{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:11:57Z","timestamp":1789996317940,"version":"4.0.1"},"reference-count":105,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T00:00:00Z","timestamp":1789689600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Anorexia nervosa (AN) is characterized by severe dietary restriction with effects that extend beyond body weight to gastrointestinal function, dietary tolerance and the gut microbiome. Weight restoration remains central to treatment, but studies suggest that microbial composition, microbial metabolites and gastrointestinal symptoms may not recover at the same pace as body mass. This narrative review examines gut microbiome alterations in AN through the clinical context of refeeding and dietetic care. Human and translational studies describe changes in microbial diversity, including shifts in carbohydrate fermenting taxa and their downstream metabolic products such as short-chain fatty acids (including butyrate), mucin-degrading taxa, neuroactive fecal metabolites, immune markers and microbial functional pathways. During refeeding, the substrates available to the gut microbiome are shaped by planned increases in energy intake, the extent to which planned meals are consumed, gastrointestinal tolerance, oral supplement use, constipation, laxative exposure or other medication, dietary variety and the gradual return of fermentable substrates. Current intervention evidence does not support routine use of probiotics, prebiotics or synbiotics for weight restoration, eating-disorder psychopathology or targeted microbiome modulation. Fiber-containing foods, fermented foods and dietary diversity may be relevant to dietary substrate exposure and gastrointestinal tolerance, but their use during AN rehabilitation should be framed as pragmatic dietetic care rather than as established microbiome-specific treatment. Their introduction should remain secondary to adequate energy provision, tolerance, normalization of eating patterns and avoidance of reinforcing restrictive behaviors. Dietitians can translate microbiome-related knowledge into cautious nutritional decision-making while ensuring that patient care remains centered on rehabilitation, safety and dietary adequacy.<\/jats:p>","DOI":"10.3390\/nu18183054","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:50:03Z","timestamp":1789995003000},"page":"3054","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Refeeding the Gut in Anorexia Nervosa: Microbiome, Nutritional Rehabilitation and Dietetic Care"],"prefix":"10.3390","volume":"18","author":[{"given":"Panagiota","family":"Margioula","sequence":"first","affiliation":[{"name":"Department of Clinical Nutrition, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-0471-6279","authenticated-orcid":false,"given":"Alexandros","family":"Nakas","sequence":"additional","affiliation":[{"name":"Diabetes Center, 1st Propaedeutic Department of Internal Medicine, School of Medicine, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5893-467X","authenticated-orcid":false,"given":"Lilian","family":"Adamidou","sequence":"additional","affiliation":[{"name":"Department of Clinical Nutrition, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eirini","family":"Simou","sequence":"additional","affiliation":[{"name":"Independent Researcher, 54638 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Petros","family":"Rafailidis","sequence":"additional","affiliation":[{"name":"2nd University Department of Internal Medicine, Department of Infectious Diseases, University General Hospital Alexandroupolis, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4296-3414","authenticated-orcid":false,"given":"Theocharis","family":"Konstantinidis","sequence":"additional","affiliation":[{"name":"Laboratory of Microbiology, Department of Medicine, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deny","family":"Tsakri","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christos","family":"Nikolaidis","sequence":"additional","affiliation":[{"name":"2nd Department of Internal Medicine, General Oncology Hospital of Kifissia \u201cAgioi Anargyroi\u201d, 14564 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5439-2149","authenticated-orcid":false,"given":"Despoina","family":"Gyriki","sequence":"additional","affiliation":[{"name":"Hepatogastroenterology Unit, Academic Department of Internal Medicine, General Oncology Hospital of Kifissia \u201cAgioi Anargyroi\u201d, National and Kapodistrian University