Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; SCIENCES lab, Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada; Ottawa Hospital Research Institute Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada; Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany.
Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
Lancet Psychiatry. 2024 Oct;11(10):818-827. doi: 10.1016/S2215-0366(24)00244-X.
Individuals with eating disorders are at a higher risk of electrolyte abnormalities than the general population. We conducted the first representative cohort study assessing whether electrolyte abnormalities in people with eating disorders were associated with mortality and physical health outcomes.
This was a retrospective population-based cohort study in Ontario including people aged 13 years or older with an eating disorder and an outpatient electrolyte measure within 1 year (between Jan 1, 2008 and June 30, 2019). An electrolyte abnormality was any of hypokalaemia, hyperkalaemia, hyponatraemia, hypernatraemia, hypomagnesaemia, hypophosphataemia, metabolic acidosis, or metabolic alkalosis. The primary outcome was all-cause mortality. Secondary outcomes were hospitalisation, a cardiac event, infection, acute or chronic kidney disease, fracture, and bowel obstruction. In additional analyses, we examined a younger cohort (<25 years old) and individuals with no previously diagnosed secondary outcome. We involved people with related lived or family experience in the study.
6163 patients with an eating disorder and an electrolyte measure within 1 year since diagnosis (mean age 26·8 years [SD 17·5]; 5456 [88·5%] female, 707 [11·5%] male; median follow-up 6·4 years [IQR 4-9]) were included. Ethnicity data were not available. The most common electrolyte abnormalities were hypokalaemia (994/1987 [50·0%]), hyponatraemia (752/1987 [37·8%]), and hypernatraemia (420/1987 [21·1%]). Overall, mortality occurred in 311/1987 (15·7%) of those with an electrolyte abnormality versus 234/4176 (5·6%) in those without (absolute risk difference 10·1%; adjusted hazard ratio 1·23 [95% CI 1·03-1·48]). Hospitalisation (1202/1987 [60·5%] vs 1979/4176 [47·4%]; 1·35 [1·25-1·46]), acute kidney injury (206/1987 [10·4%] vs 124/4176 [3%]; 1·91 [1·50-2·43]), chronic kidney disease (245/1987 [12·3%] vs 181/4176 [4·3%]; 1·44 [1·17-1·77]), bone fracture (140/1987 [7·0%] vs 167/4176 [4·0%]; 1·40 [1·10-1·78]), and bowel obstruction (72/1987 [3·6%] vs 57/4176 [1·4%]; 1·62 [1·12-2·35]) were associated with an electrolyte abnormality, but not infection or a cardiovascular event. Findings were consistent in young individuals (<25 years old) and those without secondary outcomes at baseline, by eating disorder type, and by sex.
Electrolyte abnormalities are associated with death and poor physical health outcomes, supporting the importance of monitoring and possible interventions to prevent adverse outcomes. Findings also call for a refinement of the definition of severity of eating disorder and replication of these findings in other jurisdictions.
None.
与普通人群相比，患有饮食失调症的个体发生电解质异常的风险更高。我们进行了第一项代表性队列研究，以评估饮食失调症患者的电解质异常是否与死亡率和身体健康结果相关。
这是一项在安大略省进行的基于人群的回顾性队列研究，纳入了 13 岁及以上患有饮食失调症且在 1 年内（2008 年 1 月 1 日至 2019 年 6 月 30 日）进行过门诊电解质检测的患者。电解质异常是指低钾血症、高钾血症、低钠血症、高钠血症、低镁血症、低磷血症、代谢性酸中毒或代谢性碱中毒中的任何一种。主要结局是全因死亡率。次要结局是住院、心脏事件、感染、急性或慢性肾脏病、骨折和肠梗阻。在附加分析中，我们检查了更年轻的队列（<25 岁）和没有先前诊断的次要结局的个体。我们邀请了与研究相关的有过生活或家庭经历的人参与。
在诊断后 1 年内（平均年龄 26.8 岁[标准差 17.5]；5456 名[88.5%]女性，707 名[11.5%]男性；中位数随访时间 6.4 年[IQR 4-9]）纳入了 6163 名患有饮食失调症且进行了电解质检测的患者。种族数据不可用。最常见的电解质异常是低钾血症（994/1987[50.0%]）、低钠血症（752/1987[37.8%]）和高钠血症（420/1987[21.1%]）。总的来说，在有电解质异常的患者中，311/1987（15.7%）发生了死亡，而在无电解质异常的患者中，234/4176（5.6%）发生了死亡（绝对风险差异 10.1%；调整后的危险比 1.23[95%CI 1.03-1.48]）。住院（1202/1987[60.5%] vs. 1979/4176[47.4%]；1.35[1.25-1.46]）、急性肾损伤（206/1987[10.4%] vs. 124/4176[3%]；1.91[1.50-2.43]）、慢性肾脏病（245/1987[12.3%] vs. 181/4176[4.3%]；1.44[1.17-1.77]）、骨折（140/1987[7.0%] vs. 167/4176[4.0%]；1.40[1.10-1.78]）和肠梗阻（72/1987[3.6%] vs. 57/4176[1.4%]；1.62[1.12-2.35]）与电解质异常相关，但与感染或心血管事件无关。在年轻个体（<25 岁）和基线时无次要结局的个体，以及按饮食失调症类型和性别进行分层分析时，研究结果均一致。
电解质异常与死亡和身体健康不良结果相关，支持了监测和可能进行干预以预防不良结局的重要性。研究结果还呼吁对饮食失调症严重程度的定义进行细化，并在其他司法管辖区复制这些发现。
无。
