Professor
René Klinkby Støving
Department of Endocrinology, Odense University Hospital
| Projekt styring | ||
| Projekt status | Closed | |
| Data indsamlingsdatoer | ||
| Start | 01.11.2005 | |
| Slut | 01.01.2010 | |
Funen Anorexia Nervosa Study (FANS) - a retrospective cohort study
Short summary
In the present study, we evaluate a cohort of 977 females and 38 males with DSM-IV defined eating disorders (EDs) admitted to a specialized ED-unit during an 11-year period from 1994 to 2004, in regards to treatment outcome, quality of life (QoL), and mortality and in regards to body composition, menstrual status and bone fractures.
The overall aim is to determine factors associated to QoL, mortality, menstrual status and bone fractures at baseline or during treatment.
Rationale
Eating disorders (ED) are associated with high morbidity and anorexia nervosa (AN) demonstrates the highest mortality rate of any psychiatric disorder, with a risk of premature death more than five times the general population. The prognosis remains poor with only approximately half of the patients recovering. Furthermore, health related quality of life (HRQoL) studies have found that patients with an ED have substantial impairments in this field. These impairments have been reported to be even more substantial than in some somatic diseases (i.e. cystic fibrosis and angina) and lower than in clinically depressed patients. Some studies demonstrated a significant improvement in HRQoL after treatment, but also revealed that recovered patients reported poorer HRQoL compared to the population norm.
In addition to the psychiatric aspects, eating disorders are associated to a wide range of somatic disorders related to low weight, malnutrition and purging behaviour. Amenorrhea, high levels of cortisol and resistance to growth hormone are all well known endocrine consequences of malnutrition in AN. Amenorrhea is related to both weight loss and the level of physical activity, and the resumption of menses is therefor regarded as a predictor of disease remission. What is also evident is, that the endocrine disorders have delirious effects on bone. Accordingly patients with AN have been shown to have decreased bone mineral density, even with short duration of disease. What is adding to concern is the fact that onset of AN often coincide with puberty, a period critical for accrual of peak bone mass (PBM), a predictor for the development of osteoporosis. As a consequence, AN is associated with a marked increase in fracture risk, with a relative risk of 1.98 for overall fracture and a relative risk as high as 7 for fractures at the hip, in a Danish population.
In accordance with international guidelines the Danish Board of Health recommends that the treatment of AN is centralized and built around specialized teams, and recommends a formal collaboration between psychiatric and somatic departments. Centre for Eating Disorders at Odense University Hospital (OUH) has since 1993 used a well-described two-track treatment program. Treatment includes psychotherapy, somatic control and nutritional rehabilitation. Treatment is aimed at nutritional status, eating behaviour and underlying psychological problems, and the centre deals with somatic critically ill patients as well.
The aim of the study is to evaluate the first 10 years of the described treatment initiative, in terms of outcome, mortality and purging behaviour. Psychometric and anthropometric data obtained at follow-up, allows for assessment of the relation between quality of life, eating disorder symptoms and treatment outcome, and the relationship between body composition, menstrual status and bone fractures.
Description of the cohort
Consecutive patients admitted from January 1st, 1994 to December 31st, 2004 at the specialized ED-unit at Odense University Hospital, Denmark, were included in the study. Our clinic is the only specialized facility for EDs in the county and serves as the primary referral centre for patients living on the island of Funen, which has almost 500,000 inhabitants (9.7% of the total Danish population) whose demographic and socioeconomic profile resembles that of the general Danish population. The multidisciplinary centre was established in 1994 as an interdisciplinary cooperation between endocrinologists, paediatricians and psychiatrists. In this study the diagnostic categories were converted into the terminology of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition.
All patients included in the cohort were invited to a follow-up assessment between 2007 and 2010.Data and biological material
Data obtained from medical charts
- Information on referral (1994-2004): Age, height, weight, gender, diagnosis, duration of disease, age at onset, purging behaviour, comorbidity, drug abuse, home weighing, parents socioeconomic status.
- Information at end of study (2004): Treatment status, duration of treatment, number and duration of admittances, minimum weight during treatment, home weighing, remission, socioeconomic status
Data obtained from questionnaires (2007-2010)
- SF-36: Health-related quality of life
- EDI-2: Assessment of symptom load in eating disorders
- MROS: Patient-reported outcome measure based on body image, eating behaviour, menstrual status and psychosocial factors.
Data obtained from registers (2014-2015)
- Mortality. Data obtained from the Danish Register of Causes of Death.
- Occurrence of fractures. Obtained from the Danish Nationwide Patient Registry (LPR)
Anthropometric data (2007-2010)
- Dual Energy X-ray Absorptiometry (DXA) scan: Weight, bone mineral density (BMD) at hip and lumbar spine, fat mass, lean body mass, fat percentage
Biological material
- No biological material was collected
Collaborating researchers and departments
Department of Endocrinology, Odense University Hospital
- Associate professor René Klinkby Støving, MD, PhD
- Laura Al-Dakhiel Winther, MD
- Jacob Stampe Frølich, MD
Department of Child & Adolescent Psychiatry, Psychiatry in the Region of Southern Denmark
- Kirsten Hørder, MD
Publications associated with the project