Myo-inositol in the Dorsal Anterior Cingulate Cortex is Associated with Anxiety-to-Eat in Anorexia Nervosa

Anorexia nervosa (AN) is a mental and behavioral health condition characterized by an intense fear of body weight or fat gain, restriction of food intake resulting in low body weight, and distorted body image. Substantial research has focused on general anxiety in AN, but less is known about eating-related anxiety and its underlying neurobiological mechanisms. We sought to characterize anxiety-to-eat in AN and to examine neurometabolite levels in the dorsal anterior cingulate cortex (dACC), a brain region putatively involved in modulating anxiety-related responses, using edited magnetic resonance spectroscopy. Sixteen women hospitalized with AN and 16 women of healthy weight without a lifetime history of an eating disorder (healthy controls; HC) completed a computer-based behavioral task assessing anxiety-to-eat in response to images of higher (HED) and lower energy density (LED) foods. The AN group reported greater anxiety to eat HED and LED foods relative to the HC group. Both groups reported greater anxiety to eat HED foods relative to LED foods. The neurometabolite myo-inositol (myo-I) was lower in the dACC in AN relative to HC. In the AN group only, myo-I levels negatively predicted anxiety to eat HED but not LED foods and was independent of body mass index, duration of illness, and general anxiety. These findings provide new insight into the clinically challenging feature of eating-related anxiety in AN, and indicate potential for myo-I levels in the dACC to serve as a novel biomarker of illness severity or therapeutic target in individuals vulnerable to AN.