Immune-Mediated GI Disease May Up Eating Disorder Risk

TOPLINE:

Patients with immune-mediated gastrointestinal (GI) disease — including Crohn’s disease, ulcerative colitis, and celiac disease — have a higher incidence of eating disorders, especially pediatric patients with ulcerative colitis, than the general population, according to the results of a retrospective study.

METHODOLOGY:

• Researchers used health administrative data from the province of Ontario, Canada, to assess the association between immune-mediated GI disease and the subsequent development of an eating disorder in this matched cohort study.
• The study included 83,920 individuals with a prevalent or incident diagnosis of immune-mediated GI disease between July 1, 2002, and December 31, 2020, who did not have any preexisting eating disorder; these patients were matched with 167,776 control individuals from the general population.
• A majority of the patients with immune-mediated GI disease had Crohn’s disease (40%) or ulcerative colitis (39%), followed by celiac disease (17%).
• Eating disorder diagnoses were identified through hospitalizations or emergency department visits.
• Over a median follow-up duration of around 13 years, eating disorders were identified in 161 patients with immune-mediated GI disease and 160 individuals from the general population.
• Individuals with GI disease reported nearly double the incidence of eating disorders than the control cohort, with an overall incidence rate ratio (IRR) of 1.99 (P < .001) and adjusted hazard ratio (HR) of 1.98 (P < .001).
• The incidence rate of eating disorders was more than double in the pediatric cohort with immune-mediated GI disease than in the general population (IRR, 2.65; P < .001) and higher than in the adult population with GI disease (IRR, 1.56; P = .041).
• The IRR and HR were 3.95 (P = .003) and 4.11 (P = .003), respectively, for pediatric patients with ulcerative colitis, the highest out of all the cohorts.

TAKEAWAY:

• Over a median follow-up duration of around 13 years, eating disorders were identified in 161 patients with immune-mediated GI disease and 160 individuals from the general population.
• Individuals with GI disease reported nearly double the incidence of eating disorders than the control cohort, with an overall incidence rate ratio (IRR) of 1.99 (P < .001) and adjusted hazard ratio (HR) of 1.98 (P < .001).
• The incidence rate of eating disorders was more than double in the pediatric cohort with immune-mediated GI disease than in the general population (IRR, 2.65; P < .001) and higher than in the adult population with GI disease (IRR, 1.56; P = .041).
• The IRR and HR were 3.95 (P = .003) and 4.11 (P = .003), respectively, for pediatric patients with ulcerative colitis, the highest out of all the cohorts.

IN PRACTICE:

“IBD [inflammatory bowel disease] and celiac disease are associated with the development of eating disorders,” the authors wrote. “This risk is particularly pronounced for pediatric patients, supporting the need to develop clinical strategies for detecting eating disorders in this high-risk population.”

SOURCE:

The study, led by Lakshmimathy Subramanian, MD, from the Department of Pediatrics, Queen’s University, Kingston, Ontario, Canada, was published online in Clinical and Translational Gastroenterology.

LIMITATIONS:

The diagnostic and procedural codes used to identify celiac disease and eating disorders were not validated. Eating disorders might have been underreported, as only diagnoses made in a hospital setting were included. The effects of ethnicity or race on the association between GI disease and eating disorders could not be analyzed.

DISCLOSURES:

This study was supported by the Southeastern Ontario Academic Medical Organization Innovation Fund. The authors declared no conflicts of interest.