf. Abed et al., 2012).

I-Comorbidity yokuphazamiseka kokutya

Ukuphazamiseka kokutya ngokuqhelekileyo kunezinga eliphezulu lokugula kunye nezinye iziphazamiso zengqondo (Keski-Rahkonen kunye ne-Mustelin, ngo-2016). Ngokomzekelo, i-93-95% yabantu abadala abaguli be-AN babene-comorbid mood disorder, i-55-59% yayinengxaki yokukhathazeka kunye ne-5-20% yayinengxaki enxulumene neziyobisi.Blinder et al., 2006). Uphando malunga ne-comorbidity yokuphazamiseka kwengqondo kwi-BN lubonise ukuba i-94% yezigulane ze-BN zabantu abadala zinengxaki yokuphazamiseka kwemizwelo, i-55% yayinengxaki yokuxhalabisa kwaye i-34% yayinengxaki yokusetyenziswa kweziyobisi.I-Swanson et al., 2011). I-Comorbidities yayingaphantsi rhoqo kulutsha olune-BN: i-49.9% yayinokuphazamiseka kwemizwelo, i-66.2% yayinengxaki yokuxhalabisa, ukusetyenziswa kakubi kweziyobisi kwenzeka kwi-20.1% ye-BN elivisayo ngelixa i-57.8% yayinokuphazamiseka kokuziphatha.I-Swanson et al., 2011).

Ngenxa yokuba i-BED isandula kuchazwa njengengxaki eyahlukileyo, izifundo malunga nokuphazamiseka kwengqondo okudibeneyo zinqabile (cf. U-Olguin et al., ngo-2017). Uphononongo olukhulu lwe-epidemiological kulutsha lwase-US lufumene ukuba i-45.3% yabantu abane-BED babene-comorbid mood disorder, i-65.2% yayinengxaki yokuxhalaba, ukusetyenziswa kakubi kweziyobisi kwenzeka kwi-26.8% yabakwishumi elivisayo ngelixa i-42.6% yayinengxaki yokuziphatha.I-Swanson et al., 2011).

I-OCD, eyabelana ngezinto ezininzi ezifanayo kunye nokuphazamiseka kokutya, inxulunyaniswe ne-gut microbiome dysregulation.Turna et al., 2017kunye nokutshintsha umsebenzi we-serotonin kwingqondo (Lissemore et al., 2018). Njengokuphazamiseka kokutya, i-OCD inxulunyaniswa ne-comorbidity ephezulu kunye nezinye iziphazamiso zengqondo.Hofmeijer-Sevink et al., 2013). Kuba i-gut microbiome dysregulation kunye noxinzelelo olungapheliyo zombini zinxulunyaniswa nokuphazamiseka kweemvakalelo kunye nengxaki yokuxhalaba (kuhlaziywe kwakhona Bekhbat kunye nommelwane, ngo-2018; U-Liang et al., 2018), eyona nkcazo ibambekayo malunga nokwenzeka kwezi zinto zihambelanayo kukuba kwi-OCD kunye nokuphazamiseka kokutya, ezi ngxaki zibangelwa yi-dysbiosis kunye nokuphakama kovakalelo kuxinzelelo.

Okubalulekileyo, iimpawu ze-AN ezininzi zibonakala ngathi ziimpawu ze indlala, kungekhona ngenxa yokuphazamiseka kwengqondo. Umzekelo, kuphononongo oludumileyo lwendlala eMinnesota, amadoda angama-36 asempilweni ayephantsi kwendlala kangangeenyanga ezi-6 (Izitshixo, ngo-1950). Amadoda aqala emva koko ukubonisa iimpawu ezifana nokuphazamiseka kokutya, njengokutya ngokwesiko, ukuzixakekisa ngokutya kunye nokutya. Amadoda alambileyo nawo aphuhlisa ukuqokelela kunye nokuziphatha okuthe kratya, ecebisa ukuba indlala inokubangela okanye yomeleze iimpawu ezifana ne-obsessive-compulsive disorder (OCD). Abanye abantu abalambileyo babethanda ukufunda iincwadi zokupheka, baphuphe ngokutya kwaye bahlale bethetha ngako (Izitshixo, ngo-1950). Uxinzelelo olufanayo lokutya luqhele ukubonwa kwizigulana ze-AN (Ngo-1983).

Amadoda alambileyo nawo acaphuka, anexhala kwaye adandathekile, nto leyo ebonisa ukuba indlala ikhokelele kudandatheko olubangelwa yindlala (cf. Rantala et al., 2018). Kwimixholo emininzi, iimpawu ziyaqhubeka nasemva kokuncancisa. Iziqendu zendlala ixesha elide zikhokelela ekungakhathaliyo kunye nokurhoxa ekuhlaleni (cf. Izitshixo, ngo-1950), ezikwayimpawu ze-AN eziqhelekileyo. Uphononongo lwendlala yaseMinnesota lubonise ukuba ngokukhawuleza emva kokuba uvavanyo lwendlala luphelile, amadoda amaninzi abonisa inkxalabo malunga nokufumana ubunzima obuninzi kunye "nokuba yi-flabby" (Izitshixo, ngo-1950). Uhlobo olufanayo lwemizekelo inokufumaneka kwiingxelo zemeko kunye needayari ngexesha lendlala (Izitshixo, ngo-1950). Nangona babebhityile, uninzi lwamadoda lwalungaziboni lungaphantsi kobunzima bomzimba.Izitshixo, ngo-1950). Ngaloo ndlela, kubonakala ngathi indlala inokunyusa umfanekiso ogqwethekileyo we-AN kwaye indlala ngokwayo ibangela uhlobo lwe-psychopathology ebonwa kwizigulane ze-AN.