of Athens, 14564 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7869-6824","authenticated-orcid":false,"given":"Christina","family":"Tsigalou","sequence":"additional","affiliation":[{"name":"Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, Dragana, 68100 Alexandroupolis, Greece"},{"name":"Food, Nutrition and Microbiome Program, Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8299-9035","authenticated-orcid":false,"given":"Elisavet","family":"Stavropoulou","sequence":"additional","affiliation":[{"name":"Food, Nutrition and Microbiome Program, Laboratory of Hygiene and Environmental Protection, Department of Medicine, Democritus University of Thrace, 68100 Alexandroupolis, Greece"},{"name":"Medical School, University of Nicosia, Athens Campus-UNIC Athens, Elliniko, 16777 Athens, Greece"},{"name":"Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, University of Lausanne, 1015 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,18]]},"reference":[{"key":"ref_1","unstructured":"(2022). Feeding and Eating Disorders. Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1097\/YCO.0000000000000739","article-title":"Incidence, Prevalence and Mortality of Anorexia Nervosa and Bulimia Nervosa","volume":"34","author":"Hoek","year":"2021","journal-title":"Curr. Opin. Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1038\/nrendo.2016.175","article-title":"The Endocrine Manifestations of Anorexia Nervosa: Mechanisms and Management","volume":"13","author":"Schorr","year":"2017","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1002\/erv.2679","article-title":"Gastrointestinal Alterations in Anorexia Nervosa\u2014A Systematic Review","volume":"27","author":"Schalla","year":"2019","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"294","DOI":"10.5114\/ceji.2017.70973","article-title":"Immune Disorders in Anorexia","volume":"42","year":"2017","journal-title":"Cent. Eur. J. Immunol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1002\/eat.23158","article-title":"Body Composition in Anorexia Nervosa: Meta-Analysis and Meta-Regression of Cross-Sectional and Longitudinal Studies","volume":"52","author":"Yilmaz","year":"2019","journal-title":"Int. J. Eat. Disord."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Bou Khalil, R., Sultan, A., Seneque, M., Richa, S., Lefebvre, P., Renard, E., Courtet, P., Maimoun, L., and Guillaume, S. (2022). Clinical Correlates of Measured and Predicted Resting Energy Expenditure in Patients with Anorexia Nervosa: A Retrospective Cohort Study. Nutrients, 14.","DOI":"10.3390\/nu14132727"},{"key":"ref_8","unstructured":"National Institute for Health and Care Excellence (2020). Eating Disorders: Recognition and Treatment. National Institute for Health and Care Excellence: Clinical Guidelines, National Institute for Health and Care Excellence (NICE)."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1018","DOI":"10.1002\/eat.22736","article-title":"Long-Term Outcome of Anorexia Nervosa: Results from a Large Clinical Longitudinal Study","volume":"50","author":"Fichter","year":"2017","journal-title":"Int. J. Eat. Disord."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.yclnex.2019.05.001","article-title":"Intestinal Microbiota and Anorexia Nervosa","volume":"28","author":"Breton","year":"2019","journal-title":"Clin. Nutr. Exp."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Carpinelli, L., Savarese, G., Pascale, B., Milano, W.D., and Iovino, P. (2023). Gut-Brain Interaction Disorders and Anorexia Nervosa: Psychopathological Asset, Disgust, and Gastrointestinal Symptoms. Nutrients, 15.","DOI":"10.3390\/nu15112501"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1080\/10640266.2016.1255108","article-title":"Gastrointestinal Comorbidities Which Complicate the Treatment of Anorexia Nervosa","volume":"25","author":"Mascolo","year":"2017","journal-title":"Eat. Disord."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Marzola, E., Nasser, J.A., Hashim, S.A., Shih, P.B., and Kaye, W.H. (2013). Nutritional Rehabilitation in Anorexia Nervosa: Review of the Literature and Implications for Treatment. BMC Psychiatry, 13.","DOI":"10.1186\/1471-244X-13-290"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00394-017-1445-8","article-title":"Gut Microbiota Functions: Metabolism of Nutrients and Other Food Components","volume":"57","author":"Rowland","year":"2018","journal-title":"Eur. J. Nutr."