Søeby Mette, Clausen Loa, Richelsen Bjørn, Gribsholt Sigrid Bjerge
Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark.
Int J Eat Disord. 2025 Mar;58(3):624-634. doi: 10.1002/eat.24340. Epub 2025 Jan 6.
OBJECTIVE: This study investigates the overall pattern and timing of medical diagnoses up to 10 years before an anorexia nervosa (AN) diagnosis and explores differences before and after AN diagnosis aiming to improve early detection. METHOD: In this nationwide population-based cohort study, we included all patients diagnosed with incident AN from 1987 to 2018 (n = 13,345) and a 1:10 age- and sex-matched general population comparison cohort, using Danish health registries. Using conditional logistic regression, we calculated odds ratios (ORs) of medical diagnoses up to 10 years before AN diagnosis. Additionally, we calculated crude and adjusted hazard ratios (aHRs) for risk of medical diagnoses after AN diagnosis using Cox proportional hazards model. RESULTS: AN was associated with increased odds of any medical diagnosis up to 10 years before AN diagnosis: OR 1.3 [95% CI 1.2-1.3] and the odds increased during the 12 months preceding AN diagnosis: OR 1.6 [95% CI 1.5-1.7]. The medical diagnoses associated with the highest odds up to 10 years prior AN were malnutrition: OR 5.0 [95% CI 4.0-6.3] anemia: OR 2.9 [95% CI 2.3-3.6], amenorrhea: OR 2.7 [95% CI 2.3-3.2], and irritable bowel syndrome: OR 2.1 [95% CI 1.9-2.4]. The pre-diagnosis pattern mirrored the post-diagnosis pattern. CONCLUSION: The similarity in diagnosis patterns before and after AN diagnosis suggests that many patients receive medical diagnoses for conditions potentially linked to AN-related restricted eating, malnutrition and progressive weight loss even years prior to a formal AN diagnosis. Identifying these early conditions may enable earlier AN diagnosis and improve treatment outcomes.
目的:本研究调查神经性厌食症(AN)诊断前长达10年的医学诊断总体模式和时间,并探讨AN诊断前后的差异,旨在改善早期检测。 方法:在这项基于全国人群的队列研究中,我们使用丹麦健康登记系统,纳入了1987年至2018年期间所有确诊为新发AN的患者(n = 13345)以及按年龄和性别1:10匹配的普通人群对照队列。使用条件逻辑回归,我们计算了AN诊断前长达10年的医学诊断比值比(OR)。此外,我们使用Cox比例风险模型计算了AN诊断后医学诊断风险的粗风险比和调整后风险比(aHR)。 结果:AN与AN诊断前长达10年的任何医学诊断几率增加相关:OR为1.3 [95% CI 1.2 - 1.3],且在AN诊断前的12个月内几率增加:OR为1.6 [95% CI 1.5 - 1.7]。在AN诊断前长达10年与最高几率相关的医学诊断为营养不良:OR为5.0 [95% CI 4.0 - 6.3]、贫血:OR为2.9 [95% CI 2.3 - 3.6]、闭经:OR为2.7 [95% CI 2.3 - 3.2]以及肠易激综合征:OR为2.1 [95% CI 1.9 - 2.4]。诊断前模式与诊断后模式相似。 结论:AN诊断前后诊断模式的相似性表明,许多患者甚至在正式AN诊断前数年就因可能与AN相关的饮食限制、营养不良和体重逐渐减轻有关的状况而接受医学诊断。识别这些早期状况可能有助于更早地诊断AN并改善治疗结果。
J Eat Disord. 2023-2-15
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