There is a positive association between hospital-treated infections and risk for subsequent diagnosis of an eating disorder, according to study results published in JAMA Psychiatry.
Investigators conducted a nationwide, population-based, prospective cohort study of 525,643 girls born between January 1, 1989, and December 31, 2006, using data abstracted from Danish longitudinal registers. Participants were followed until December 31, 2012. The Danish National Patient Register was used to identify exposures of interest, including hospital admission for infections and prescribed anti-infective agents for infection. The outcomes of interest were diagnoses registered in the Danish Psychiatric Central Research Register or the Danish National Patient Register of anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) for eating disorders following each exposure.
Among the cohort, 2131 participants 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). Individuals were followed-up until a mean age of 16.2 years (range, 10.5-22.7 years) for a total of 4,601,720.4 person-years of follow-up.
Severe infections that required hospitalization were associated with an increased risk for subsequent diagnosis of anorexia nervosa (HR, 1.22; 95% CI, 1.10-1.35), bulimia nervosa (HR, 1.35; 95% CI, 1.13-1.60), and eating disorder not otherwise specified (HR, 1.39; 95% CI, 1.23-1.57) compared with girls who were not hospitalized for infections. Infections treated with anti-infective agents were also associated with significantly increased risk for diagnosis of anorexia nervosa (HR, 1.23; 95% CI, 1.10-1.37), bulimia nervosa (HR, 1.63; 95% CI, 1.32-2.02), and eating disorder not otherwise specified (HR, 1.45; 95%CI, 1.25-1.67) compared with adolescent girls without infections treated with anti-infective agents.
These data show that hospital-treated infections and infections treated with anti-infective agents may be associated with an increased risk for subsequent diagnosis of an eating disorder. Further research is necessary to determine whether the association is causal and to examine the role of infection-associated inflammation in eating disorder pathology.
Breithaupt L, Köhler-Forsberg O, Larsen JT, et al. Association of exposure to infections in childhood with risk of eating disorders in adolescent girls [published online April 24, 2019]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2019.0297