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Ghenciulescu, A., Park, R.J., and Burnet, P.W.J. (2021). The Gut Microbiome in Anorexia Nervosa: Friend or Foe?. Front. Psychiatry, 11.","DOI":"10.3389\/fpsyt.2020.611677"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1038\/s41564-023-01355-5","article-title":"The Gut Microbiota Contributes to the Pathogenesis of Anorexia Nervosa in Humans and Mice","volume":"8","author":"Fan","year":"2023","journal-title":"Nat. Microbiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"26752","DOI":"10.1038\/srep26752","article-title":"Weight Gain in Anorexia Nervosa Does Not Ameliorate the Faecal Microbiota, Branched Chain Fatty Acid Profiles and Gastrointestinal Complaints","volume":"6","author":"Mack","year":"2016","journal-title":"Sci. Rep."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Borgo, F., Riva, A., Benetti, A., Casiraghi, M.C., Bertelli, S., Garbossa, S., Anselmetti, S., Scarone, S., Pontiroli, A.E., and Morace, G. (2017). Microbiota in Anorexia Nervosa: The Triangle between Bacterial Species, Metabolites and Psychological Tests. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0179739"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Morita, C., Tsuji, H., Hata, T., Gondo, M., Takakura, S., Kawai, K., Yoshihara, K., Ogata, K., Nomoto, K., and Miyazaki, K. (2015). Gut Dysbiosis in Patients with Anorexia Nervosa. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0145274"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"110114","DOI":"10.1016\/j.pnpbp.2020.110114","article-title":"Anorexia Nervosa and Gut Microbiota: A Systematic Review and Quantitative Synthesis of Pooled Microbiological Data","volume":"106","author":"Mondot","year":"2021","journal-title":"Prog. Neuropsychopharmacol. Biol. Psychiatry"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1080\/17474124.2022.2056017","article-title":"Anorexia Nervosa and Gut Microbiome: Implications for Weight Change and Novel Treatments","volume":"16","author":"Wei","year":"2022","journal-title":"Expert Rev. Gastroenterol. Hepatol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1038\/nature12820","article-title":"Diet Rapidly and Reproducibly Alters the Human Gut Microbiome","volume":"505","author":"David","year":"2014","journal-title":"Nature"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"3915","DOI":"10.1007\/s00394-022-02929-5","article-title":"Dietary Variety Relates to Gut Microbiota Diversity and Abundance in Humans","volume":"61","author":"Huang","year":"2022","journal-title":"Eur. J. Nutr."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Katagiri, S., Shiba, T., Tohara, H., Yamaguchi, K., Hara, K., Nakagawa, K., Komatsu, K., Watanabe, K., Ohsugi, Y., and Maekawa, S. (2019). Re-Initiation of Oral Food Intake Following Enteral Nutrition Alters Oral and Gut Microbiota Communities. Front. Cell. Infect. Microbiol., 9.","DOI":"10.3389\/fcimb.2019.00434"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1016\/j.jand.2020.04.024","article-title":"Nutrition Support and the Gastrointestinal Microbiota: A Systematic Review","volume":"120","author":"Andersen","year":"2020","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1038\/s41467-019-14177-z","article-title":"Impact of Commonly Used Drugs on the Composition and Metabolic Function of the Gut Microbiota","volume":"11","author":"Collij","year":"2020","journal-title":"Nat. Commun."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1001\/jamapediatrics.2020.3359","article-title":"Short-Term Outcomes of the Study of Refeeding to Optimize Inpatient Gains for Patients With Anorexia Nervosa: A Multicenter Randomized Clinical Trial","volume":"175","author":"Garber","year":"2021","journal-title":"JAMA Pediatr."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Riedlinger, C., Mazurak, N., Sch\u00e4ffeler, N., Stengel, A., Giel, K.E., Zipfel, S., Enck, P., and Mack, I. (2022). Gastrointestinal Complaints in Patients with Anorexia Nervosa in the Timecourse of Inpatient Treatment. Front. Psychiatry, 13.","DOI":"10.3389\/fpsyt.2022.962837"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1097\/PSY.0000000000000247","article-title":"The Intestinal Microbiota in Acute Anorexia Nervosa and During Renourishment: Relationship to Depression, Anxiety, and Eating Disorder Psychopathology","volume":"77","author":"Kleiman","year":"2015","journal-title":"Psychosom. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1545","DOI":"10.1007\/s00213-018-5159-2","article-title":"The Gut Microbiome in Anorexia Nervosa: Relevance for Nutritional Rehabilitation","volume":"236","author":"Ruusunen","year":"2019","journal-title":"Psychopharmacology"},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Parada Venegas, D., De la Fuente, M.K., Landskron, G., Gonz\u00e1lez, M.J., Quera, R., Dijkstra, G., Harmsen, H.J.M., Faber, K.N., and Hermoso, M.A. (2019). Short Chain Fatty Acids (SCFAs)-Mediated Gut Epithelial and Immune Regulation and Its Relevance for Inflammatory Bowel Diseases. Front. Immunol., 10.","DOI":"10.3389\/fimmu.2019.01486"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1897212","DOI":"10.1080\/19490976.2021.1897212","article-title":"The Role of Short-Chain Fatty Acids in the Interplay between Gut Microbiota and Diet in Cardio-Metabolic Health","volume":"13","author":"Nogal","year":"2021","journal-title":"Gut Microbes"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.1152\/physrev.00018.2018","article-title":"The Microbiota-Gut-Brain Axis","volume":"99","author":"Cryan","year":"2019","journal-title":"Physiol. Rev."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1038\/s41579-020-00460-0","article-title":"The Gut Microbiota-Brain Axis in Behaviour and Brain Disorders","volume":"19","author":"Morais","year":"2021","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e458","DOI":"10.1038\/tp.2014.98","article-title":"Bacterial ClpB Heat-Shock Protein, an Antigen-Mimetic of the Anorexigenic Peptide \u03b1-MSH, at the Origin of Eating Disorders","volume":"4","author":"Tennoune","year":"2014","journal-title":"Transl. Psychiatry"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"105959","DOI":"10.1016\/j.psyneuen.2022.105959","article-title":"Gastrointestinal Symptoms, Gut Microbiome, Probiotics and Prebiotics in Anorexia Nervosa: A Review of Mechanistic Rationale and Clinical Evidence","volume":"147","author":"Dhopatkar","year":"2023","journal-title":"Psychoneuroendocrinology"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"4137","DOI":"10.1016\/j.cell.2021.06.019","article-title":"Gut Microbiota-Targeted Diets Modulate Human Immune Status","volume":"184","author":"Wastyk","year":"2021","journal-title":"Cell"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1038\/s41575-020-00390-5","article-title":"The International Scientific Association for Probiotics and Prebiotics (ISAPP) Consensus Statement on Fermented Foods","volume":"18","author":"Marco","year":"2021","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Vinelli, V., Biscotti, P., Martini, D., Del Bo\u2019, C., Marino, M., Mero\u00f1o, T., Nikoloudaki, O., Calabrese, F.M., Turroni, S., and Taverniti, V. (2022). Effects of Dietary Fibers on Short-Chain Fatty Acids and Gut Microbiota Composition in Healthy Adults: A Systematic Review. Nutrients, 14.","DOI":"10.3390\/nu14132559"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Heruc, G.A., Little, T.J., Kohn, M., Madden, S., Clarke, S., Horowitz, M., and Feinle-Bisset, C. (2018). Appetite Perceptions, Gastrointestinal Symptoms, Ghrelin, Peptide YY and State Anxiety Are Disturbed in Adolescent Females with Anorexia Nervosa and Only Partially Restored with Short-Term Refeeding. Nutrients, 11.","DOI":"10.3390\/nu11010059"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1902","DOI":"10.1016\/j.jand.2020.07.014","article-title":"Academy of Nutrition and Dietetics: Revised 2020 Standards of Practice and Standards of Professional Performance for Registered Dietitian Nutritionists (Competent, Proficient, and Expert) in Eating Disorders","volume":"120","author":"Hackert","year":"2020","journal-title":"J. Acad. Nutr. Diet."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Butler, M.J., Perrini, A.A., and Eckel, L.A. (2021). The Role of the Gut Microbiome, Immunity, and Neuroinflammation in the Pathophysiology of Eating Disorders. Nutrients, 13.","DOI":"10.3390\/nu13020500"},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Seitz, J., Dahmen, B., Keller, L., and Herpertz-Dahlmann, B. (2020). Gut Feelings: How Microbiota Might Impact the Development and Course of Anorexia Nervosa. Nutrients, 12.","DOI":"10.3390\/nu12113295"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1093\/ajcn\/87.4.810","article-title":"Dietary Energy Density and Diet Variety as Predictors of Outcome in Anorexia Nervosa","volume":"87","author":"Schebendach","year":"2008","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1137","DOI":"10.1016\/j.clnu.2020.07.021","article-title":"Multi-Omics Data Integration in Anorexia Nervosa Patients before and after Weight Regain: A Microbiome-Metabolomics Investigation","volume":"40","author":"Monteleone","year":"2021","journal-title":"Clin. Nutr."