Descriptives and genetic correlates of eating disorder diagnostic transitions and presumed remission in the Danish registry

Abstract

Objective: Eating disorders (EDs) are serious psychiatric disorders with an estimated 3.3 million healthy life-years lost worldwide yearly. Understanding the course of illness, diagnostic transitions and remission, and their associated genetic correlates could inform both ED etiology and treatment. The authors investigated occurrences of ED transitions and presumed remission and their genetic correlates as captured by polygenic scores (PGSs) in a large Danish register-based cohort.

Methods: The sample compromised of 10,565 individuals with a diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (EDNOS) with at least two registered hospital contacts between 1995 and 2018. Based on medical records, occurrence of diagnostic transitions and periods of presumed remission were identified. Associations between 422 PGS and diagnostic transitions and presumed remission were evaluated using Cox proportional hazard models.

Results: A minority of ED cases (14.1%-23.1%) experienced a diagnostic transition. Presumed remission ranged between 86.9%-89.8%. Higher (one SD increase) PGS for major depressive disorder and multisite chronic pain were positively associated with transitioning from AN to either BN or EDNOS. Higher PGS on a measure of body fat percentage and financial difficulties were positively associated with presumed remission from AN. Higher PGS for mood swings was positively associated with presumed remission from EDNOS whereas higher PGS for health rating showed the opposite.

Conclusions: The authors found that most ED patients did not experience diagnostic transitions but were more likely to experience a period of presumed remission. Both diagnostic transitions and presumed remission have significant polygenic component.

Keywords: anorexia nervosa; bulimia nervosa; diagnostic transition; eating disorders; polygenic risk scores; remission.

Figure 1:

Associations between polygenic scores (PGS) and eating disorder (ED) diagnostic transition and remission. Depicted are the associations that remained significant after correcting for multiple hypothesis testing. Associations are depicted in hazard ratios (HR) per one standard deviation (SD) increase in the PGS with dots representing the HR point estimate and the line depicting the 95% confidence interval A. Associations of PGS with transitioning from AN to BN or EDNOS. B. Associations of PGS with ED presumed remission.