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Mortality of Eating Disorders: A Follow-Up Study of Treatment in a Specialist Unit 1974-2000
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
2011 (English)In: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 44, no 4, 304-310 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To study excess mortality, causes of death, and co-morbidity in patients with eating disorder (ED), treated in a Swedish specialist facility. Method: A retrospective cohort study of 201 patients with ED followed from 1974 to year 2001 in the Swedish Causes of Death Register (SCODR). Standardized mortality ratio (SMR) was calculated with respect to the Swedish population, by gender, age, and calendar time. Results: In the complete follow-up of 201 patients, 23 had died. At a mean follow-up of 14.3 years the overall SMR was 10. Patients with body mass index (BMI) over 11.5 had an average SMR of about 7 and for those with BMI lower than 11.5 had SMR above 30. Six patients died from AN/starvation, nine due to suicide, and eight from other causes. Discussion: SMR in anorexia nervosa (AN) is high but not in bulimia nervosa. A risk stratification of AN, based on BMI is suggested.

Place, publisher, year, edition, pages
2011. Vol. 44, no 4, 304-310 p.
Keyword [en]
eating disorder, mortality, substance abuse, suicide, comorbidity
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-153288DOI: 10.1002/eat.20827ISI: 000289373900003PubMedID: 21472749OAI: oai:DiVA.org:uu-153288DiVA: diva2:416046
Available from: 2011-05-10 Created: 2011-05-10 Last updated: 2014-01-07Bibliographically approved
In thesis
1. Eating Disorders - Aspects of Treatment and Outcome
Open this publication in new window or tab >>Eating Disorders - Aspects of Treatment and Outcome
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Eating disorders (ED) usually develop during adolescence, and intervention to stop further weight loss is believed to improve outcome and long-term prognosis. Adolescents with ED who do not receive effective treatment risk poor outcome and even untimely death as adults.

The first aim of this thesis was to investigate long-term mortality and causes of death in a series of female adults with chronic ED. The second aim was to study the one-year outcome of an unselected series of adolescent girls with anorexia nervosa (AN) and “other restrictive eating disorders” who had been treated within a specialist ED out-patient service focused on nutritional rehabilitation based on family therapy and without planned hospitalization. The third aim was to investigate the possible metabolic and hormonal side effects of olanzapine when used as an adjunct to facilitate nutritional rehabilitation. The fourth aim was to investigate the relationship between polyunsaturated fatty acid (PUFA) status and depression.

In adult women with chronic ED, a very low body mass index and psychiatric co-morbidity confer a substantially increased risk of premature death.

A treatment programme for adolescent ED with rapid access to assessment and prompt start of treatment with initial emphasis on nutritional rehabilitation proved efficient. The outcome was encouraging, as 43% of all patients with ED and 19% of those with AN did not have an ED at one-year follow-up. Of the remaining patients the vast majority had gained weight and regained menstruation, and were back in school on a full-time basis. Olanzapine was used to reduce anxiety, excessive exercise and rumination over weight and shape. Side effects were similar to those observed in normal-weight individuals, and do not preclude its use in underweight adolescents with ED. Low ω3 PUFA were associated with depression. The ω3 PUFA status improved during nutritional rehabilitation with ordinary foods and without supplementation.

The investigations indicate that adolescent ED can be successfully treated in an out-/day-patient setting. An essential feature of the service is rapid handling and weight gain. Further weight loss can be avoided, and chronic disease hopefully prevented.



Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 67 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 916
Anorexia Nervosa, Eating Disorders, Mortality, Standard Mortality Ratio, Adolescent, Family-Based Treatment, Out-patient, Olanzapine, Omega-3
National Category
Research subject
Child and Youth Psychiatry
urn:nbn:se:uu:diva-204209 (URN)978-91-554-8706-5 (ISBN)
Public defence
2013-09-12, Rudbeck salen, Rudbeckslaboratoriet, ing. C, bv, Dag Hammarskjöldsväg 20, Uppsala, 09:15 (Swedish)
Available from: 2013-08-21 Created: 2013-07-24 Last updated: 2014-01-07Bibliographically approved

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