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1002\/eat.23435","article-title":"Gut Microbiota Alteration in Adolescent Anorexia Nervosa Does Not Normalize with Short-Term Weight Restoration","volume":"54","author":"Schulz","year":"2021","journal-title":"Int. J. Eat. Disord."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1902771","DOI":"10.1080\/19490976.2021.1902771","article-title":"The Intestinal Microbiota and Metabolites in Patients with Anorexia Nervosa","volume":"13","author":"Prochazkova","year":"2021","journal-title":"Gut Microbes"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"2304158","DOI":"10.1080\/19490976.2024.2304158","article-title":"Longitudinal Analysis of the Gut Microbiome in Adolescent Patients with Anorexia Nervosa: Microbiome-Related Factors Associated with Clinical Outcome","volume":"16","author":"Andreani","year":"2024","journal-title":"Gut Microbes"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"112164","DOI":"10.1016\/j.jpsychores.2025.112164","article-title":"Beyond the Surface: Gut Microbiome and Implicit Learning in Anorexia Nervosa\u2014A Pilot Study","volume":"194","author":"Kipper","year":"2025","journal-title":"J. Psychosom. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2143217","DOI":"10.1080\/19490976.2022.2143217","article-title":"Reproducible Changes in the Anorexia Nervosa Gut Microbiota Following Inpatient Therapy Remain Distinct from Non-Eating Disorder Controls","volume":"14","author":"Fouladi","year":"2022","journal-title":"Gut Microbes"},{"key":"ref_51","doi-asserted-by":"crossref","unstructured":"K\u00e4ver, L., Voelz, C., Specht, H.E., Thelen, A.C., Keller, L., Dahmen, B., Andreani, N.A., Tenbrock, K., Biemann, R., and Borucki, K. (2024). Cytokine and Microbiome Changes in Adolescents with Anorexia Nervosa at Admission, Discharge, and One-Year Follow-Up. Nutrients, 16.","DOI":"10.3390\/nu16111596"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"1031","DOI":"10.1152\/physrev.2001.81.3.1031","article-title":"Short-Chain Fatty Acids and Human Colonic Function: Roles of Resistant Starch and Nonstarch Polysaccharides","volume":"81","author":"Topping","year":"2001","journal-title":"Physiol. Rev."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1016\/j.cell.2016.05.041","article-title":"From Dietary Fiber to Host Physiology: Short-Chain Fatty Acids as Key Bacterial Metabolites","volume":"165","author":"Koh","year":"2016","journal-title":"Cell"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1080\/19490976.2015.1134082","article-title":"Formation of Short Chain Fatty Acids by the Gut Microbiota and Their Impact on Human Metabolism","volume":"7","author":"Morrison","year":"2016","journal-title":"Gut Microbes"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1111\/1462-2920.13589","article-title":"Formation of Propionate and Butyrate by the Human Colonic Microbiota","volume":"19","author":"Louis","year":"2017","journal-title":"Environ. Microbiol."},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Rios-Covian, D., Gonz\u00e1lez, S., Nogacka, A.M., Arboleya, S., Salazar, N., Gueimonde, M., and de Los Reyes-Gavil\u00e1n, C.G. (2020). An Overview on Fecal Branched Short-Chain Fatty Acids Along Human Life and as Related With Body Mass Index: Associated Dietary and Anthropometric Factors. Front. Microbiol., 11.","DOI":"10.3389\/fmicb.2020.00973"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2325","DOI":"10.1194\/jlr.R036012","article-title":"The Role of Short-Chain Fatty Acids in the Interplay between Diet, Gut Microbiota, and Host Energy Metabolism","volume":"54","author":"Groen","year":"2013","journal-title":"J. Lipid Res."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/asj.13118","article-title":"Pitfalls in Short-Chain Fatty Acid Research: A Methodological Review","volume":"90","author":"Sakata","year":"2019","journal-title":"Anim. Sci. J."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"e00541","DOI":"10.14309\/ctg.0000000000000541","article-title":"Associations of Fecal Short Chain Fatty Acids With Colonic Transit, Fecal Bile Acid, and Food Intake in Irritable Bowel Syndrome","volume":"14","author":"Waseem","year":"2023","journal-title":"Clin. Transl. Gastroenterol."