ORCID Profile
0000-0001-7772-3264
Current Organisations
University of North Carolina at Chapel Hill
,
Karolinska Institutet
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Publisher: Wiley
Date: 29-11-2022
DOI: 10.1002/EAT.23858
Abstract: To compare in iduals who have experienced binge‐eating disorder (BED) and anorexia nervosa (AN) (BED AN+) to those who have experienced BED and not AN (BED AN–). Participants ( N = 898) met criteria for lifetime BED and reported current binge eating. Approximately 14% had a lifetime diagnosis of AN. Analyses compared BED AN+ and BED AN– on sociodemographic variables and clinical history. The presence of lifetime AN was associated with more severe eating disorder symptoms, including earlier onset, more frequent, more chronic, and more types of eating disorder behaviors over the lifetime, as well as a higher lifetime prevalence of bulimia nervosa ( BN ). Participants with lifetime AN reported being more likely to have received treatments for BED or BN , had significantly lower minimum, current, and maximum BMIs , had more severe general anxiety, and were significantly more likely to be younger and female. In the full s le, the lifetime prevalence of unhealthy weight control behaviors was high and treatment utilization was low, despite an average 15‐year history since symptom onset. Gastrointestinal disorders and comorbid anxiety, depression, and attention‐deficit/hyperactivity disorder symptoms were prevalent. In iduals fared poorly on a wide array of domains, yet those with lifetime AN fared considerably more poorly. All patients with BED should be screened for mental health and gastrointestinal comorbidities and offered referral and treatment options. In iduals experiencing binge‐eating disorder have severe symptomology, but those who have experienced binge‐eating disorder and anorexia nervosa fare even more poorly. Our study emphasizes that patients with binge‐eating disorder would benefit from being screened for mental health and gastrointestinal comorbidities, and clinicians should consider history of unhealthy weight control behaviors to inform treatment and relapse prevention.
Publisher: SAGE Publications
Date: 05-04-2017
Abstract: Anorexia nervosa is a severe psychiatric disorder with high mortality rates. While its aetiology is poorly understood, there is evidence of a significant genetic component. The Anorexia Nervosa Genetics Initiative is an international collaboration which aims to understand the genetic basis of the disorder. This paper describes the recruitment and characteristics of the Australasian Anorexia Nervosa Genetics Initiative s le, the largest s le of in iduals with anorexia nervosa ever assembled across Australia and New Zealand. Participants completed an online questionnaire based on the Structured Clinical Interview Diagnostic and Statistical Manual of Mental Disorders (4th ed. DSM-IV) eating disorders section. Participants who met specified case criteria for lifetime anorexia nervosa were requested to provide a DNA s le for genetic analysis. Overall, the study recruited 3414 Australians and 543 New Zealanders meeting the lifetime anorexia nervosa case criteria by using a variety of conventional and social media recruitment methods. At the time of questionnaire completion, 28% had a body mass index ⩽ 18.5 kg/m 2 . Fasting and exercise were the most commonly employed methods of weight control, and were associated with the youngest reported ages of onset. At the time of the study, 32% of participants meeting lifetime anorexia nervosa case criteria were under the care of a medical practitioner those with current body mass index 18.5 kg/m 2 were more likely to be currently receiving medical care (56%) than those with current body mass index ⩾ 18.5 kg/m 2 (23%). Professional treatment for eating disorders was most likely to have been received from general practitioners (45% of study participants), dietitians (42%) and outpatient programmes (42%). This study was effective in assembling the largest community s le of people with lifetime anorexia nervosa in Australia and New Zealand to date. The proportion of people with anorexia nervosa currently receiving medical care, and the most common sources of treatment accessed, indicates the importance of training for general practitioners and dietitians in treating anorexia nervosa.
Publisher: Wiley
Date: 24-09-2010
DOI: 10.1002/EAT.20823
Abstract: To explore similarities and differences in clinical and personality variables across three groups: binge eating disorder (BED), bulimia nervosa-purging type (BN-P), and bulimia nervosa-non purging type (BN-NP). The participants were 102 female eating disorders patients (34 BED, 34 BN-P, and 34 BN-NP) consecutively admitted to the eating disorders unit, at the University Hospital of Bellvitge, and diagnosed according to DSM-IV criteria. BED patients were older, and more likely to have personal and family history of obesity. A gradient in psychopathological scores emerged with BN-P patients having higher pathological scores on the SCL-90-R, followed by BN-NP and BED patients. No statistically significant differences were observed in personality traits. Our data supported that eating disorders (namely BED, BN-NP, and BN-P) followed a linear trend in general psychopathology. Whereas personality may represent a shared vulnerability factor, differences in clinical severity suggest there to be a continuum with BN-P being the most severe and BED being the least severe.
Publisher: S. Karger AG
Date: 25-11-2016
DOI: 10.1159/000449025
Abstract: b i Objective: /i /b Although cognitive-behavioral therapy (CBT) represents the first-line evidence-based psychotherapy for bulimia nervosa (BN), most in iduals seeking treatment do not have access to this specialized intervention. We compared an Internet-based manualized version of CBT group therapy for BN conducted via a therapeutic chat group (CBT4BN) to the same treatment conducted via a traditional face-to-face group therapy (CBTF2F). b i Method: /i /b In a two-site, randomized, controlled noninferiority trial, we tested the hypothesis that CBT4BN would not be inferior to CBTF2F. A total of 179 adult patients with BN (2.6% males) received up to 16 sessions of group CBT over 20 weeks in either CBT4BN or CBTF2F, and outcomes were compared at the end of treatment and at the 12-month follow-up. b i Results: /i /b At the end of treatment, CBT4BN was inferior to CBTF2F in producing abstinence from binge eating and purging. However, by the 12-month follow-up, CBT4BN was mostly not inferior to CBTF2F. Participants in the CBT4BN condition, but not CBTF2F, continued to reduce their binge-eating and purging frequency from the end of treatment to the 12-month follow-up. b i Conclusions: /i /b CBT delivered online in a group chat format appears to be an efficacious treatment for BN, although the trajectory of recovery may be slower than face-to-face group therapy. Online chat groups may increase accessibility of treatment and represent a cost-effective approach to service delivery. However, barriers in service delivery such as state-specific license and ethical guidelines for online therapists need to be addressed.
