Mayo Clinic Proceedings study finds little variance in survival

A long-term study of patients in Rochester, Minn., with the eating disorder anorexia nervosa found that their survival rates did not differ from the expected survival rates of others of the same age and sex.

The results, published in the March issue of Mayo Clinic Proceedings, add to the knowledge of anorexia nervosa and point to other areas that need greater study from researchers.

“Although our data suggest that overall mortality is not increased among community patients with anorexia nervosa in general, these findings should not lead to complacency in clinical practice because deaths do occur,” says L. Joseph Melton, III, M.D., Mayo Clinic epidemiologist and an author of the report.

Dr. Melton notes the need for more research to define the association of suicide and alcoholism in patients with anorexia nervosa.

Many clinical studies of patients with anorexia nervosa have reported higher death rates, due to the fact that many patients studied are at tertiary care centers, where their disease is more advanced than those seen in a primary care setting, such as many of the patients studied in the Mayo Clinic study.

To obtain a more representative picture, Mayo Clinic researchers examined the survival of a population-based cohort of residents in Rochester, who met diagnostic criteria for anorexia nervosa from 1935 to 1989 and who were monitored for up to 63 years. Patient records were reviewed using the Rochester Epidemiology Project.

Of the 208 patients (193 women and 15 men) studied, one woman died of complications of anorexia nervosa, two women committed suicide and six patients (five women and one man) died of complications of alcoholism.

“More research is needed to define the association of suicide and alcoholism in patients with anorexia nervosa,” Dr. Melton said. “Early recognition of anorexia nervosa and its appropriate treatment are warranted.”

The study was supported in part by a research grant from the National Institutes of Health, U.S. Public Health Service.

In an editorial in the same issue of Mayo Clinic Proceedings, Patrick Sullivan, M.D., of the Departments of Genetics and Psychiatry, Carolina Center for Genome Sciences at the University of North Carolina at Chapel Hill, writes that the study advances the knowledge of the long-term consequences of anorexia nervosa.

“It adds to the impressive body of work on the epidemiology of eating disorders in Rochester, Minn.,” Dr. Sullivan writes. He said the study raises a number of questions that further studies need to address about patients with anorexia nervosa.

“However, the value of their study is twofold. It seems increasingly clear that anorexia nervosa exists along a spectrum,” Dr. Sullivan writes. “This distinction is not captured by the criteria generally used for classifying anorexia nervosa. In addition, it seems plausible that prognosis varies with illness severity.”