Imiba yoMngcipheko wokuphazamiseka kokuTya

Izinto zeGenetic kunye neNeuroinflammation

Usapho, amawele kunye nophononongo lokuthatha umntwana ongamzalanga abe ngowakho luye lwabonisa ngokungaguquguqukiyo ukuba izinto zemfuza zinegalelo kumahluko ekuchaphazelekeni kukuphazamiseka kokutya. Uqikelelo lwelifa le-BED luphakathi kwe-41 kunye ne-57%; Uqikelelo lwelifa le-BN luphakathi kwe-30 kunye ne-83%, ngelixa i-AN inelifa le-28-78% (UT Thornton et al., 2011). Ukuphazamiseka kokutya kungokwentsapho: izalamane zabasetyhini zabantu abane-AN zinamathuba angama-11.3 ngaphezulu kokuphuhlisa i-AN kunezalamane zabantu abangenayo i-AN; Izalamane zabasetyhini zabantu abane-BN zinamathuba angama-12.3 ngaphezulu okuhlakulela i-BN kunezihlobo zabantu abangenayo i-BN (Strober et al., 2000). Zimbalwa izinto ezinobungozi obuthile eziye zachongwa ngokugqibeleleyo ngenxa yokuphazamiseka kokutya (kuphononongwe kwi Mayhew et al., 2018), nangona uphando lwakutsha nje lubonise iindawo ezisibhozo zofuzo eziphantsi kwe-AN etiology, ebonisa imvelaphi ye-metabo-psychiatric yesi sifo (UWatson et al., 2019). Izifundo ezimbini zibonise ukuba kukho ukuhanjiswa okwabelwanayo phakathi kokuphazamiseka kokutya kunye nokuphazamiseka kokuxhalabisa (Keel et al., 2005), phakathi kwe-AN kunye ne-OCD (Altman kunye noShankman, ngo-2009) kunye naphakathi kwe-BN kunye ne-panic disorder (Keel et al., 2005). Inkcazo enokwenzeka kakhulu yezi ziphumo kukuba ukuhanjiswa okwabelwanayo kubangelwa ukuba sesichengeni kwi-neuroinflammation kunye nokuphendula koxinzelelo, njengoko kuphakanyiswe bubungqina obuhlaziywe ngasentla. Oku kuchaphazeleka kwe-neuroinflammation kunye noxinzelelo kunokuchaza ukuba kutheni izifundo ze-GWAS zifumene ulungelelwaniso lwemfuza phakathi kwe-AN kunye nezinye iingxaki ezininzi zengqondo ezifana ne-schizophrenia, ingxaki enkulu yoxinzelelo, ukuphazamiseka kwengqondo kunye ne-autism.uAntila et al., ngo-2018; USullivan et al., 2018), kuba i-neuroinflammation idlala indima kuzo zonke (Najjar et al., 2013). Kunye nomahluko kukwakheka kwe-microbiome, ezi zithintelo zemfuzo kwi-neuroinflammation zinokucacisa ngokuyinxenye ukuba ukhuphiswano lwe-intrasexual lukhokelela kwi-BED, BN okanye i-AN (cf. Umzobo 2).

Ukuphathwa kakubi kwabantwana, uxinzelelo, i-Epigenetics kunye neMicrobiota

Ukuphathwa gadalala kwabantwana ngendlela yokuxhatshazwa ngokwesondo, ngokwasemoyeni okanye ngokwasemzimbeni kwandisa umngcipheko wokuphazamiseka okuchaphazelekileyo (okuhlaziywe kwakhona Hoppen kunye noChalder, ngo-2018). Ukuphathwa kakubi kwabantwana kwandisa umngcipheko wokuba nengxaki yokutya ngaphezu kwezihlandlo ezithathu (Caslini et al., 2016). Ukuphathwa gadalala kwabantwana kwandisa ukuphendula koxinzelelo ebudaleni, isiphumo esiqhutywa ngokuyinxenye ziindlela ze-epigenetic ezinje nge-DNA methylation (DNAm) etshintshiweyo ye-HPA axis genes.Bustamante et al., 2016). Ukuxinezeleka okungapheliyo ebuntwaneni kunokuchaphazela i-microbiome ngendlela yokuba i-microbiome etshintshileyo, engaphantsi kweyona nto ibeka abantu ukuba banyuke uxinzelelo (O'Mahony et al., 2016). Ukongeza kokunyuka kobuntununtunu kuxinzelelo, uxinzelelo lobomi bokuqala lunokukhokelela kwi-microglia, enokuthi ikhokelele kwimpendulo enokubakho ye-neuroinfigueation kuxinzelelo olulandelayo (luhlaziywe kwakhona Calcia et al., 2016). Uxinzelelo olungapheliyo luhlala luxelwa phakathi konyaka ngaphambi kokuqala kwe-AN kwizifundo ze-epidemiological (Rojo et al., 2006). Izigulana ze-AN zichaze amanqanaba aphezulu oxinzelelo olupheleleyo lobomi kunye nobunzima obuninzi bokujongana noxinzelelo kunolawulo olusempilweni (Soukup et al., 1990). Uphononongo lokubuyela emva lufumene ukuba uxinzelelo olunzima lobomi luyahluka phakathi kwe-AN kunye neesampuli zokulawula, ukuqikelela ukuqala kwe-AN kwi-67% yamatyala (Schmidt et al., 2012).