Publisher: Elsevier BV
Date: 12-2015
Publisher: Wiley
Date: 12-11-2016
DOI: 10.1002/EAT.22644
Publisher: Cold Spring Harbor Laboratory
Date: 15-11-2022
DOI: 10.1101/2022.11.09.22281216
Abstract: The complement system, including complement components 3 and 4 (C3, C4), traditionally has been linked to innate immunity. More recently, complement components have also been implicated in brain development and the risk of schizophrenia. Based on a large, population-based case-cohort study, we measured the blood concentrations of C3 and C4 in 68,768 neonates. We found a strong correlation between the concentrations of C3 and C4 (phenotypic correlation = 0.65, P -value 1.0×10 −100 , genetic correlation = 0.38, P -value = 1.9×10 −35 ). A genome-wide association study (GWAS) for C4 protein concentration identified 36 independent loci, 30 of which were in or near the major histocompatibility complex on chromosome 6 (which includes the C4 gene), while six loci were found on six other chromosomes. A GWAS for C3 identified 15 independent loci, seven of which were located in the C3 gene on chromosome 19, and eight loci on five other chromosomes. We found no association between (a) measured neonatal C3 and C4 concentrations, imputed C4 haplotypes, or predicted C4 gene expression, with (b) schizophrenia (SCZ), bipolar disorder (BIP), depression (DEP), autism spectrum disorder, attention deficit hyperactivity disorder or anorexia nervosa diagnosed in later life. Mendelian randomisation (MR) suggested a small positive association between higher C4 protein concentration and an increased risk of SCZ, BIP, and DEP, but these findings did not persist in more stringent analyses. Evidence from MR supported causal relationships between C4 concentration and several autoimmune disorders: systemic lupus erythematosus (SLE, OR and 95% confidence interval, 0.37, 0.34 – 0.42) type-1 diabetes (T1D, 0.54, 0.50 - 0.58) multiple sclerosis (MS, 0.68, 0.63 - 0.74) rheumatoid arthritis (0.85, 0.80 - 0.91) and Crohn’s disease (1.26, 1.19 - 1.34). A phenome-wide association study (PheWAS) in UK Biobank confirmed that the genetic correlates of C4 concentration were associated a range of autoimmune disorders including coeliac disease, thyrotoxicosis, hypothyroidism, T1D, sarcoidosis, psoriasis, SLE and ankylosing spondylitis. We found no evidence of associations between C3 versus mental or autoimmune disorders based on either MR or PheWAS. In general, our results do not support the hypothesis that C4 is causally associated with the risk of SCZ (nor several other mental disorders). We provide new evidence to support the hypothesis that higher C4 concentration is associated with lower risks of autoimmune disorders.
Publisher: Elsevier BV
Date: 11-2008
DOI: 10.1016/J.PSYCHRES.2007.10.003
Abstract: The goals of the study were to compare anger expressions in in iduals with eating disorders and healthy controls, and to explore the relation among eating disorder symptoms, comorbid psychopathology, personality traits, and impulsive behaviours. Participants comprised 135 eating disorder patients consecutively admitted to our unit and 103 healthy controls. Assessment measures included the Eating Disorders Inventory 2 (EDI-2), Bulimic Investigatory Test Edinburgh (BITE), Symptom Checklist-Revised (SCL-90-R), Social Avoidance Distress Scale (SAD), Temperament and Character Inventory-Revised (TCI-R), State-Trait Anger Expression Inventory 2 (STAXI-2), and other clinical and psychopathological indices. In the control group also the General Health Questionnaire-28 (GHQ-28) was also used. Women with eating disorders obtained significantly higher mean scores than controls on all STAXI-2 scales except for Anger Control. When various purging methods were assessed independently, the frequency of laxative use was associated with anger suppression. Eating disorder symptoms and specific personality traits were positively associated with different forms of anger expression. Finally, patients with higher scores on anger suppression were more likely to report self-harming behaviors. Eating disorder patients may have inadequate anger expression and deficits in coping with anger and frustration. Furthermore, different purging methods may be related to different facets of anger.
Publisher: Center for Open Science
Date: 04-03-2021
Abstract: Anorexia nervosa (AN) polygenic liability has been associated with mental health traits, eating problems, and body mass index (BMI) in adolescence and adulthood, but little is known about its manifestations in early childhood. We explore AN polygenic score (PGS) associations with six childhood domains: BMI, eating problems, neurodevelopment, emotional problems, disruptive/aggressive behaviour, and temperament ersonality in 15,205 children from the Norwegian Mother, Father and Child Cohort Study. Results did not support associations between AN PGS and developmental phenotypes in girls. For boys, we observed an association between AN PGS and higher temperamental fussiness at 6 months, (b= 0.036 [95% CI=0.010,0.061]). Our results suggest that genetic risk for AN as indexed by the PGS has few observable manifestations in key neurodevelopmental domains in the first 8 years of life. Future studies with more powerful PGS that track children longer may aid in understanding how and when genetic risk for AN manifest developmentally.
