Department of Psychology, George Mason University, Fairfax, Virginia.
Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston.
JAMA Psychiatry. 2019 Aug 1;76(8):800-809. doi: 10.1001/jamapsychiatry.2019.0297.
Infections are recognized as playing a critical role in the risk of psychiatric disorders and suicidal behavior; however, few studies have evaluated the risk of eating disorders.
To evaluate the association of hospitalization for infections and treatment with anti-infective agents with the risk of an eating disorder diagnosis.
DESIGN, SETTING, AND PARTICIPANTS: A nationwide, population-based, prospective cohort study of 525 643 girls born from January 1, 1989, to December 31, 2006, and followed up until December 31, 2012, was conducted using individual-level data drawn from Danish longitudinal registers. Data were analyzed from January 15 to June 15, 2018, using survival analysis models and adjusted for age, calendar period, parental educational level, and parental history of psychiatric illness.
Hospital admission for infections and prescribed anti-infective agents for infections.
The main outcome of interest was diagnosis of an eating disorder (anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified) in a hospital, outpatient clinic, or emergency department setting. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) and accompanying 95% CIs.
The study population consisted of 525 643 adolescent girls: 2131 received a diagnosis of anorexia nervosa (median [range] age, 15.2 [8.6-21.3] years), 711 received a diagnosis of bulimia nervosa (median [range] age, 17.9 [13.4-22.7] years), and 1398 received a diagnosis of an eating disorder not otherwise specified (median [range] age, 15.6 [8.6-21.6] years). A total of 525 643 adolescent girls were followed up for 4 601 720.4 person-years until a mean age of 16.2 years (range, 10.5-22.7 years). Severe infections that required hospitalization were associated with an increased risk of a subsequent diagnosis of anorexia nervosa by 22% (HR, 1.22; 95% CI, 1.10-1.35), bulimia nervosa by 35% (HR, 1.35; 95% CI, 1.13-1.60), and eating disorder not otherwise specified by 39% (HR, 1.39; 95% CI, 1.23-1.57) compared with adolescent girls without hospitalizations for infections. Infections treated with anti-infective agents were associated with an increased risk of a subsequent diagnosis of anorexia nervosa by 23% (HR, 1.23; 95% CI, 1.10-1.37), bulimia nervosa by 63% (HR, 1.63; 95% CI, 1.32-2.02), and eating disorder not otherwise specified by 45% (HR, 1.45; 95% CI, 1.25-1.67) compared with adolescent girls without infections treated with anti-infective agents.
The findings suggest that hospital-treated infections and less severe infections treated with anti-infective agents are associated with increased risk of subsequent anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified and that future studies should investigate whether these associations are causal and identify the exact mechanisms between infections and subsequent inflammatory processes with eating disorders.
重要性：感染被认为在精神障碍和自杀行为的风险中起着关键作用；然而，很少有研究评估饮食失调的风险。
目的：评估因感染住院和使用抗感染药物治疗与饮食失调诊断风险之间的关联。
设计、地点和参与者：这是一项全国性、基于人群的前瞻性队列研究，纳入了 1989 年 1 月 1 日至 2006 年 12 月 31 日期间出生的 525643 名女孩，并随访至 2012 年 12 月 31 日，使用来自丹麦纵向登记处的个人水平数据进行分析。数据分析于 2018 年 1 月 15 日至 6 月 15 日进行，采用生存分析模型，并根据年龄、日历期、父母教育水平和父母精神病史进行调整。
暴露：因感染住院和因感染开具的抗感染药物。
主要结果和措施：主要结局是在医院、门诊或急诊环境下诊断为饮食失调（神经性厌食症、神经性贪食症或未特指的饮食失调）。采用 Cox 比例风险回归模型估计风险比（HR）和伴随的 95%置信区间（CI）。
结果：研究人群包括 525643 名青春期女孩：2131 人被诊断为神经性厌食症（中位数[范围]年龄，15.2[8.6-21.3]岁），711 人被诊断为神经性贪食症（中位数[范围]年龄，17.9[13.4-22.7]岁），1398 人被诊断为未特指的饮食失调（中位数[范围]年龄，15.6[8.6-21.6]岁）。共有 525643 名青春期女孩接受了 4601720.4 人年的随访，平均年龄为 16.2 岁（范围，10.5-22.7 岁）。需要住院治疗的严重感染与随后诊断为神经性厌食症的风险增加 22%（HR，1.22；95%CI，1.10-1.35）、神经性贪食症增加 35%（HR，1.35；95%CI，1.13-1.60）和未特指的饮食失调增加 39%（HR，1.39；95%CI，1.23-1.57）相关，与无感染住院的青春期女孩相比。用抗感染药物治疗的感染与随后诊断为神经性厌食症的风险增加 23%（HR，1.23；95%CI，1.10-1.37）、神经性贪食症增加 63%（HR，1.63；95%CI，1.32-2.02）和未特指的饮食失调增加 45%（HR，1.45；95%CI，1.25-1.67）相关，与无感染且未用抗感染药物治疗的青春期女孩相比。
结论和相关性：研究结果表明，医院治疗的感染和用抗感染药物治疗的较轻感染与随后发生神经性厌食症、神经性贪食症和未特指的饮食失调的风险增加相关，未来的研究应调查这些关联是否具有因果关系，并确定感染与随后的炎症过程之间的具体机制与饮食失调。
