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Review
. 2023 Sep 20;11(1):163.
doi: 10.1186/s40337-023-00882-0.

Systematic review of prospective studies assessing risk factors to predict anorexia nervosa onset

Jean-Philippe Charrat  1   2 , Catherine Massoubre  3   4   5 , Natacha Germain  3   4   5 , Aurélia Gay  3   6 , Bogdan Galusca  3   4   5
Affiliations
Review

Systematic review of prospective studies assessing risk factors to predict anorexia nervosa onset

Jean-Philippe Charrat et al. J Eat Disord. .

Abstract

Background: According to case‒control studies, a multitude of factors contribute to the emergence of anorexia nervosa (AN). The present systematic review examines prospective studies specifically designed to evaluate the prediction of AN onset.

Methods: According to the ARMSTAR 2 and PRISMA 2020 checklists, the PubMed, PsycINFO and Cochrane databases were searched. The methodological quality of the studies was assessed with the Downs and Black checklist.

Results: Three articles concerning prospective studies of the general population were ultimately included in the review. The methodological quality of these studies was not optimal. Bidirectional amplification effects were observed between risk factors, some of which could have a relative predictive force as low bodyweight or body dissatisfaction. Even if not included according to specified criteria for this systematic review 11 longitudinal studies, with retrospective analysis of AN onset' prediction, were also discussed. None of these studies asserted the predictive value of particular risk factors as low body weight, anxiety disorders or childhood aggression.

Conclusions: To date there are insufficient established data to propose predictive markers of AN onset for predictive actions in pre-adolescent or adolescent populations. Future work should further evaluate potential risk factors previously identified in case‒control/retrospective studies within larger prospective investigations in preadolescent populations. It is important to clearly distinguish predisposing factors from precipitating factors in subjects at risk of developing AN.

Keywords: Anorexia nervosa; Predictors; Prospective studies; Risk factors; Systematic review.

Plain language summary

Currently health care guidelines for eating disorders do not include proposal of markers to predict the onset of anorexia nervosa. The current work provides a systematic review of the scientific literature concerning this subject. To date only three published studies were designed in a prospective longitudinal way to evaluate potential predictors of anorexia nervosa onset. When taking into account these studies only low bodyweight and body dissatisfaction in early puberty were proposed as predicting elements for further anorexia nervosa development. Meanwhile the prediction precision was calculated for none of them. No other psychological elements were retained or studied. The age range of the population entering the follow up in these studies was too large covering the peak age of anorexia nervosa itself (13–16 years of age). Larger prospective studies including prepubescent individual and evaluating more psychological markers (perfectionism, negative affectivity or negative self-evaluation) or environmental ones are needed.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Search strategy for the PubMed, PsycINFO and Cochrane databases
Fig. 2
Fig. 2
Study selection flow diagram for the current systematic literature review according to the PRISMA statement
See this image and copyright information in PMC

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