Publisher: Cambridge University Press (CUP)
Date: 20-11-2012
DOI: 10.1017/S0033291712002516
Abstract: We internally validated previously published rates of remission, continuation and incidence of broadly defined eating disorders during pregnancy in the Norwegian Mother and Child Cohort (MoBa) at the Norwegian Institute of Public Health. A total of 77 267 pregnant women enrolled at 17 weeks gestation between 2001 and 2009 were split into a training s le ( n = 41 243) from the version 2 dataset and a validation s le ( n = 36 024) from the version 5 dataset who were not in the original study. Internal validation of original rate models involved fitting a calibration model to compare model parameters between the two s les and bootstrap estimates of bias in the entire version 5 dataset. Remission, continuation and incidence estimates remained stable. Pre-pregnancy prevalence estimates in the validation s le were: anorexia nervosa (AN 0.1%), bulimia nervosa (BN 1.0%), binge eating disorder (BED 3.3%) and eating disorder not otherwise specified-purging disorder (EDNOS-P 0.1%). In early pregnancy, estimates were: BN (0.2%), BED (4.8%) and EDNOS-P ( .01%). Incident BN and EDNOS-P during pregnancy were rare. The highest rates were for full or partial remission for BN and EDNOS-P and continuation for BED. We validated previously estimated rates of remission, continuation and incidence of eating disorders during pregnancy. Eating disorders, especially BED, during pregnancy were relatively common, occurring in nearly one in every 20 women. Pregnancy was a window of remission from BN but a window of vulnerability for BED. Training to detect eating disorders by obstetricians/gynecologists and interventions to enhance pregnancy and neonatal outcomes warrant attention.
Publisher: Wiley
Date: 07-2022
DOI: 10.1002/AJMG.B.32906
Abstract: We present innovative research practices in psychiatric genetic studies to ensure representation of in iduals from erse ancestry, sex assigned at birth, gender identity, age, body shape and size, and socioeconomic backgrounds. Due to histories of inappropriate and harmful practices against marginalized groups in both psychiatry and genetics, people of certain identities may be hesitant to participate in research studies. Yet their participation is essential to ensure erse representation, as it is incorrect to assume that the same genetic and environmental factors influence the risk for various psychiatric disorders across all demographic groups. We present approaches developed as part of the Eating Disorders Genetics Initiative (EDGI), a study that required tailored approaches to recruit erse populations across many countries. Considerations include research priorities and design, recruitment and study branding, transparency, and community investment and ownership. Ensuring representation in participants is costly and funders need to provide adequate support to achieve ersity in recruitment in prime awards, not just as supplemental afterthoughts. The need for erse s les in genetic studies is critical to minimize the risk of perpetuating health disparities in psychiatry and other health research. Although the EDGI strategies were designed specifically to attract and enroll in iduals with eating disorders, our approach is broadly applicable across psychiatry and other fields.
Publisher: Wiley
Date: 28-12-2018
DOI: 10.1002/AJMG.B.32709
Publisher: Springer Science and Business Media LLC
Date: 18-12-2019
DOI: 10.1038/S41467-019-13544-0
Abstract: Body composition is often altered in psychiatric disorders. Using genome-wide common genetic variation data, we calculate sex-specific genetic correlations amongst body fat %, fat mass, fat-free mass, physical activity, glycemic traits and 17 psychiatric traits (up to N = 217,568). Two patterns emerge: (1) anorexia nervosa, schizophrenia, obsessive-compulsive disorder, and education years are negatively genetically correlated with body fat % and fat-free mass, whereas (2) attention-deficit/hyperactivity disorder (ADHD), alcohol dependence, insomnia, and heavy smoking are positively correlated. Anorexia nervosa shows a stronger genetic correlation with body fat % in females, whereas education years is more strongly correlated with fat mass in males. Education years and ADHD show genetic overlap with childhood obesity. Mendelian randomization identifies schizophrenia, anorexia nervosa, and higher education as causal for decreased fat mass, with higher body fat % possibly being a causal risk factor for ADHD and heavy smoking. These results suggest new possibilities for targeted preventive strategies.
Publisher: Cold Spring Harbor Laboratory
Date: 18-02-2021
DOI: 10.1101/2021.02.12.21250941
Abstract: Anorexia nervosa (AN) is a psychiatric disorder with complex etiology, with a significant portion of disease risk imparted by genetics. Traditional GWAS studies produce principal evidence for the association of genetic variants with disease, and provide a jumping-off point for downstream functional analyses. Transcriptomic imputation (TI) allows for the translation of SNPs into regulatory mechanisms, which can then be used to assess the functional outcome of genetically regulated gene expression (GReX) in a more broad setting through the use of phenome-wide association studies (PheWAS) in large and erse clinical biobank populations with electronic health record (EHR) phenotypes. Here, we applied TI using S-PrediXcan to translate the most recent PGC-ED AN GWAS findings into AN-GReX. For significant genes, we imputed AN-GReX in the Mount Sinai Bio Me ™ Biobank and performed PheWAS on over 2000 clinical outcomes to test the clinical consequences of aberrant expression of these genes. We performed a secondary analysis to assess the impact of BMI on AN-GReX clinical associations. Our S-PrediXcan analysis identified 47 genes associated with AN, including what is, to our knowledge, the first genetic association of AN with the Major Histocompatibility Complex (MHC). AN-GReX was associated with autoimmune, anthropometric, metabolic, psychiatric and gastrointestinal diagnoses in our biobank cohort, as well as measures of anthropometry, substance use, and pain score. Our analyses reveal that AN-GReX associations with measures of weight and substance use are modified by BMI, and indicate potential avenues of functional mechanism to investigate further.
Publisher: Cold Spring Harbor Laboratory
Date: 23-10-2021
DOI: 10.1101/2021.10.13.21261078
Abstract: Obsessive-compulsive disorder (OCD) is a heritable disorder, but no definitive, replicated OCD susceptibility loci have yet been identified by any genome-wide association study (GWAS). Here, we report results from a GWAS in the largest OCD case-control s le (N = 14,140 OCD cases and N = 562,117 controls) to date. We explored the genetic architecture of OCD, including its genetic relationships to other psychiatric and non-psychiatric phenotypes. In the GWAS analysis, we identified one SNP associated with OCD at a genome-wide significant level. Subsequent gene-based analyses identified additional two genes as potentially implicated in OCD pathogenesis. All SNPs combined explained 16% of the heritability of OCD. We show sub-stantial positive genetic correlations between OCD and a range of psychiatric disorders, including anxiety disorders, anorexia nervosa, and major depression. We thus for the first time provide evidence of a genome-wide locus implicated in OCD and strengthen previous literature suggesting a polygenic nature of this disorder.
