Mortality Rates in Patients With Anorexia Nervosa and Other Eating Disorders A Meta-analysis of 36 Studies

Loughborough University Centre for Research into Eating Disorders, Loughborough University England.
Archives of general psychiatry (Impact Factor: 14.48). 07/2011; 68(7):724-31. DOI: 10.1001/archgenpsychiatry.2011.74
Source: PubMed


Morbidity and mortality rates in patients with eating disorders are thought to be high, but exact rates remain to be clarified.
To systematically compile and analyze the mortality rates in individuals with anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS).
A systematic literature search, appraisal, and meta-analysis were conducted of the MEDLINE/PubMed, PsycINFO, and Embase databases and 4 full-text collections (ie, ScienceDirect, Ingenta Select, Ovid, and Wiley-Blackwell Interscience).
English-language, peer-reviewed articles published between January 1, 1966, and September 30, 2010, that reported mortality rates in patients with eating disorders.
Primary data were extracted as raw numbers or confidence intervals and corrected for years of observation and sample size (ie, person-years of observation). Weighted proportion meta-analysis was used to adjust for study size using the DerSimonian-Laird model to allow for heterogeneity inclusion in the analysis.
From 143 potentially relevant articles, we found 36 quantitative studies with sufficient data for extraction. The studies reported outcomes of AN during 166 642 person-years, BN during 32 798 person-years, and EDNOS during 22 644 person-years. The weighted mortality rates (ie, deaths per 1000 person-years) were 5.1 for AN, 1.7 for BN, and 3.3 for EDNOS. The standardized mortality ratios were 5.86 for AN, 1.93 for BN, and 1.92 for EDNOS. One in 5 individuals with AN who died had committed suicide.
Individuals with eating disorders have significantly elevated mortality rates, with the highest rates occurring in those with AN. The mortality rates for BN and EDNOS are similar. The study found age at assessment to be a significant predictor of mortality for patients with AN. Further research is needed to identify predictors of mortality in patients with BN and EDNOS.

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    • "Anorexia nervosa (AN) and bulimia nervosa (BN) are severe mental disorders with high mortality rates (Arcelus et al. 2011; Smink et al. 2013). The etiology is still largely unknown (Treasure et al. 2010; Walsh, 2013). "
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    ABSTRACT: Background: Whether the incidence of eating disorders in Western, industrialized countries has changed over time has been the subject of much debate. The purpose of this primary-care study was to examine changes in the incidence of eating disorders in The Netherlands during the 1980s, 1990s and 2000s. Method: A nationwide network of general practitioners (GPs), serving a representative sample (~1%) of the total Dutch population, recorded newly diagnosed patients with anorexia nervosa (AN) and bulimia nervosa (BN) in their practice during 1985-1989, 1995-1999, and 2005-2009. GPs are key players in the Dutch healthcare system, as their written referral is mandatory in order to get access to specialized (mental) healthcare, covered by health insurance. Health insurance is virtually universal in The Netherlands (99% of the population). A substantial number of GPs participated in all three study periods, during which the same case identification criteria were used and the same psychiatrist was responsible for making the final diagnoses. Incidence rates were calculated and for comparison between periods, incidence rate ratios. Results: The overall incidence rate of BN decreased significantly in the past three decades (from 8.6 per 100 000 person-years in 1985-1989 to 6.1 in 1995-1999, and 3.2 in 2005-2009). The overall incidence of AN remained fairly stable during three decades, i.e. 7.4 per 1 00 000 person-years in 1985-1989, 7.8 in 1995-1999, and 6.0 in 2005-2009. Conclusions: The incidence rate of BN decreased significantly over the past three decades, while the overall incidence rate of AN remained stable.
    Full-text · Article · Dec 2015 · Psychological Medicine
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    • "Common comorbid psychiatric disorders include major depression disorder and anxiety disorders56789. Among all psychiatric disorders, AN has one of the highest mortality rates10111213141516. However, interventions for AN have shown limited success and the hospitalization for weight regain is time consuming and expensive171819. "
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    ABSTRACT: Background Anorexia nervosa (AN) is a complex psychiatric disease with a moderate to strong genetic contribution. In addition to conventional genome wide association (GWA) studies, researchers have been using machine learning methods in conjunction with genomic data to predict risk of diseases in which genetics play an important role. Methods In this study, we collected whole genome genotyping data on 3940 AN cases and 9266 controls from the Genetic Consortium for Anorexia Nervosa (GCAN), the Wellcome Trust Case Control Consortium 3 (WTCCC3), Price Foundation Collaborative Group and the Children’s Hospital of Philadelphia (CHOP), and applied machine learning methods for predicting AN disease risk. The prediction performance is measured by area under the receiver operating characteristic curve (AUC), indicating how well the model distinguishes cases from unaffected control subjects. Results Logistic regression model with the lasso penalty technique generated an AUC of 0.693, while Support Vector Machines and Gradient Boosted Trees reached AUC’s of 0.691 and 0.623, respectively. Using different sample sizes, our results suggest that larger datasets are required to optimize the machine learning models and achieve higher AUC values. Conclusions To our knowledge, this is the first attempt to assess AN risk based on genome wide genotype level data. Future integration of genomic, environmental and family-based information is likely to improve the AN risk evaluation process, eventually benefitting AN patients and families in the clinical setting.
    Preview · Article · Dec 2015 · BMC Medical Genomics
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    • "Genetic studies have indicated high heritability rates, however thus far the search for the genes implicated in the development of AN has yielded disappointing results (Bulik et al., 2006). AN has one of the highest morbidity rates amongst psychiatric conditions, due to physical complications as well as high suicide rates (Arcelus et al., 2011), however despite this there is currently no recommended first-line treatment for adults with AN (NICE, 2004), and although family-based treatments are recommended for children and adolescents, there are still a significantly high number of non-responders to this treatment (Agras et al., 2004). "

    Full-text · Dataset · Nov 2015
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