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1948","DOI":"10.1021\/acs.jproteome.8b00536","article-title":"Evaluation and Optimization of Sample Handling Methods for Quantification of Short-Chain Fatty Acids in Human Fecal Samples by GC-MS","volume":"18","author":"Hsu","year":"2019","journal-title":"J. Proteome Res."},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Dalenbrook, S., Naab, S., Garber, A.K., Correll, C.U., Voderholzer, U., and Haas, V. (2022). Outcomes of a Standardized, High-Caloric, Inpatient Re-Alimentation Treatment Protocol in 120 Severely Malnourished Adolescents with Anorexia Nervosa. J. Clin. Med., 11.","DOI":"10.3390\/jcm11092585"},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/j.jadohealth.2013.05.014","article-title":"Higher Caloric Intake in Hospitalized Adolescents with Anorexia Nervosa Is Associated with Reduced Length of Stay and No Increased Rate of Refeeding Syndrome","volume":"53","author":"Golden","year":"2013","journal-title":"J. Adolesc. Health"},{"key":"ref_63","doi-asserted-by":"crossref","unstructured":"Riedlinger, C., Schmidt, G., Weiland, A., Stengel, A., Giel, K.E., Zipfel, S., Enck, P., and Mack, I. (2020). Which Symptoms, Complaints and Complications of the Gastrointestinal Tract Occur in Patients With Eating Disorders? A Systematic Review and Quantitative Analysis. Front. Psychiatry, 11.","DOI":"10.3389\/fpsyt.2020.00195"},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1136\/flgastro-2021-101857","article-title":"Anorexia Nervosa and the Gastrointestinal Tract","volume":"13","author":"Jafar","year":"2022","journal-title":"Frontline Gastroenterol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"1415","DOI":"10.1016\/0016-5085(90)91070-M","article-title":"Gastrointestinal Symptoms in Anorexia Nervosa: A Prospective Study","volume":"98","author":"Waldholtz","year":"1990","journal-title":"Gastroenterology"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"867","DOI":"10.1016\/j.jpeds.2013.03.011","article-title":"Effect of Nutritional Rehabilitation on Gastric Motility and Somatization in Adolescents with Anorexia","volume":"163","author":"Perez","year":"2013","journal-title":"J. Pediatr."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"178","DOI":"10.1002\/ncp.10474","article-title":"ASPEN Consensus Recommendations for Refeeding Syndrome","volume":"35","author":"Seres","year":"2020","journal-title":"Nutr. Clin. Pract."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1016\/0016-5085(91)90083-W","article-title":"Delayed Gastrointestinal Transit Times in Anorexia Nervosa and Bulimia Nervosa","volume":"101","author":"Kamal","year":"1991","journal-title":"Gastroenterology"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"e70100","DOI":"10.1111\/jhn.70100","article-title":"Management of Constipation in Eating Disorders-A Scoping Review","volume":"38","author":"Heathcote","year":"2025","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s40519-023-01529-4","article-title":"Anorexia Nervosa and Microbiota: Systematic Review and Critical Appraisal","volume":"28","author":"Garcia","year":"2023","journal-title":"Eat. Weight. Disord."},{"key":"ref_71","doi-asserted-by":"crossref","unstructured":"Silva, Y.P., Bernardi, A., and Frozza, R.L. (2020). The Role of Short-Chain Fatty Acids From Gut Microbiota in Gut-Brain Communication. Front. Endocrinol., 11.","DOI":"10.3389\/fendo.2020.00025"},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1486","DOI":"10.1053\/j.gastro.2020.10.066","article-title":"The Microbiota-Gut-Brain Axis: From Motility to Mood","volume":"160","author":"Margolis","year":"2021","journal-title":"Gastroenterology"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1016\/j.chom.2018.05.003","article-title":"Gut Microbiota Regulation of Tryptophan Metabolism in Health and Disease","volume":"23","author":"Agus","year":"2018","journal-title":"Cell Host Microbe"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.psyneuen.2014.09.031","article-title":"Inflammatory Cytokines and Anorexia Nervosa: A Meta-Analysis of Cross-Sectional and Longitudinal Studies","volume":"51","author":"Solmi","year":"2015","journal-title":"Psychoneuroendocrinology"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.jpsychires.2018.06.002","article-title":"A Meta-Analysis of Cytokine Concentrations in Eating Disorders","volume":"103","author":"Dalton","year":"2018","journal-title":"J. Psychiatr. Res."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1038\/s43856-025-01122-z","article-title":"Cytokine Concentrations in People with Eating Disorders: A Comprehensive Updated Systematic Review and Meta-Analysis","volume":"5","author":"Keeler","year":"2025","journal-title":"Commun. Med."