Publisher: Springer Science and Business Media LLC
Date: 26-11-2015
DOI: 10.1038/NRDP.2015.74
Abstract: Anorexia nervosa (AN) is a psychiatric condition characterized by severe weight loss and secondary problems associated with malnutrition. AN predominantly develops in adolescence in the peripubertal period. Without early effective treatment, the course is protracted with physical, psychological and social morbidity and high mortality. Despite these effects, patients are noted to value the beliefs and behaviours that contribute to their illness rather than regarding them as problematic, which interferes with screening, prevention and early intervention. Involving the family to support interventions early in the course of the illness can produce sustained changes however, those with a severe and/or protracted illness might require inpatient nursing support and/or outpatient psychotherapy. Prevention programmes aim to moderate the overvaluation of 'thinness' and body dissatisfaction as one of the proximal risk factors. The low prevalence of AN limits the ability to identify risk factors and to study the timing and sex distribution of the condition. However, genetic profiles, premorbid features, and brain structures and functions of patients with AN show similarities with other psychiatric disorders and contrast with obesity and metabolic disorders. Such studies are informing approaches to address the neuroadaptation to starvation and the other various physical and psychosocial deficits associated with AN. This Primer describes the epidemiology, diagnosis, screening and prevention, aetiology, treatment and quality of life of patients with AN.
Publisher: Wiley
Date: 09-04-2013
DOI: 10.1002/EAT.22133
Publisher: Wiley
Date: 22-08-2012
DOI: 10.1002/EAT.22052
Abstract: To determine whether a variant bulimic-type presentation, whereby one meets criteria for bulimia nervosa (BN) except that binge eating episodes are not objectively large (i.e., "subjective bulimia nervosa," SBN), has comparable clinical severity to established eating disorders, particularly BN. Treatment-seeking adults with BN (N = 112), SBN (N = 28), anorexia nervosa restricting type (AN-R) (N = 45), and AN-binge urge type (AN-B/P) (N = 24) were compared. Overall, SBN could not be meaningfully distinguished from BN. SBN and BN had equivalent eating pathology, depression and anxiety symptoms, low quality of life, impulsivity, Axis I comorbidity, and lifetime psychiatric history, and comparable clinical severity to AN-R and AN-B/P. In iduals with SBN, differing from BN only by the smaller size of their binge eating episodes, had a form of eating disorder comparable in clinical severity to threshold AN and BN and warranting clinical attention. Health professionals and the community require greater awareness of this variant to optimize detection, treatment-seeking, and outcomes.
Publisher: Wiley
Date: 19-11-2014
DOI: 10.1002/ERV.2334
Publisher: Springer Science and Business Media LLC
Date: 09-08-2011
DOI: 10.1038/MP.2011.94
Publisher: Springer Science and Business Media LLC
Date: 13-03-2011
DOI: 10.1038/NG.789
Publisher: Physicians Postgraduate Press, Inc
Date: 07-07-2016
DOI: 10.4088/PCC.16M01939
Publisher: Elsevier BV
Date: 2018
DOI: 10.1016/J.EATBEH.2017.11.005
Abstract: Research suggests that in iduals with high liking for sweets are at increased risk for binge eating, which has been minimally investigated in in iduals with binge-eating disorder (BED). Forty-one adults (85% female, 83% white) with binge eating concerns completed a sweet taste test and measures of eating disorder behaviors and food cravings. A subset of participants with BED completed an oral glucose tolerance test (OGTT N=21) and a 24-hour dietary recall (N=26). Regression models were used to compare highest sweet preferers (HSP [N=18]) to other sweet preferers (OSP [N=23]) and were used to assess associations between sweet taste preference and outcome variables. Effect sizes (ηp
Publisher: Springer Science and Business Media LLC
Date: 05-08-2023
DOI: 10.1038/S41467-023-40330-W
Abstract: The predictive performance of polygenic scores (PGS) is largely dependent on the number of s les available to train the PGS. Increasing the s le size for a specific phenotype is expensive and takes time, but this s le size can be effectively increased by using genetically correlated phenotypes. We propose a framework to generate multi-PGS from thousands of publicly available genome-wide association studies (GWAS) with no need to in idually select the most relevant ones. In this study, the multi-PGS framework increases prediction accuracy over single PGS for all included psychiatric disorders and other available outcomes, with prediction R 2 increases of up to 9-fold for attention-deficit/hyperactivity disorder compared to a single PGS. We also generate multi-PGS for phenotypes without an existing GWAS and for case-case predictions. We benchmark the multi-PGS framework against other methods and highlight its potential application to new emerging biobanks.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-2015
Publisher: Wiley
Date: 26-04-2022
DOI: 10.1002/ERV.2898
Abstract: Cognitive‐behavioural therapy (CBT) delivered face‐to‐face and via the internet reduces bulimia nervosa (BN) symptoms. However, our empirical understanding of factors affecting patient outcomes is limited. Using data from a randomised, controlled trial comparing internet‐based (CBT4BN, n = 78) with face‐to‐face (CBTF2F, n = 71) group CBT (97% female, M = 28 years), we examined general treatment (across conditions) and modality‐specific predictors of end‐treatment and 1‐year outcomes (abstinence, binge‐eating frequency, purging frequency). Improved eating disorder‐related quality of life (EDQOL) during treatment and follow‐up predicted abstinence at end‐treatment and 1‐year assessments. Improved EDQOL, disordered eating cognitions, and anxiety symptoms predicted less frequent binge eating and purging. Previous CBT and being employed predicted more frequent binge eating and purging at both assessments. Higher self‐transcendence and self‐directedness predicted less frequent binge eating. More severe binge eating and purging at baseline and end‐treatment predicted more frequent binge eating and purging at subsequent assessments. Improved EDQOL was more strongly associated with positive outcome in CBT4BN improved depressive symptoms and health‐related QOL predicted positive outcome in CBT4BN but not CBTF2F. Symptom improvement and certain character traits predicted positive outcome, whereas more severe presentation and prior CBT experience predicted poorer outcome. Consideration of intreatment symptom improvement may facilitate care recommendations, particularly for internet‐based modalities.