Indima yeeHormones zesini

Amanqanaba eehomoni zangaphambi kokubeleka kunye nezangoku zibonakala zinefuthe ngokuyinxenye ukuba ukhuphiswano lwe-intrasexual lokubhitya lukhokelela kukuphazamiseka kokutya. Iihomoni zesondo nazo zinefuthe kuhlobo lokuphazamiseka kokutya okuphuhliweyo (Umzobo 2). I-Estrogen yaziwa ngokuvuselela umsebenzi we-HPA, ngaloo ndlela inyusa ukuphendula koxinzelelo (Kudielka kunye neKirschbaum, ngo-2005). I-Androgens, ngokuchaseneyo, ithande ukunciphisa umsebenzi we-HPA kwaye ngaloo ndlela inciphise ukuphendula koxinzelelo (Kudielka kunye neKirschbaum, ngo-2005). Amadoda ahlala ebonisa ukusebenza okuphezulu kwe-HPA kwiimeko ezinxulumene nemeko ngelixa abafazi bebonisa ukusebenza okuphezulu kwe-HPA kwiimeko ezibandakanya ukwaliwa kwezentlalo (ihlaziywe Del Giudice et al., 2011).

Ngoko ke kunokuqikelelwa ukuba amabhinqa amaninzi athandana nesini esahlukileyo (UBártová et al., 2020), oko kukuthi, abafazi abane-androgen ephezulu yokuvezwa kwangaphambi kokubeletha okanye amanqanaba aphezulu e-testosterone yangoku (uLuoto et al., 2019a, b) - kwaye, ngoko, i-drive ephezulu yesimo sentlalo (cf. Nave et al., 2018) - amathuba aphezulu okuphuhlisa i-AN. Ngokwahlukileyo koko, abasetyhini abaninzi ababhinqileyo abanovakalelo ngakumbi ekwaliwa kwezentlalo kulindeleke ukuba babe nomngcipheko omkhulu wokuphuhlisa i-BED. Ngokwenene, umlinganiselo wedijithi (2D: 4D, okt, i-biomarker yokuvezwa kwe-androgen yangaphambi kokubeleka: uLuoto et al., 2019a) ngamadoda amaninzi kwizigulane ze-AN kunezigulane ze-BN, kunye nolawulo olunomlinganiselo wedijithi ephakathi (Quinton et al., 2011). Oku kuphakamisa ukuba izigulane ze-AN zinokuba namava aphezulu e-androgen yangaphambi kokubeleka kunezigulane ze-BN kunye nolawulo (ukufumana ingxoxo ecacileyo yezi ndlela zophuhliso kubantu abangenazo iikliniki, bona uLuoto et al., 2019a, b). Kwabasetyhini, amanqanaba aphantsi e-testosterone yangaphambi kokubeleka kunye namanqanaba aphezulu ehomoni ye-ovarian ye-pubertal abonakala enyusa umngcipheko we-BED; emadodeni, amanqanaba aphezulu e-testosterone yokukhulelwa abonakala ekhusela kwi-BED (Klump et al., 2017). Ezi ziphumo zibonisa indima yeehomoni zesini kwi-phenotypic variation (Umzobo 2) kunye neeyantlukwano zesini kwiingxaki zokutya.

Unyango lwangoku lweSifo sokuTya

Unyango lweengxaki zokutya alusebenzi kangako kunonyango lwezinye izigulo zengqondo. Kuphela yi-46% yezigulane ze-AN ezichacha ngokupheleleyo, isinye kwisithathu sichacha ngokuyinxenye kwaye kwi-20% i-AN ihlala iyimeko engapheliyo (UArcelus et al., 2011). Ubude bexesha lokugula yiminyaka emi-6 (Schmidt et al., 2016). Okwangoku, akukho nyango lusebenzayo lwe-pharmacological lwe-AN. I-serotonin reuptake inhibitors ekhethiweyo (SSRIs) ayisebenzi kwi-AN (UDavis no-Attia, ngo-2017). Akukho mayeza avunyiweyo okunyanga i-anorexia nervosa e-US okanye kwi-EU (UBodell noKeel, ngo-2010; Starr kunye noKreipe, ngo-2014). Unyango ke ngoko lusekwe kwiintlobo ezahlukeneyo zonyango kunye neenzame zokubuyisela ubunzima (umz., Brockmeyer et al., 2017; UHarrison et al., 2018 kunye neembekiselo kuyo). Ukusebenza konyango olusekelwe kusapho (FBT) kuthiwa luphezulu kunezinye iindlela zonyango lwengqondo (Starr kunye noKreipe, ngo-2014).

