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Bidirectional relationship between eating disorders and autoimmune diseases
Author(s) -
Hedman Anna,
Breithaupt Lauren,
Hübel Christopher,
Thornton Laura M.,
Tillander Annika,
Norring Claes,
Birgegård Andreas,
Larsson Henrik,
Ludvigsson Jonas F.,
Sävendahl Lars,
Almqvist Catarina,
Bulik Cynthia M.
Publication year - 2019
Publication title -
journal of child psychology and psychiatry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.652
H-Index - 211
eISSN - 1469-7610
pISSN - 0021-9630
DOI - 10.1111/jcpp.12958
Subject(s) - medicine , psoriasis , autoimmune disease , disease , anorexia nervosa , immune dysregulation , eating disorders , population , proportional hazards model , inflammatory bowel disease , immunology , psychiatry , environmental health
Background Immune system dysfunction may be associated with eating disorders ( ED ) and could have implications for detection, risk assessment, and treatment of both autoimmune diseases and ED s. However, questions regarding the nature of the relationship between these two disease entities remain. We evaluated the strength of associations for the bidirectional relationships between ED s and autoimmune diseases. Methods In this nationwide population‐based study, Swedish registers were linked to establish a cohort of more than 2.5 million individuals born in Sweden between January 1, 1979 and December 31, 2005 and followed up until December 2013. Cox proportional hazard regression models were used to investigate: (a) subsequent risk of ED s in individuals with autoimmune diseases; and (b) subsequent risk of autoimmune diseases in individuals with ED s. Results We observed a strong, bidirectional relationship between the two illness classes indicating that diagnosis in one illness class increased the risk of the other. In women, the diagnoses of autoimmune disease increased subsequent hazards of anorexia nervosa ( AN ), bulimia nervosa ( BN ), and other eating disorders ( OED ). Similarly, AN , BN , and OED increased subsequent hazards of autoimmune diseases.Gastrointestinal‐related autoimmune diseases such as, celiac disease and Crohn's disease showed a bidirectional relationship with AN and OED . Psoriasis showed a bidirectional relationship with OED . The previous occurence of type 1 diabetes increased the risk for AN , BN , and OED . In men, we did not observe a bidirectional pattern, but prior autoimmune arthritis increased the risk for OED . Conclusions The interactions between ED s and autoimmune diseases support the previously reported associations. The bidirectional risk pattern observed in women suggests either a shared mechanism or a third mediating variable contributing to the association of these illnesses.