Publisher: Springer Science and Business Media LLC
Date: 15-02-2023
DOI: 10.1038/S41467-023-36392-5
Abstract: The vitamin D binding protein (DBP), encoded by the group-specific component ( GC ) gene, is a component of the vitamin D system. In a genome-wide association study of DBP concentration in 65,589 neonates we identify 26 independent loci, 17 of which are in or close to the GC gene, with fine-mapping identifying 2 missense variants on chromosomes 12 and 17 (within SH2B3 and GSDMA , respectively). When adjusted for GC haplotypes, we find 15 independent loci distributed over 10 chromosomes. Mendelian randomization analyses identify a unidirectional effect of higher DBP concentration and (a) higher 25-hydroxyvitamin D concentration, and (b) a reduced risk of multiple sclerosis and rheumatoid arthritis. A phenome-wide association study confirms that higher DBP concentration is associated with a reduced risk of vitamin D deficiency. Our findings provide valuable insights into the influence of DBP on vitamin D status and a range of health outcomes.
Publisher: Wiley
Date: 20-03-2019
DOI: 10.1002/EAT.23073
Publisher: American Psychiatric Association Publishing
Date: 09-2017
Publisher: Elsevier BV
Date: 11-2018
Publisher: Springer Science and Business Media LLC
Date: 22-01-2021
Publisher: American Psychological Association (APA)
Date: 07-2017
DOI: 10.1037/ABN0000241
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.JPSYCHORES.2018.02.011
Abstract: Capturing trends in healthcare utilization may help to improve efficiencies in the detection and diagnosis of illness, to plan service delivery, and to forecast future health expenditures. For binge-eating disorder (BED), issues include lengthy delays in detection and diagnosis, missed opportunities for recognition and treatment, and morbidity. The study objective was to compare healthcare utilization and expenditure in people with and without BED. A case-control design and nationwide registers were used. All in iduals diagnosed with BED at eating disorder clinics in Sweden between 2005 and 2009 were included (N = 319, 97% female, M age = 22 years). Ten controls (N = 3190) were matched to each case on age-, sex-, and location of birth. Inpatient, hospital-based outpatient, and prescription medication utilization and expenditure were analyzed up to eight years before and four years after the index date (i.e., date of diagnosis of the BED case). Cases had significantly higher inpatient, hospital-based outpatient, and prescription medication utilization and expenditure compared with controls many years prior to and after diagnosis of BED. Utilization and expenditure for controls was relatively stable over time, but for cases followed an inverted U-shape and peaked at the index year. Care for somatic conditions normalized after the index year, but care for psychiatric conditions remained significantly higher. In iduals with BED had substantially higher healthcare utilization and costs in the years prior to and after diagnosis of BED. Since previous research shows a delay in diagnosis, findings indicate clear opportunities for earlier detection and clinical management. Training of providers in detection, diagnosis, and management may help curtail morbidity. A reduction in healthcare utilization was observed after BED diagnosis. This suggests that earlier diagnosis and treatment could improve long-term health outcomes and reduce the economic burden associated with BED.
Publisher: Wiley
Date: 28-07-2020
DOI: 10.1002/EAT.23353
Publisher: Wiley
Date: 2007
DOI: 10.1002/ERV.780
Abstract: The aim of this study was to understand the clinical impact of the motivational stage of change on the psychopathology and symptomatology of anorexia nervosa (AN), bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS). The participants were 218 eating disorder (ED) patients (58 AN, 95 BN and 65 EDNOS), consecutively admitted to our hospital. All patients fulfilled DSM-IV criteria for these disorders. Assessment measures included the Eating Disorders Inventory (EDI), Bulimic Investigation Test Edinburgh (BITE), Beck Depression Inventory (BDI), four analogue scales of motivational stage, as well as a number of other clinical and psychopathological indices. Our results indicated higher motivation for change in BN than in AN and EDNOS patients (p < 0.05). For all groups, motivation to change was predicted by chronological age (p < 0.05). However, a longer duration of illness was only predictive of the motivational levels in EDNOS (p < 0.05) patients. Compared to BN, AN and EDNOS patients are most resistant to change and the younger these patients are, the less likely they are to be motivated to change their disturbed eating behaviour.
Publisher: Wiley
Date: 25-04-2018
DOI: 10.1002/EAT.22869
Publisher: Wiley
Date: 19-09-2016
DOI: 10.1002/EAT.22624
Publisher: Wiley
Date: 25-05-2023
DOI: 10.1002/EAT.23997
Abstract: To examine sex differences in risk factors for anorexia nervosa (AN). This population‐based study involved 44,743 in iduals (6,239 AN cases including 5,818 females and 421 males, and 38,504 controls including 18,818 females and 19,686 males) born in Denmark between May 1981 and December 2009. Follow‐up began on the in idual's sixth birthday and ended at AN diagnosis, emigration, death, or December 31, 2016, whichever occurred first. Exposures included socioeconomic status (SES), pregnancy, birth, and early childhood factors based on data from Danish registers, and psychiatric and metabolic polygenic risk scores (PRS) based on genetic data. Hazard ratios were estimated using weighted Cox proportional hazards models stratified by sex (assigned at birth), with AN diagnosis as the outcome. The effects of early life exposures and PRS on AN risk were comparable between females and males. Although we observed some differences in the magnitude and direction of effects, there were no significant interactions between sex and SES, pregnancy, birth, or early childhood exposures. The effects of most PRS on AN risk were highly similar between the sexes. We observed significant sex‐specific effects of parental psychiatric history and body mass index PRS, though these effects did not survive corrections for multiple comparisons. Risk factors for AN are comparable between females and males. Collaboration across countries with large registers is needed to further investigate sex‐specific effects of genetic, biological, and environmental exposures on AN risk, including exposures in later childhood and adolescence as well as the additive effects of exposures. Sex differences in the prevalence and clinical presentation of AN warrant examination of sex‐specific risk factors. This population‐based study indicates that the effects of polygenic risk and early life exposures on AN risk are comparable between females and males. Collaboration between countries with large registers is needed to further investigate sex‐specific AN risk factors and improve early identification of AN.
