Section of Eating Disorders, Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, 103 Denmark Hill, SE5 8AZ, UK; Institute of Child Health, University College London, Gower Street, London WC1E 6BT, UK.
Institute of Child Health, University College London, Gower Street, London WC1E 6BT, UK; Health and Life Sciences, De Montfort University, Leicester LE1 9BH3, UK.
J Psychosom Res. 2019 Jan;116:115-122. doi: 10.1016/j.jpsychores.2018.12.005. Epub 2018 Dec 17.
Although Eating Disorders (ED) are known to affect bone health and development, little is known about the longitudinal effect of ED and ED behaviours on bone health in community dwelling adult women. Women (n = 3507) enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC) participated in a two-phase prevalence study to assess lifetime ED and ED behaviours (fasting, restrictive eating, vomiting and misuse of medication). Crude and adjusted linear regression methods investigated the association between ED diagnoses and behaviours, and total body, hip, leg and arm bone mineral density (BMD) DXA scans at mean ages of 48 and 52 years. Lifetime occurrence of Anorexia Nervosa (AN) was associated with lower BMD Z-scores for the whole body (mean difference (MD) = -0.28; 95% CI: -0.49, -0.05), hip (MD = -0.45; 95% CI -0.74, -0.16), leg (MD = -0.28; 95% CI -0.52, -0.03) and arm (MD = -0.44; 95% CI -0.68, -0.19) compared to no ED. This effect was mostly accounted for by lowest ever BMI. In post-hoc analyses, Restrictive AN, but not Binge-Purge AN was associated with a lower total body BMD Z-scores (MD = -0.37; 95% CI -0.62, -0.12). Lifetime Fasting and Restrictive Eating were associated with low BMD of the total body, hip, arm and leg in adjusted analyses, all p < 0.05. Both lifetime ED diagnoses and ED behaviours in a large community sample were predictive of low BMD in mid-life. This study confirms that the effects of AN, fasting and restrictive eating, and low BMI on bone health seen in clinical samples also occur in community samples.
尽管人们知道饮食失调（ED）会影响骨骼健康和发育，但对于社区居住的成年女性中 ED 及其行为对骨骼健康的纵向影响知之甚少。参加阿冯纵向父母与子女研究（ALSPAC）的女性（n=3507）参加了一项两阶段流行性病学研究，以评估终生 ED 和 ED 行为（禁食、限制饮食、呕吐和滥用药物）。采用粗线性回归和调整线性回归方法，研究 ED 诊断和行为与全身、臀部、腿部和手臂骨密度（DXA）扫描之间的关系，平均年龄分别为 48 岁和 52 岁。终生发生神经性厌食症（AN）与全身（平均差异（MD）= -0.28；95%CI：-0.49，-0.05）、臀部（MD = -0.45；95%CI -0.74，-0.16）、腿部（MD = -0.28；95%CI -0.52，-0.03）和手臂（MD = -0.44；95%CI -0.68，-0.19）的 BMD Z 评分较低有关。这种影响主要归因于最低体重指数。在事后分析中，限制型 AN，而不是暴食-清肠型 AN，与全身 BMD Z 评分较低有关（MD = -0.37；95%CI -0.62，-0.12）。在调整后的分析中，终生禁食和限制进食与全身、臀部、手臂和腿部的低骨密度有关，所有 p 值均<0.05。在大型社区样本中，终生 ED 诊断和 ED 行为均能预测中年时期的低骨密度。这项研究证实，临床样本中观察到的 AN、禁食和限制饮食以及低 BMI 对骨骼健康的影响也存在于社区样本中。
