Predicting the Trajectory of Restrictive Eating in Childhood from Genetic Risk for Anorexia Nervosa
Anorexia nervosa has the highest mortality rate of any psychiatric illness, and is also extremely difficult to treat—treatment typically relies on supportive therapy, with no actual medications designed to target the core biology of the illness. “Picky eating” in childhood can be a warning that anorexia will develop later in adulthood, but little is known about the genetic reasons for this behavior. This project will comb the comprehensive, long-term Norwegian Mother and Child Cohort Study for genetic and/or environmental clues that point to restrictive eating behavior, with the ultimate goal of preventing this devastating illness in its earliest stages.
Stephanie Zerwas, Ph.D.
and Hunna Watson, Ph.D.
Need/Problem: Restrictive or picky eating in childhood has been associated with risk for anorexia nervosa, a serious and perplexing psychiatric disorder. Our recent studies have demonstrated that we can measure each individual’s genetic risk for the disorder. This study will examine whether genetic risk for anorexia nervosa is associated with restrictive and picky eating in childhood.
Grant Summary: By drawing on the wealth of large longitudinal research in Norway, we will be able to examine the joint contribution of genetic risk and maternal eating disorder status for restrictive and picky eating in childhood.
Goals & Projected Outcomes: Our ultimate goal is to improve both prevention and early detection of anorexia nervosa by understanding how genetic predispositions and eating behavior interact to increase risk for the disorder.
Grant Details: Around 30% of AN patients develop a chronic, relapsing course. In those who do recover, the recovery process is long (7 years on average).8 The AN treatment is weak with no efficacious treatments and no medications targeting the core biology of the illness. Thus, AN ranks among the ten leading causes of disability in young women and has the highest mortality rate of any psychiatric illness. Funding for AN research is limited. In a white paper published by the National Institute of Mental Health (NIMH), director Dr. Thomas Insel wrote, “eating disorders …receive less funding than they ‘should’ based on” estimates of the life lost to illness. Funding for innovative research on AN etiology and biology is desperately needed to help us a) prevent AN and b) treat AN. Translating these findings back to prevention efforts, clinical care, and future pharmacotherapy, has potential to reduce the unacceptably high societal and personal burden on patients with AN and their families.
The proposed research will examine how restrictive eating develops in childhood and will ultimately assist in the early detection and prevention of eating disorders. The project leverages existing resources from a K01 grant (PI: Zerwas) and data from The Norwegian Mother and Child Study (MoBa).8,9 Norwegian and NIMH initial investment in MoBa has been estimated at ~$45 million dollars. MoBa is a longitudinal, prospective birth cohort study and biobank of ~114,000 offspring and ~90,000 mothers who have been followed up routinely since pregnancy and as such is a unique resource. Data are currently available from pregnancy to the most recent survey with 8 year olds; children in the sample are turning 12 years old and completing another survey this year.
The overarching aim of this proposal is to understand risk and causal pathways to the development of restrictive eating which is a putative childhood prodrome for AN. Describing the genetic and environmental pathways to disordered eating represents our greatest opportunity to avert the development of anorexia nervosa and to reduce the devastating personal, familial, and societal burden caused by the disorder.