Publisher: Norwegian University of Science and Technology (NTNU) Library
Date: 22-12-2014
Abstract: This review summarizes studies on eating disorders in pregnancy and the postpartum period that have been conducted as part of the broader Norwegian Mother and Child Cohort Study (MoBa). Prior to the 2000s, empirical literature on eating disorders in pregnancy was sparse and consisted mostly of studies in small clinical s les. MoBa has contributed to a new era of research by making population-based and larges le research possible. To date, MoBa has led to 19 eating disorder studies on erse questions including the prevalence, course, and risk correlates of eating disorders during pregnancy and the postpartum. The associations between eating disorder exposure and pregnancy, birth and obstetric outcomes, and maternal and offspring health and well-being, have also been areas of focus. The findings indicate that eating disorders in pregnancy are relatively common and appear to confer health risks to mother and her child related to sleep, birth outcomes, maternal nutrition, and child feeding and eating.
Publisher: Cold Spring Harbor Laboratory
Date: 07-10-2021
DOI: 10.1101/2021.10.04.21264526
Abstract: Longitudinal weight trajectories may reflect in idual health status. We examined the genetic aetiology and clinical consequences of adult weight trajectories in males and females leveraging genetic and phenotypic data in the electronic health records (EHR) of the Bio Me ™ Biobank. We constructed four longitudinal weight trajectories using annual EHR-recorded weights (stable weight, weight gain, weight loss, or weight cycle) (n=21,487). After validating the accuracy of the trajectories (n=100), we conducted a hypothesis-free phenome-wide association study (PheWAS), including sex-stratified PheWAS, to identify diseases associated with each weight trajectory. We then performed a hypothesis-driven polygenic risk score (PRS) analysis on these weight trajectories, focusing on anorexia nervosa (AN) and depression—both commonly associated with weight changes. Weight trajectory classification was highly accurate (accuracy, sensitivity, and specificity 97% for all four trajectories). Hypothesis-free PheWAS analyses identified a significant association between depression and weight cycle (OR=1.4, p≤7.7×10 −16 ) after Bonferroni correction, but not with weight gain or loss. Compared to other weight trajectories, we also observed a significant association of osteoporosis-related phecodes with weight loss in females only (OR female =1.4, p female ≤ 1.4×10 −7 , OR male =0.8, p male ≥ 0.18). AN-PRS was positively associated with weight loss trajectory among in iduals without eating disorder diagnoses (OR top vs. bottom 10% PRS =1.95, p=0.00035). Consistent effect direction was observed across three ancestry groups. The AN-PRS-weight loss association was not attenuated by obesity-PRS (OR top vs. bottom 10% PRS =1.94). Adult weight trajectory is associated with disease both phenotypically and genetically. Our PheWAS reveals unique relationships between diseases and weight trajectory patterns, including the association of depression and weight cycle trajectory in both males and females, and osteoporosis-weight loss trajectory association in females only. In addition, our PRS analysis suggests that adults with higher AN genetic risk are more likely to have a weight loss trajectory, and this association may be independent of BMI/obesity-related genetic pathways. Klarman Family Foundation, NIMH. We used PubMed and medRxiv to search for phenome-wide association studies (PheWAS) of BMI/weight that have been published and/or are currently in preprint. For the weight PheWAS, we used search terms: “(phewas[tiab] OR phenome wide[tiab]) AND (weight[tiab] OR BMI[tiab] OR body mass index[tiab])” on PubMed, and “phewas weight”, “phewas BMI”, “phewas body mass index”, “phenome weight”, “phenome BMI”, or “phenome body mass index” for abstract or title search on medRxiv (up to March 17, 2021). The literature search identified 45 studies in total. From title screening, 13 of the studies were further reviewed, and 5 studies were ultimately included as relevant evidence of PheWAS on weight or BMI. These five PheWAS included four studies of adult populations of European ancestry, and one study conducted in children (ALSPAC). The weight-related exposure variables used in these studies were genetic variants of the obesity-associated FTO gene, BMI-associated SNPs, BMI PRS, BMI value, and obesity status. Through using BMI/obesity-related exposures, these published PheWAS identified comorbidities associated with obesity, including type 2 diabetes, sleep apnea, hypertension, edema, liver disease, asthma, bronchitis, and earlier age of puberty in at least two of the PheWAS. The childhood PheWAS found positive associations of BMI PRS with multiple biomarkers, including leptin, C-reactive protein, IL6, triglyceride, very low-density lipoprotein, and a negative association with high density lipoprotein. One BMI PheWAS published in 2020 observed that hyperlipidemia and gastroesophageal reflux disease were only significantly associated with BMI on a phenotypic level, but not on a genetic level (e.g., BMI or obesity SNPs), likely due to the small genetic effect of single genetic variants. Regarding the impact of anorexia nervosa (AN) and depression genetic risk on weight trajectory, we searched “anorexia nervosa[title] AND (weight[title] OR BMI[title] OR body mass index[title]) AND (genetic[tiab])” or “depression[title] AND (weight[title] OR BMI[title] OR body mass index[title]) AND (genetic[tiab])” on PubMed, and “anorexia polygenic weight” or “anorexia polygenic BMI” or “anorexia polygenic body mass index” or “depression polygenic weight” or “depression BMI” or “depression body mass index” for abstract or title search on medRxiv (up to March 17, 2021). The literature search identified 36 studies in total, and 21 were further reviewed through the title screening. No studies were identified that examined the effect of depression genetic risk on BMI or weight, and only two were included as relevant evidence of AN genetic risk on BMI and weight. Of these two studies, one was cross-sectional in a small adult s le (age 18-59, n=380), and the other was longitudinal in a children/young adult population in the ALSPAC cohort (age 10-24, n=8,654). BMI PRS was found to be associated with lower BMI cross-sectionally, and with weight loss over time only in females. In this study, we create a novel inflection-point based method to classify longitudinal weight trajectory using weights recorded in the EHR in a hospital-based biobank (Mount Sinai Bio Me ™ Biobank), with an accuracy of 98% or higher through our validation study (n=100). With this validated phenotype of weight pattern over time (i.e., weight