Immune-mediated gut problems tied to eating disorders

People with immune-mediated gastrointestinal (GI) disease, especially children, are more prone to eating disorders, as shown in a study.

Analysis of data from the Ontario Health Administrative Database Study showed an increased incidence of eating disorders following a diagnosis of any immune-mediated GI disease (incidence rate ratio [IRR], 1.99, 95 percent confidence interval [CI], 1.60–2.48; p<0.001). This was true for Crohn’s disease (IRR, 1.79, 95 percent CI, 1.26–2.53; p<0.001), ulcerative colitis (IRR, 2.14, 95 percent CI, 1.40–3.27; p<0.001), and celiac disease (IRR, 2.14, 95 percent CI, 1.44–3.18; p<0.001), reported principal investigator Dr Lakshmi Subramanian of Queen’s University, Kingston, Ontario, Canada. [Subramanian L, et al, PAS 2024]

Notably, the incidence rate of eating disorders was much higher in the paediatric group (≤18 years of age) who had any immune-mediated GI disease (IRR, 2.65, 95 percent CI, 1.88–3.73; p<0.001), including Crohn’s disease (IRR, 2.31, 95 percent CI, 1.26–4.23; p=0.007), ulcerative colitis (IRR, 3.95, 95 percent CI, 1.60–9.78; p=0.003), and celiac disease (IRR, 2.57, 95 percent CI, 1.56–4.23; p<0.001), Subramanian added.

In adjusted Cox proportional models, immune-mediated GI diseases were associated with a more than twofold increase in the risk of incident eating disorders among children. The corresponding hazard ratios (HRs) were 2.62 (95 percent CI, 1.85–3.70) for any immune-mediated GI disease (p<0.001), 2.17 (95 percent CI, 1.18–3.99) for Crohn’s disease (p=0.013), and 2.59 (95 percent CI, 1.55–4.32) for any immune-mediated GI disease (p<0.001).

“The [risk of eating disorders] was particularly significant for paediatric patients with ulcerative colitis,” where there was a more than fourfold risk increase (4.11, 95 percent CI, 1.64–10.31; p=0.003), according to Subramanian.

Crohn’s disease, ulcerative colitis, and celiac disease have been on the rise in the North American communities. These diseases are lifelong and often require very strict dietary regimens, thus leading to a disordered eating pattern and consequently eating disorders, Subramanian pointed out.

The incidence of eating disorders peaks in adolescence, with the management of these disorders carrying significant healthcare and economic costs, she said. Individuals with these disorders also have a higher mortality rate than the general population.

“Thus, there is a need to develop clinical strategies for early screening and detection of eating disorders,” particularly in the high-risk paediatric population, according to Subramanian.

The Ontario Health Administrative Database Study included 251,696 participants, of which 83,920 had a diagnosis of an immune-mediated GI disorder (median age at index date 32.0 years, 54.5 percent female). The mean interval between the diagnosis of the GI disorder and that of the eating disorder was 60.9 months.

Subramanian acknowledged the diagnostic and procedural codes to identify celiac disease and eating disorders from the healthcare database have not been validated. This was a limitation of the current study.