Olona nyango luphambili lwe-BN lunyango lokuziphatha kwengqondo (CBT) olujolise ekutshintsheni iipatheni zokucinga ezingalunganga ezibangela ukutya kakhulu ngelixa uzama ukulungelelanisa indlela yokuziphatha yokutya.Fairburn, 2008). I-SSRIs icinezela kancinane indlela yokuziphatha yokutya kakhulu kodwa ayikuphelisi ngokuqhelekileyo (UMitchell et al., 2013). Izinga lokuyeka kunyango lwe-antidepressant kwizigulane ze-BN malunga ne-40% (Bacaltchuk kunye noHay, ngo-2003). Unyango lwangoku lwe-BN alusebenzi ngokukodwa: izifundo ezilandelelweyo zibonise ukuba kwixesha le-10 leminyaka, kuphela i-50% yezigulane ezichacha ngokupheleleyo.Hay et al., ngo-2009).

Ii-Antidepressants zisebenza ngokuthozamayo ngokuchasene neziqendu zokutya ngokuzingxala ngexesha elifutshane, kodwa ukusebenza kwazo kwexesha elide akwaziwa.McElroy et al., 2012). Ukongeza, abancedisi ukunciphisa ubunzima bomzimba kwaye ababonakali benyusa i-antibinge yokutya iziphumo ze-CBT (McElroy et al., 2012). Isizukulwana sesibini se-antipsychotics esisetyenziswa kunyango lwe-AN enyanisweni sibangela okanye sikhulise ukutya kakhulu kwizigulana ezine-BED kunye ne-BN (McElroy et al., 2012; Cuesto et al., 2017). Iimvavanyo eziphindwe kabini ezingaboniyo kunye ne-placebo zibonise ukuba i-agent echasene ne-epileptic, i-topiramate, iyasebenza ngokuchasene neziqephu zokuzibhokoxa kwi-BED kunye nokukhuluphala. I-Topiramate inezixhobo eziphezulu ezichasayo, kwaye ibonakaliswe ukunciphisa i-neuroinflammation kunye noxinzelelo lwe-oxidative kwiigundane (Pinheiro et al., 2015). Kukwabonakalisiwe ukuthoba uxinzelelo-olubangela ukwanda kotywala kwiimpuku (Farook et al., 2009), ecebisa ukuba inokunciphisa ukuphendula koxinzelelo. Kuyathakazelisa ukuba i-topiramate inciphisa ngokufanelekileyo ukunyanzeliswa kwi-OCD (URubio et al., ngo-2006; Van Ameringen et al., 2006; Mowla et al., 2010; Berlin et al., 2011). Ngelishwa, i-topiramate ayifanelekanga njengonyango lwe-AN okanye izigulane ezinembali ye-AN kuba i-topiramate iyanciphisa ukutya kunye nokuphucula ukulahleka kwesisindo njengempembelelo yecala. Isenokubangela i-AN kwabo banemiba yomngcipheko eyaziwayo ye-AN (Lebow et al., 2015). EUnited States naseKhanada, ekuphela kweyeza elivunyiweyo le-BED ephakathi kunye nengqongqo yi-lisidexamfetamine, ekwasetyenziselwa ukunyanga ingxaki yokungakhathali (ADHD)UHeo kunye noDuggan, ngo-2017). Ulingo olungenamkhethe oluphindwe kabini oluyimfama lubonise ukuba i-lisdexamfetamine isebenza ngakumbi ngokuchasene nokutya kakhulu kune-placebo. Nangona kunjalo, i-lisdexamfetamine ineziphumo ezibi ezinobungozi njengomlomo owomileyo, intloko ebuhlungu kunye nokungalali okukhokelela ekuyekisweni kweziyobisi kwizigulana ezininzi.UHeo kunye noDuggan, ngo-2017). Ukongeza, inciphisa nje iimpawu kunokususa ingxaki esisiseko ebangela ingxaki yokutya, ngaloo ndlela ibonelela ngesisombululo sexesha elide (cf. Rantala et al., 2017).