trajectory), our PheWAS analysis afforded us the opportunity to examine comorbidity across the weight spectrum and across time. We identified 143 diseases associated with weight cycle (e.g., depression, anemias, renal failure),13 diseases positively associated with weight gain trajectory (e.g., obesity, obstructive sleep apnea, edema), and 36 with weight loss (e.g., protein-calorie malnutrition, gastrointestinal complication, end stage renal disease), after Bonferroni correction, using 5% as the cutoff for clinically relevant weight change. All diseases were negatively associated with a stable weight trajectory. Furthermore, we performed, to our knowledge, the first sex-stratified PheWAS related to weight trajectory, and identified eight sex-stratified associations with weight gain (e.g., obstructive sleep apnea), eight with weight loss (e.g., osteoporosis), and ten with weight cycle (e.g., vitamin B-complex deficiencies). On a genetic level, our study fills in the gap of the impact of AN genetic risk on longitudinal weight changes in the adult population. Unlike the finding in adolescents in the ALSPAC study, which found an AN-PRS-weight loss trajectory association only in females, we found an association of higher AN genetic risk with weight loss trajectory in both men and women, with consistent effect direction observed across in iduals with European, African, and Hispanic ancestry in the Bio Me ™ Biobank. Additionally, this association of AN genetics with weight loss was independent of the influence of obesity/BMI related genetic variants on weight. PheWAS is an excellent tool for exploring comorbidities associated across the weight spectrum. Our PheWAS findings identify diseases with different weight patterns (e.g., depression and weight cycle), which may reflect characteristics of these diseases, including age of onset, progression pattern, severity, and chronicity (e.g., the episodic nature of depression with the weight cycle pattern). In addition, our sex-stratified PheWAS implicates the important role of sex in weight regulation in the presence of disease. Certain sub-populations may be at greater risk of weight loss in some disease states (e.g., women with osteoporosis) and may need targeted treatment to address nutritional needs and to prevent further weight loss. Our study also suggests that people who have high AN genetic risk are at greater risk of displaying a weight loss trajectory during adulthood. However, given the limited amount of variation in the outcome of interest (e.g., weight loss) explained by the AN-PRS, the PRS may have to be jointly modeled with other risk factors to predict weight loss more accurately, or to identify subgroups at risk of weight loss. In addition, given our finding that the effect of AN genetics on weight loss was minimally affected by the obesity-related genetics, and the previously reported low genetic correlation of −0.22 between AN and obesity in the 2019 AN GWAS, this may indicate that AN- and obesity-related weight changes might have unique genetic underpinnings. Future studies that assess the pathway-specific genetic risk on weight pattern will further our understanding of the genetic architecture of longitudinal weight trajectory.
Publisher: Elsevier BV
Date: 09-2007
DOI: 10.1016/J.COMPPSYCH.2007.03.008
Abstract: The objective of the study was to assess the predictive value of personality profiles to classify in iduals with bulimia nervosa (BN), pathological gambling (PG), and a nonpsychiatric comparison group while controlling for sex. The s le comprised 270 BN (241 women, 29 men), 429 PG (42 women, 387 men), and 96 comparison (nonpsychiatric) subjects (35 women, 61 men). All patients were consecutively admitted to our Psychiatry Department and were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. We administered the Temperament and Character Inventory-Revised as well as other clinical indices. Multinomial and binary logistic regression models adjusted for age and stratified by sex were used to assess the predictive value of personality in relation to group status. In comparison to controls, high Novelty Seeking (P < .001) was specifically associated with a diagnosis of PG. Independently of sex, low Self-Directedness was associated with both BN (P < .001) and PG (P < .001). Some sex-specific differences were also observed namely, women with BN and PG displayed higher Harm Avoidance and Cooperativeness than control women, whereas men with PG reported higher Reward Dependence and Persistence than control men. Our results suggested that, whereas there are some shared personality traits between BN and PG when compared with healthy controls, there are also some sex- and diagnostic-specific personality traits that weigh against the consideration of BN as an impulse control disorder.
Publisher: Wiley
Date: 17-06-2014
DOI: 10.1002/EAT.22318
Publisher: American Psychological Association (APA)
Date: 04-2017
DOI: 10.1037/ABN0000254
Publisher: Wiley
Date: 27-10-2014
DOI: 10.1002/EAT.22359
Publisher: Cambridge University Press (CUP)
Date: 05-04-2022
DOI: 10.1017/S0033291721004554
Abstract: Anorexia nervosa (AN) is a psychiatric disorder with complex etiology, with a significant portion of disease risk imparted by genetics. Traditional genome-wide association studies (GWAS) produce principal evidence for the association of genetic variants with disease. Transcriptomic imputation (TI) allows for the translation of those variants into regulatory mechanisms, which can then be used to assess the functional outcome of genetically regulated gene expression (GReX) in a broader setting through the use of phenome-wide association studies (pheWASs) in large and erse clinical biobank populations with electronic health record phenotypes. Here, we applied TI using S-PrediXcan to translate the most recent PGC-ED AN GWAS findings into AN-GReX. For significant genes, we imputed AN-GReX in the Mount Sinai Bio Me ™ Biobank and performed pheWASs on over 2000 outcomes to test the clinical consequences of aberrant expression of these genes. We performed a secondary analysis to assess the impact of body mass index (BMI) and sex on AN-GReX clinical associations. Our S-PrediXcan analysis identified 53 genes associated with AN, including what is, to our knowledge, the first-genetic association of AN with the major histocompatibility complex. AN-GReX was associated with autoimmune, metabolic, and gastrointestinal diagnoses in our biobank cohort, as well as measures of cholesterol, medications, substance use, and pain. Additionally, our analyses showed moderation of AN-GReX associations with measures of cholesterol and substance use by BMI, and moderation of AN-GReX associations with celiac disease by sex. Our BMI-stratified results provide potential avenues of functional mechanism for AN-genes to investigate further.