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1038\/s41398-019-0422-9","article-title":"Immunoglobulin G Modulation of the Melanocortin 4 Receptor Signaling in Obesity and Eating Disorders","volume":"9","author":"Lucas","year":"2019","journal-title":"Transl. Psychiatry"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.coph.2019.07.004","article-title":"On the Origin of Eating Disorders: Altered Signaling between Gut Microbiota, Adaptive Immunity and the Brain Melanocortin System Regulating Feeding Behavior","volume":"48","author":"Fetissov","year":"2019","journal-title":"Curr. Opin. Pharmacol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1038\/s41522-025-00850-3","article-title":"Targeted Proteomics Reveal \u03b1-MSH-like Enterobacterial ClpB Protein in Gut Microbiota of Patients with Anorexia Nervosa","volume":"11","author":"Bremard","year":"2025","journal-title":"npj Biofilms Microbiomes"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"2441","DOI":"10.1210\/en.2019-00408","article-title":"The Gut Microbiome Derived From Anorexia Nervosa Patients Impairs Weight Gain and Behavioral Performance in Female Mice","volume":"160","author":"Hata","year":"2019","journal-title":"Endocrinology"},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"1897216","DOI":"10.1080\/19490976.2021.1897216","article-title":"Gut Microbial Communities from Patients with Anorexia Nervosa Do Not Influence Body Weight in Recipient Germ-Free Mice","volume":"13","author":"Glenny","year":"2021","journal-title":"Gut Microbes"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"1868","DOI":"10.1002\/eat.24231","article-title":"Fecal Microbiota Transplantation of Patients with Anorexia Nervosa Did Not Alter Flexible Behavior in Rats","volume":"57","author":"Kooij","year":"2024","journal-title":"Int. J. Eat. Disord."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s40337-025-01276-0","article-title":"Investigating Fecal Microbiota Transplants from Individuals with Anorexia Nervosa in Antibiotic-Treated Mice Using a Cross-over Study Design","volume":"13","author":"Maschek","year":"2025","journal-title":"J. Eat. Disord."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1038\/s41575-020-0344-2","article-title":"The International Scientific Association for Probiotics and Prebiotics (ISAPP) Consensus Statement on the Definition and Scope of Synbiotics","volume":"17","author":"Swanson","year":"2020","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1038\/nrgastro.2017.75","article-title":"Expert Consensus Document: The International Scientific Association for Probiotics and Prebiotics (ISAPP) Consensus Statement on the Definition and Scope of Prebiotics","volume":"14","author":"Gibson","year":"2017","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1038\/nrgastro.2014.66","article-title":"The International Scientific Association for Probiotics and Prebiotics Consensus Statement on the Scope and Appropriate Use of the Term Probiotic","volume":"11","author":"Hill","year":"2014","journal-title":"Nat. Rev. Gastroenterol. Hepatol."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1002\/erv.3069","article-title":"Probiotic and Prebiotic Interventions in Eating Disorders: A Narrative Review","volume":"32","author":"Baenas","year":"2024","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1186\/s40337-024-01143-4","article-title":"Probiotics and Eating Disorders: A Systematic Review of Humans and Animal Model Studies","volume":"12","author":"Bahari","year":"2024","journal-title":"J. Eat. Disord."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"S27","DOI":"10.1038\/sj.ejcn.1601659","article-title":"The Effect of Fermented Milk on Interferon Production in Malnourished Children and in Anorexia Nervosa Patients Undergoing Nutritional Care","volume":"56","author":"Solis","year":"2002","journal-title":"Eur. J. Clin. Nutr."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1007\/s00394-006-0589-8","article-title":"Effects of a Nutritional Intervention with Yogurt on Lymphocyte Subsets and Cytokine Production Capacity in Anorexia Nervosa Patients","volume":"45","author":"Nova","year":"2006","journal-title":"Eur. J. Nutr."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1016\/j.clnu.2015.10.014","article-title":"Influence of a Fermented Protein-Fortified Dairy Product on Serum Insulin-like Growth Factor-I in Women with Anorexia Nervosa: A Randomized Controlled Trial","volume":"35","author":"Trombetti","year":"2016","journal-title":"Clin. Nutr."