Ukutya okuNyango kweZingxaki eziSekwe kwiPsychoneuroimmunology

Imodeli ye-psychoneuroimmunological esiyibonisile inamandla okuphucula ukusebenza konyango lokuphazamiseka kokutya. Imodeli ibeka ukuba, kunokubonelela ngonyango olusekelwe kwintsapho kunye nonyango lwengqondo kwizigulane ze-AN, kunokusebenza ngakumbi ukuzama ukunciphisa ukunyanzeliswa kokunciphisa umzimba ngokunciphisa i-neuroinflammation kunye noxinzelelo olungapheliyo. Sikwacebisa ukuba i-CBT esekwe kwinzululwazi yengqondo inokunceda ngakumbi ekutshintsheni umfanekiso wesigulana kunye neengcinga zobuhle obuncinci ukuya kwicala elinempilo. Ngokucacileyo, imodeli yethu ye-psychoneuroimmunological icebisa ukuba utshintsho lwendlela yokuphila olwehlisa i-neuroinflammation kunye noxinzelelo kulindeleke ukuba lunciphise iimpawu ze-AN, nangona izifundo ezongezelelweyo zeklinikhi ziyafuneka ukuze oku kuqinisekiswe ngamandla.

Amayeza e-AN angaJonga i-Neuroinflammation

Uphononongo lwakutsha nje lucebisa ukuba unyango lwe-olanzapine (iyeza lokulwa ne-atypical antipsychotic) lukhokelela ekufumaneni ubunzima obukhulu kwizigulana ezine-AN.Dold et al., 2015; Himmerich et al., 2017). Uphononongo kwiimpuku lubonise ukuba i-olanzapine yehlisa i-neuroinflammation (USharon-Granit et al., ngo-2016). Ikwacinezela i-TNF-α kunye ne-IL-6 kwaye yandisa amanqanaba e-IL-10, eyi-cytokine echasayo (i-anti-inflammatory cytokine).Sugino et al., 2009). Ke, indlela enokwenzeka yokuba i-olanzapine inceda njani izigulana ze-AN zinokuncitshiswa kwe-neuroinflammation, nangona oku kusafuneka kuqinisekiswe ngamandla.

Uphononongo lwezifundo lubonisa isiphumo esihle sonyango lwe-anti-TNF-α kwi-AN (USolmi et al., 2013). Esalatmanesh et al. (2016) yafumanisa ukuba i-antibiotic ye-minocycline eyaziwayo ngeempawu zayo ezichasayo zinciphisa kakhulu iimpawu ze-OCD kwi-OCD-izigulane ngaphandle kokubangela nayiphi na imiphumo eyingozi.

I-Zinc, i-Anorexia Nervosa kunye ne-Neuroinflammation

Ubungqina obuvela kwizifundo zeklinikhi bubonisa ukuba izigulane ze-AN zinezinga eliphantsi le-zinc kwi-serum kunye namazinga aphantsi e-urinary zinc excretion (Katz et al., 1987). Ubunzima bokusilela kwe-zinc bunxulunyaniswa nobunzima be-AN, kunye namanqanaba aphezulu oxinzelelo kunye noxinzelelo (Katz et al., 1987). Izilingo ezininzi ezilawulwa ngokungahleliwe ze-zinc supplementation ziye zabika ukunyuka okuphawulekayo kubunzima bezifundo (Safai-Kutti kunye noKutti, ngo-1986; Safai-Kutti, ngo-1990; Birmingham et al., 1994; IBirmingham kunye neGritzner, ngo-2006). Ukunqongophala kwe-Zinc kuyaziwa ukuba kuhambelana nokuveliswa kwemveliso ye-proinflammatory cytokines, ngakumbi i-TNF-α kunye ne-IL-6.IGammoh kunye neRink, ngo-2017). Ke, sicebisa ukuba indlela enokwenzeka phakathi kwe-zinc supplementation kunye nokuncipha kweempawu ze-AN kunye nokuzuza ubunzima kunokusebenza ngokuncipha kwe-neuroinflammation. Ukunciphisa i-neuroinflammation, ngokulandelayo, kunciphisa i-obsessions. Le ngcaciso ixhaswa ngokufunyaniswa kwezilingo ezilawulwa yi-placebo eziye zachaza ukuba izimo zengqondo malunga nokutya kunye nokutya zaba ngcono ngakumbi kwizigulane ze-AN ezazidla iipilisi ze-zinc (ngokungafaniyo nalabo bafumana iipilisi ze-placebo) (Khademian et al., 2014). Ke, kubonakala ngathi i-zinc inciphisa iimpawu ze-OCD kwizigulana ze-AN. Kuyathakazelisa ukuba izongezo ze-zinc zinciphisa iimpawu nakwizigulane ezine-OCD ezingenangxaki yokutya (Sayyah et al., 2012). Ngokubanzi, uphando oluninzi luyafuneka ukuqonda indlela (ii) apho i-zinc ichaphazela iimpawu ze-AN.

Ukongeza kwi-zinc, ezinye i-micronutrients zinokusetyenziselwa ukunciphisa i-neuroinflammation. Ngokomzekelo, izigulane ze-AN zineentsilelo ze-vitamin D (Veronese et al., 2015; Tasegian et al., 2016) kunye nokuxhaswa kwe-vitamin D kuyaziwa ukunciphisa ukuvuvukala (Grossmann et al., 2012; Zhang et al., 2012; UBerk et al., 2013kunye ne-neuroinflammation (Koduah et al., 2017).

