biological associations of autoimmune and autoinflammatory disease with eating disorders are “becoming increasingly clear,” the researchers note in their article

Ties Between Immune Dysfunction, Eating Disorders 'Increasingly Clear'

 Megan Brooks

NEW YORK (Reuters Health) - A large Danish study of children and adolescents finds that autoimmune and autoinflammatory disorders raise the risk for development of an eating disorder, and having an eating disorder raises the risk of subsequent autoimmune disease.

“Understanding the role of immune system disturbance for the etiology and pathogenesis of eating disorders could point toward novel treatment targets,” write Dr. Cynthia Bulik from University of North Carolina at Chapel Hill and colleagues in a November 9 online article in Pediatrics.

Their study included 930,977 children and adolescents (49% girls) born in Denmark between 1989 and 2006, with follow-up through 2012. An autoimmune or autoinflammatory disease was diagnosed in 25,984 children (54% girls), a subgroup that had significantly higher risks for eating disorders: 36% higher for anorexia nervosa (AN), 73% for bulimia nervosa (BN), 72% for eating disorder not otherwise specified (EDNOS) and 50% for any eating disorder.

Autoimmune diseases with gastrointestinal involvement were associated with a 74% higher risk of AN and a 148% higher risk of EDNOS, while autoinflammatory diseases raised the risk of EDNOS by 179%.

AN and EDNOS also were significantly associated with subsequent development of an autoimmune or autoinflammatory disease.

In addition, adolescents who had a parent diagnosed with an autoimmune or autoinflammatory disease had higher odds of developing an eating disorder: 13% higher for AN, 29% higher for BN, 27% higher for EDNOS and 19% higher for any eating disorder, the researchers report.

The authors note that unmeasured environmental mediators might explain the observed associations, such as shared environmental exposures like nutrition and smoking exposure, or increased stress levels in the family.

“Importantly,” Dr. Bulik commented in email to Reuters Health, for all disorders “it is important for clinicians to take a careful history of childhood adversities. The results suggest that it is especially important to address these issues in individuals with bulimia nervosa and EDNOS (now renamed as 'other specific feeding and eating disorder' or OSFED) in the new DSM-5). For some individuals, it may be important to include treatment goals related to the adverse events in order to achieve recovery,” Dr. Bulik said.

The biological associations of autoimmune and autoinflammatory disease with eating disorders are “becoming increasingly clear,” the researchers note in their article. “Our findings support compelling lines of evidence from researchers suggesting that immune system disturbance is both comorbid with psychiatric disorders and can increase risk for illness. Research into immune system dysfunction represents a novel lens to examine risks for eating disorders and could inform new treatments.”