The intestinal microbiota and metabolites in patients with anorexia nervosa

Gut Microbes. 2021 Jan-Dec;13(1):1-25. doi: 10.1080/19490976.2021.1902771.


Brain-gut microbiota interactions are intensively studied in connection with various neurological and psychiatric diseases. While anorexia nervosa (AN) pathophysiology is not entirely clear, it is presumably linked to microbiome dysbiosis. We aimed to elucidate the gut microbiota contribution in AN disease pathophysiology. We analyzed the composition and diversity of the gut microbiome of patients with AN (bacteriome and mycobiome) from stool samples before and after renourishment, and compared them to healthy controls. Further, levels of assorted neurotransmitters and short-chain fatty acids (SCFA) were analyzed in stool samples by MS and NMR, respectively. Biochemical, anthropometric, and psychometric profiles were assessed. The bacterial alpha-diversity parameter analyses revealed only increased Chao 1 index in patients with AN before the realimentation, reflecting their interindividual variation. Subsequently, core microbiota depletion signs were observed in patients with AN. Overrepresented OTUs (operation taxonomic units) in patients with AN taxonomically belonged to Alistipes, Clostridiales, Christensenellaceae, and Ruminococcaceae. Underrepresented OTUs in patients with AN were Faecalibacterium, Agathobacter, Bacteroides, Blautia, and Lachnospira. Patients exhibited greater interindividual variation in the gut bacteriome, as well as in metagenome content compared to controls, suggesting altered bacteriome functions. Patients had decreased levels of serotonin, GABA, dopamine, butyrate, and acetate in their stool samples compared to controls. Mycobiome analysis did not reveal significant differences in alpha diversity and fungal profile composition between patients with AN and healthy controls, nor any correlation of the fungal composition with the bacterial profile. Our results show the changed profile of the gut microbiome and its metabolites in patients with severe AN. Although therapeutic partial renourishment led to increased body mass index and improved psychometric parameters, SCFA, and neurotransmitter profiles, as well as microbial community compositions, did not change substantially during the hospitalization period, which can be potentially caused by only partial weight recovery.

Keywords: BMI; EDE-Q; Microbiome; SCFA; bacteriome; dysbiosis; gut-brain-microbiota axis; mycobiome; neurotransmitter; renourishment.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anorexia Nervosa / metabolism*
  • Anorexia Nervosa / microbiology*
  • Archaea / classification
  • Archaea / growth & development
  • Bacteria / classification
  • Bacteria / growth & development
  • Bacteria / metabolism
  • Body Mass Index
  • Brain-Gut Axis
  • Fatty Acids, Volatile / metabolism*
  • Feces / microbiology
  • Female
  • Fungi / classification
  • Fungi / growth & development
  • Fungi / metabolism
  • Gastrointestinal Microbiome*
  • Humans
  • Longitudinal Studies
  • Metagenome
  • Mycobiome
  • Neurotransmitter Agents / metabolism*
  • Young Adult


  • Fatty Acids, Volatile
  • Neurotransmitter Agents

Grant support

This work was supported by the Ministry of Health of the Czech Republic [NV18-01-00040]; Ministry of Health of the Czech Republic [17-28905A].