I-Fecal Microbiota Transplantation kunye neProbiotics

Ukuba ukuqhubela phambili kwezenzululwazi kuyaqhubeka nokubonelela ngenkxaso yobungqina kwindima ye-microbiota kwi-etiology yokuphazamiseka kokutya, kunokwenzeka ukuba i-fecal microbiota transplants esuka kubantu abaphilileyo iya kuba yinxalenye yonyango lwexesha elizayo lokuphazamiseka kokutya. Isifundo sokuqala esipapashiweyo (de Clercq et al., 2019) ingxelo ebalulekileyo yokufumana ubunzima bomzimba emva kokutshintshwa kwe-fecal microbiota kwisigulane esine-AN. Nangona kunjalo, uphando kule nkalo lusekutsha. Ukongeza kwi-fecal microbiota transplantation, i-gut microbiota inokuthi iqhutywe ngonyango kunye ne-probiotics okanye ezinye izongezo (UStevens et al., ngo-2019). Ngelishwa, nangona ubungqina obuqokelelweyo bubonisa ukuba i-probiotics lunyango oluthembisayo lwe-adjuvant yokunciphisa ukusebenza kokuvuvukala okufunyenwe kwingxaki enkulu yokudakumba (kuhlaziywe Park et al., 2018), izifundo malunga nokusebenza kweprobiotics njengoko unyango lwengxaki yokutya lunqongophele okwangoku.

I-Binge Eating Disorder (BED) Unyango olusekelwe kwi-Evolutionary Psychiatry

Unyango lwe-BED olusekwe kunyango lwengqondo lwendaleko kufuneka, ngokombono wethu, lugxininise ekunqandeni umjikelo okhohlakeleyo wemizamo yokutya eyenza ukuba iziqendu zokutya ngokuzonwabisa. Izigulane kufuneka zizame ukunciphisa umzimba ngokutya okunempilo kunye nokuzilolonga (cf. Lindeberg, ngo-2010; UTemko et al., 2017; ULeone et al., ngo-2018) kunokuba uzame ukunciphisa ukuthathwa kwekhalori ngokuzila ukutya. Le yindlela efana kakhulu nonyango lwangoku lwe-CBT lwe-BED (cf. UHilbert, ngo-2013). Ukutya okunempilo kunokunceda ekunciphiseni ukuphendulwa koxinzelelo lwezigulane ze-BED: izifundo zovavanyo kwizilwanyana zibonise ukuba i-intestinal microbiota inefuthe ekuphenduleni uxinzelelo.Bravo et al., 2011). Ukongeza, ukutya okunempilo, ngakumbi i-omega-3 fatty acids kunye ne-polyphenols, kunciphisa ukuvuvukala (U-Ricordi et al., ngo-2015), eyaziwa ngokuvuselela umsebenzi we-HPA (I-Yau kunye nePotenza, 2013; Rohleder, 2019) kunye nokwehla kwamandla okulawula ukuzilawula (Izihlangu et al., 2017). Ukuzivocavoca kunokunceda ukunciphisa ukuphendula koxinzelelo (cf. Zschucke et al., 2015). Ukusebenza kolu khetho zonyango lwe-BED kufuneka kumiselwe kwizifundo zeklinikhi ezizayo.

UThintelo lweNqanaba lokuGqibela iZifo zokuTya

Olu nyango lungentla lujolise kwiindlela ezisondeleyo ezisisiseko sokuphazamiseka kokutya; ukanti, ukuze naluphi na unyango lube nempumelelo yexesha elide, unobangela wokugqibela wokuphazamiseka kokutya kufuneka kuqwalaselwe. Iinkqubo zeMedia literacy zingenza umqathango osebenzayo wokuthintela ukuphazamiseka kokutya (Li et al., 2014) ukuya kuthi ga kwimifanekiso enqwenelekayo yabasetyhini abancinci kunye namadoda anemisipha kumajelo eendaba asebenzise ngaphezulu kweenjongo zokhuphiswano lwe-intrasexual (UBoothroyd et al., 2016; Borau kunye neBonnefon, ngo-2017; Saunders kunye ne-Eaton, ngo-2018), kwaye njengokuba kunzima kubantu abatsha ukunciphisa ukubonakaliswa kwabo ngokubanzi kwimidiya. Iinkqubo zokufundisa kumajelo eendaba zijolise ekwenzeni abathabathi-nxaxheba babe nolwazi ngabasebenzisi bosasazo. Zibandakanya amacandelo e-psychoeducational kwaye zibonisa indlela isoftware yokuhlela ifoto esetyenziswa ngayo ukwenza imifanekiso ibonakale “igqibelele” (Li et al., 2014). Iinkqubo zokufunda nokubhala zosasazo zisekwe kwingcinga yokuba ngokunika abantu abancinci iinyani malunga nentengiso kunye nemifanekiso yemidiya, baya kuba semngciphekweni wokungena ngaphakathi kwiimbono zemizimba emincinci kwaye bangazikhathazi ngobunzima babo: ngenxa yoko, indlela yokuziphatha ehambelana nokuphazamiseka kokutya kuya kuncitshiswa. (Li et al., 2014).