Publisher: Cambridge University Press (CUP)
Date: 10-12-2012
DOI: 10.1017/S0033291712002620
Abstract: Anorexia nervosa is a potentially deadly psychiatric illness that develops predominantly in females around puberty but is increasingly being recognized as also affecting boys and men and women across the lifespan. The aim of this environmental scan is to provide an overview of best practices in anorexia nervosa treatment across the age spectrum. A triangulation approach was used. First, a detailed review of randomized controlled trials (RCTs) for anorexia nervosa published between 1980 and 2011 was conducted second, clinical practice guidelines were consulted and reviewed third, information about RCTs currently underway was sourced. This approach facilitated a comprehensive overview, which addressed the extant evidence base, recent advances in evidence and improvements in treatment, and future directions. The evidence base for the treatment of anorexia nervosa is advancing, albeit unevenly. Evidence points to the benefit of family-based treatment for youth. For adults no specific approach has shown superiority and, presently, a combination of renourishment and psychotherapy such as specialist supportive clinical management, cognitive behavioral therapy, or interpersonal psychotherapy is recommended. RCTs have neither sufficiently addressed the more complex treatment approaches seen in routine practice settings, such as multidisciplinary treatment or level of care, nor specifically investigated treatment in ethnically erse populations. Methodological challenges that hinder progress in controlled research for anorexia nervosa are explained. The review highlights evidence-based and promising treatment modalities for anorexia nervosa and presents a triangulated analysis including controlled research, practice guidelines, and emerging treatments to inform and support clinical decision making.
Publisher: Physicians Postgraduate Press, Inc
Date: 21-02-2018
DOI: 10.4088/JCP.16M11314
Publisher: Wiley
Date: 25-06-2013
DOI: 10.1002/JCLP.22006
Abstract: The literature on later age of onset (LAO) in women with eating disorders is scarce. We compared the severity of eating disorders, eating disorder subtype, and personality profiles in a clinical s le of consecutively assessed women with eating disorders with later age of onset (LAO, > = 25 years) to women with typical age of onset (TAO, <25 years). All eating disorder patients met the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) criteria and were admitted to the Eating Disorder Unit of the University Hospital of Bellvitge in Barcelona, Spain. Ninety-six patients were classified as LAO and 759 as TAO. Measures included the Eating Attitude Test-40 (EAT-40), Eating Disorders Inventory-2 (EDI-2), Bulimic Investigatory Test Edinburgh (BITE), Symptom Checklist Revised (SCL-90-R), and the Temperament and Character Inventory-Revised (TCI-R), as well as other clinical and psychopathological indices. LAO in iduals reported significantly fewer weekly vomiting episodes, fewer self-harming behaviours, less drug abuse, and lower scores on the BITE symptoms, the EDI-2 drive for thinness, and the TCI-R harm avoidance scales than TAO in iduals. Conversely, the LAO group reported more current and premorbid obesity than the TAO group. LAO eating disorder patients in this s le presented with milder symptomatology and less extreme personality traits. Premorbid obesity may be more relevant to LAO than TAO eating disorders and should be routinely assessed and considered when planning treatment.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-2008
Publisher: American Association for the Advancement of Science (AAAS)
Date: 22-06-2018
Abstract: Consistent classification of neuropsychiatric diseases is problematic because it can lead to misunderstanding of etiology. The Brainstorm Consortium examined multiple genome-wide association studies drawn from more than 200,000 patients for 25 brain-associated disorders and 17 phenotypes. Broadly, it appears that psychiatric and neurologic disorders share relatively little common genetic risk. However, different and independent pathways can result in similar clinical manifestations (e.g., psychosis, which occurs in both schizophrenia and Alzheimer's disease). Schizophrenia correlated with many psychiatric disorders, whereas the immunopathological affliction Crohn's disease did not, and posttraumatic stress syndrome was also largely independent of underlying traits. Essentially, the earlier the onset of a disorder, the more inheritable it appeared to be. Science , this issue p. eaap8757
Publisher: Springer Science and Business Media LLC
Date: 25-07-2017
DOI: 10.1038/MP.2017.88
Abstract: Anorexia nervosa (AN) is a complex neuropsychiatric disorder presenting with dangerously low body weight, and a deep and persistent fear of gaining weight. To date, only one genome-wide significant locus associated with AN has been identified. We performed an exome-chip based genome-wide association studies (GWAS) in 2158 cases from nine populations of European origin and 15 485 ancestrally matched controls. Unlike previous studies, this GWAS also probed association in low-frequency and rare variants. Sixteen independent variants were taken forward for in silico and de novo replication (11 common and 5 rare). No findings reached genome-wide significance. Two notable common variants were identified: rs10791286, an intronic variant in OPCML ( P =9.89 × 10 −6 ), and rs7700147, an intergenic variant ( P =2.93 × 10 −5 ). No low-frequency variant associations were identified at genome-wide significance, although the study was well-powered to detect low-frequency variants with large effect sizes, suggesting that there may be no AN loci in this genomic search space with large effect sizes.
Publisher: Wiley
Date: 27-10-2014
DOI: 10.1002/EAT.22361
Location: United States of America
No related grants have been discovered for Cynthia Bulik.