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.clnesp.2021.08.016","article-title":"The Role of L. reuteri DSM17938 in Nutritional Recovery and Treatment of Constipation in Children and Adolescents with Anorexia Nervosa\u2014A Randomized, Double Blind, Placebo Controlled Study","volume":"46","author":"Tiljak","year":"2021","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1002\/erv.2876","article-title":"The Effects of Probiotics Administration on the Gut Microbiome in Adolescents with Anorexia Nervosa\u2014A Study Protocol for a Longitudinal, Double-Blind, Randomized, Placebo-Controlled Trial","volume":"30","author":"Zeiler","year":"2022","journal-title":"Eur. Eat. Disord. Rev."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1417","DOI":"10.3390\/nu5041417","article-title":"Fiber and Prebiotics: Mechanisms and Health Benefits","volume":"5","author":"Slavin","year":"2013","journal-title":"Nutrients"},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Ioni\u021b\u0103-M\u00eendrican, C.-B., Ziani, K., Mititelu, M., Oprea, E., Neac\u0219u, S.M., Moro\u0219an, E., Dumitrescu, D.-E., Ro\u0219ca, A.C., Dr\u0103g\u0103nescu, D., and Negrei, C. (2022). Therapeutic Benefits and Dietary Restrictions of Fiber Intake: A State of the Art Review. Nutrients, 14.","DOI":"10.3390\/nu14132641"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.1093\/ajcn\/nqac178","article-title":"Associations of Dietary Diversity with the Gut Microbiome, Fecal Metabolites, and Host Metabolism: Results from 2 Prospective Chinese Cohorts","volume":"116","author":"Xiao","year":"2022","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Ozdal, T., Sela, D.A., Xiao, J., Boyacioglu, D., Chen, F., and Capanoglu, E. (2016). The Reciprocal Interactions between Polyphenols and Gut Microbiota and Effects on Bioaccessibility. Nutrients, 8.","DOI":"10.3390\/nu8020078"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"104169","DOI":"10.1016\/j.jff.2020.104169","article-title":"Prebiotic Effect of Dietary Polyphenols: A Systematic Review","volume":"74","author":"Sugizaki","year":"2020","journal-title":"J. Funct. Foods"},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1002\/eat.20922","article-title":"Dietary Energy Density and Diet Variety as Risk Factors for Relapse in Anorexia Nervosa: A Replication","volume":"45","author":"Schebendach","year":"2012","journal-title":"Int. J. Eat. Disord."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"1571","DOI":"10.1038\/nn.4136","article-title":"Neural Mechanisms Supporting Maladaptive Food Choices in Anorexia Nervosa","volume":"18","author":"Foerde","year":"2015","journal-title":"Nat. Neurosci."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1017\/S0033291723002933","article-title":"Change in Food Choice during Acute Treatment and the Effect on Longer-Term Outcome in Patients with Anorexia Nervosa","volume":"54","author":"Steinglass","year":"2024","journal-title":"Psychol. Med."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1176\/appi.ajp.23180001","article-title":"The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders","volume":"180","author":"Crone","year":"2023","journal-title":"Am. J. Psychiatry"},{"key":"ref_103","unstructured":"Royal College of Psychiatrists (2022). Medical Emergencies in Eating Disorders: Guidance on Recognition and Management, Royal College of Psychiatrists. College Report."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1186\/s40337-022-00731-6","article-title":"Assessment and Management of Disorders of Gut-Brain Interaction in Patients with Eating Disorders","volume":"11","author":"Atkins","year":"2023","journal-title":"J. Eat. Disord."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1053\/j.gastro.2021.09.015","article-title":"A Rome Working Team Report on Brain-Gut Behavior Therapies for Disorders of Gut-Brain Interaction","volume":"162","author":"Keefer","year":"2022","journal-title":"Gastroenterology"}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/18\/3054\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T12:55:03Z","timestamp":1789995303000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/18\/3054"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,18]]},"references-count":105,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["nu18183054"],"URL":"https:\/\/doi.org\/10.3390\/nu18183054","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,18]]}}}