Iinkqubo zokufundisa kumajelo eendaba zisebenze kakuhle ekunciphiseni iimeko zengqondo ezinxulumene nokuphazamiseka kokutya. Uphononongo lwabafundi abangekabinazidanga babika ukuba ungenelelo lwe-4-iveki yolwazi lokufunda nokubhala kumajelo eendaba kunciphisa ukunganeliseki komzimba kunye nokufakwa ngaphakathi kweembono zenkcubeko yentlalo yokuncipha (Watson kunye noVaugn, ngo-2006). Olunye uphononongo lufumene ukuba ukuthatha inxaxheba kwiiseshoni ezisibhozo zenkqubo yokufunda nokubhala kumajelo eendaba kuncitshiswe imilo, ubunzima kunye nokukhathazeka kokutya kunye nokunganeliseki komzimba kumantombazana afikisayo - umphumo uqhubekile ekulandeleni inyanga ye-30, ebonisa ukuphuculwa kwexesha elide.Wilksch kunye noWade, ngo-2009). Ukongeza kulwazi lokufunda nokubhala kumajelo eendaba, iindlela ezisekelwe kwi-dissonance, apho abathathi-nxaxheba baqeqeshelwa ukuthatha isimo sengqondo esichasene nemibono yobuhle obuncinci, baye basebenza kakuhle ekunciphiseni ukuziphatha kunye neengcinga ezinxulumene nokuphazamiseka kokutya.I-Stice et al., 2001, 2006; Becker et al., 2006; Yager kunye ne-O'Dea, ngo-2008). Li et al. (2014) ucebise ukuba indibaniselwano yeenkqubo zokufundisa kumajelo eendaba kunye nenkqubo ye-dissonance inokuba yindlela esebenzayo yokuthintela ukuphazamiseka kokutya kwabafikisayo.

isiphelo

Ubungqina obuguqukayo bubonisa ukuba ukuphazamiseka kokutya kudla ngokuba ziimpendulo ezingalunganga kukhuphiswano lwe-intrasexual ngenxa yokuncipha. Ingqikelelo engafaniyo echazwe kwicandelo elithi “I-Mismatch Hypothesis ye-Eating Disorders” iphinda iqonde ukuba iimeko ezintsha zokutya kokutya kunye nendlela yokuphila yokungaphumli zikhokelela ekubeni umntu aphile ubomi obungenamkhethe. i-adaptive metaproblem apho iindlela zengqondo zokuthathwa kokutya zingqubana neendlela zengqondo ezinxulumene nokudibana. Ukuxhaphaka okukhulu kokuphazamiseka kokutya kubantu banamhlanje yinto entsha yendaleko: akukho malungu ezinye iintlobo aziwa ngokuba balambe bade bafe ngenxa yentabalala yokutya. Oku kukuqonda okumangalisayo kwenzululwazi yengqondo enolwazi ngendaleko.

Ubungqina obuhlaziywe kweli nqaku buye bakhokelela ekubeni sicebise ukuba kunokuba sicinge ngokuphazamiseka kokutya njengeemeko ezicacileyo, kufuneka zijongwe ngokuqhubekayo. Ngokwemodeli ye-psychoneuroimmunological esiyinike yona kweli nqaku, ukwahluka kokuphazamiseka kokutya kunokuvela kumahluko omntu ngamnye kwi-gut microbiota kunye nokuphendula koxinzelelo (Umzobo 2), enefuthe kwi-neuroinflammation kunye nenkqubo ye-serotonergic (Umzobo 1). Imodeli yethu yokwenziwa ibonelela ngeempendulo kwimibuzo emine ethe gqolo: (1) kutheni iimpawu zokuxilonga kunye nokuziphatha okuhambelanayo zidibana kakhulu kulo lonke uluhlu lweengxaki zokutya, (2) kutheni ukufumanisa ukuphazamiseka kokutya kulucelomngeni, (3) kutheni ukuxilongwa kwesigulana kunokutshintsha phakathi kokuphazamiseka kokutya ngaphezulu ixesha kunye (4) kutheni i-AN ikhona ngeendlela ezimbini: i-fat-phobic AN kunye ne-non-fat-phobic AN. Umsebenzi wexesha elizayo wamandla okhokelwa yile modeli kulindeleke ukuba uphuhlise ngakumbi ukuqonda okukhoyo kwe-biopsychosocial yokuphazamiseka kokutya.

Eli nqaku lokuphonononga libonisa ukuba iyantlukwano phakathi kokuphazamiseka kokutya kunokudityaniswa ngokuhlukahluka kunye nokudibanisa kwimpendulo yoxinzelelo kunye neuroinflammation ebangelwa kuxinzelelo olungapheliyo. Xa iqondo loxinzelelo kunye (emva koko) ukuphendula koxinzelelo kunye neuroinflammation utshintsho, imodeli iqikelela ukuba iimpawu zesigulana kunye nokuxilongwa kokuphazamiseka kokutya kutshintsha ngokufanelekileyo (Umzobo 2). Ubungqina esiye sahlaziywa bubonisa ukuba umehluko phakathi kwe-BN kunye ne-AN phenotypes ivela kwinqanaba le-neuroinflammation elibangelwa uxinzelelo olungapheliyo, kunye nezigulane ze-AN ezine-neuroinflammation enamandla kunezigulane ze-BN. Ngaloo ndlela, indawo yesigulana kwingxaki yokutya eqhubekayo (Umzobo 2) igqitywe ngokuphendula kwabo ngoxinzelelo kunye neuroinflammation, zombini ezo ziphenjelelwa kukunganyangeki koxinzelelo lwabo.

