Risk of somatic diseases in patients with eating disorders: the role of comorbid substance use disorders

Abstract

Aims Eating disorders (EDs) and substance use disorders (SUDs) often co-occur, and both involve somatic diseases. So far, no study has considered whether comorbid SUDs may impact somatic disease risk in patients with EDs. Therefore, this study aimed to examine the impact of comorbid SUDs on the risk of 11 somatic disease categories in patients with anorexia nervosa (AN), bulimia nervosa (BN) and unspecified eating disorder (USED) compared to matched controls. Methods A retrospective cohort study was conducted using Danish nationwide registries. The study population included 20 759 patients with EDs and 83 036 controls matched on month and year of birth, sex and ethnicity. Hazard ratios (HRs) were calculated to compare the risk of being diagnosed with a somatic disease (within 11 categories defined by the ICD-10) following first ED diagnosis (index date) between ED patients and controls both with and without SUDs (alcohol, cannabis or hard drugs). Results The ED cohort and matched controls were followed for 227 538 and 939 628 person-years, respectively. For ED patients with SUDs, the risk pattern for being diagnosed with different somatic diseases (relative to controls without SUDs) varied according to type of ED and SUD [adjusted HRs ranged from 0.95 (99% CI = 0.57; 1.59) to 4.17 (2.68, 6.47)]. The risk estimates observed among ED patients with SUDs were generally higher than those observed among ED patients without SUDs [adjusted HRs ranged from 1.08 (99% CI = 0.95, 1.22) to 2.56 (2.31, 2.84)]. Abuse of alcohol only had a non-synergistic effect on six disease categories in AN patients and five in BN and USED patients. Abuse of cannabis (with/without alcohol) had a non-synergistic effect on five disease categories in AN and BN patients and two in USED patients. Abuse of hard drugs (with/without alcohol or cannabis) had a non-synergistic effect on nine disease categories in AN patients, eight in BN patients and seven in USED patients. Conclusions The present study documents non-synergistic but not synergistic harmful somatic consequences of SUDs among patients with different EDs, with AN and hard drugs being the most predominant factors. Hence, EDs and SUDs did not interact and result in greater somatic disease risk than that caused by the independent effects. Since EDs and SUDs have independent effects on many somatic diseases, it is important to monitor and treat ED patients for SUD comorbidity to prevent exacerbated physical damage in this vulnerable population.

Clinical and Peripheral Biomarkers in Female Patients Affected by Anorexia: Does the Neutrophil/Lymphocyte Ratio (NLR) Affect Severity?

“…Our finding is consistent with previous literature reporting that the risk of substance use disorders in AN is influenced by subtype (i.e., it is more prevalent in the bingeeating/purge type than in restrictive type) [73] and by severity of symptoms, particularly in adolescents and for alcohol misuse [74]. The comorbidity of substance use disorders in subjects affected by AN is associated with a worse prognosis and an increased risk of somatic diseases and mortality [75,76].…”

Clinical Factors Associated with Binge-Eating Episodes or Purging Behaviors in Patients Affected by Eating Disorders: A Cross-Sectional Study

“…Particularly, the connection between binge eating and SUDs has been extensively studied and demonstrated in various countries [ 61 , 62 , 63 ], suggesting that these two disorders may share underlying neurobiological mechanisms regardless of food availability. Importantly, the impact of SUDs on mortality rates in EDs appears to be additive compared to control subjects without SUDs [ 64 ], and the comorbidity between EDs and SUDs increases the risk for somatic diseases beyond the effects of each disorder independently [ 65 ]. It is noteworthy that drugs and food have different neurobiological effects, with drugs having a more pronounced impact than food on neurobiological processes [ 66 ].…”