Ngenxa yobungqina obuhlaziywe kweli nqaku, kuyacaca ukuba i-neuroinflammation igcina i-obsession yokulahlekelwa ubunzima kwizigulane ezineengxaki zokutya, eziphakamileyo kwi-AN kwaye ziphantsi kwizigulane ze-BED. Izigulana ze-BED azicoci, nto leyo ebonisa ukuba buthathaka kakhulu ukwehlisa umzimba kunezigulana ze-BN. Olu xinzelelo lulawulwa kukungena kwengqondo okuxhaphakileyo malunga nokutya, ubunzima bomzimba, ukutya, umthambo kunye nenkangeleko, kunye nokuziphatha okufana ne-OCD ekujoliswe kuyo ukujongana nale miba. Siqikelela ukuba okona kunamandla i-neuroinflammation kwizigulana ze-AN, kokukhona kunamandla kukufuna kwabo ukunciphisa umzimba kunye noloyiko lokufumana ubunzima, kwaye okona kuzingisa ngakumbi kwaye kugqithisile kukuziphatha kwabo okufana ne-OCD.Umzobo 1). Obunye ubungqina bemodeli yethu bunikezelwa ngokufunyaniswa kokusebenza kwe-olanzapine (Dold et al., 2015; Himmerich et al., 2017) kunye nezinc njengonyango lwe-AN (Safai-Kutti kunye noKutti, ngo-1986; Safai-Kutti, ngo-1990; Birmingham et al., 1994; IBirmingham kunye neGritzner, ngo-2006). Emva koko, zombini ziyaziwa ukuba zinezixhobo ezichasayo. Uphando lwexesha elizayo lunokwenziwa ekusebenzeni kwenye i-agent echasayo, i-minocycline, njengokhetho lonyango lwe-AN kunye ne-BN (cf. Esalatmanesh et al., 2016).

Ukusukela oko ubungqina obuguqukayo (nangona obungathanga ngqo) bubonisa ukuba izigulana ezine-anorexia nervosa zine-neuroinflammation, izifundo ze-positron emission tomography scanning (PET) ziyafuneka ukunika inkxaso eyongezelelweyo kwi-hypothesis yokuba i-neuroinflammation yindlela yebhayoloji ephantsi koluhlu lweengxaki zokutya. Ukongeza, izifundo ezilandelelweyo apho amanqanaba ehomoni yoxinzelelo, ukuphendula koxinzelelo, amanqanaba e-serotonin, i-neuroinflammation kunye nokwakheka kwe-gut microbiota kulinganiswa kwizigulana. ekhosini Ukuphazamiseka kokutya kungatyhila ukuba ngaba iimpawu ziyatshintsha ngokwengqikelelo evela kwimodeli. Ekugqibeleni, sinethemba lokuba imodeli ye-evolutionary psychoneuroimmunological echazwe apha iya kukhuthaza umsebenzi owongezelelekileyo, ibonelele ngophuculo olukhulu kunyango lonyango kunye namachiza okuphazamiseka kokutya kwaye ekugqibeleni ibonakalise ukuba luncedo kwayo kwizigidi zabantu abaphila ubomi obunzima kakhulu kukuphazamiseka kokutya.

Umbhali Wemivuzo

UMR uyile lo mbhalo-ngqangi. UMR ucinge ngemodeli ye-psychoneuroimmunological. I-SL yenza ingqikelelo yengqikelelo engafanelekanga. I-SL, i-TK, kunye ne-IK ihlolisise ngokunzulu umbhalo wesandla womxholo wengqondo. UMR kunye no-SL balungiselele amanani. Bonke ababhali babe negalelo baza bavuma inguqulelo yokugqibela yombhalo-ngqangi.

Inkxaso

I-SL yaxhaswa yinkxaso-mali evela kwi-Emil Aaltonen Foundation (ye-SL's Ph.D. uphando). I-IK ixhaswe yi-Estonian Research Council (PUT-1223) kunye ne-Latvian Council of Science (lzp-2018/1-0393). I-TK yaxhaswa yiBhunga leSayensi yaseLatvia (lzp-2018/2-0057). Imithombo yenkxaso-mali ayizange ibe nampembelelo ekubhalweni kwalo mbhalo-ngqangi.

Ukugqubana kwemidla

Ababhali bavakalisa ukuba uphando lwenziwe ngokungabikho naluphi na ulwalamano lwezorhwebo okanye lwezezimali olubhekiswa njengengxabano yenzuzo.

Ucaphulo