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Electrolyte Disturbances a Harbinger of Eating Disorders?

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Electrolyte abnormalities may serve as a precursor to a future diagnosis of an eating disorder, a finding that may help identify candidates for screening.

Researchers found that adolescents and adults with electrolyte abnormalities during routine outpatient lab work were twice as likely as those without these disorders to later be diagnosed with an eating disorder.

“These electrolyte abnormalities were actually observed long before (>1 year on average) when the patients were diagnosed with eating disorders,” said study researcher Gregory Hundemer, MD, Department of nephrology, University of Ottawa in Ontario. Medscape Medical News.

“Electrolyte abnormalities discovered incidentally in outpatient settings may help identify individuals who may benefit from more targeted screening for an underlying eating disorder. This, in turn, may allow for more diagnostic and therapeutic intervention. early,” Hundemer said.

The study was published online November 8 in JAMA network open.

Tailor-made screening?

Electrolyte abnormalities are often found when a person is diagnosed with an eating disorder, but it is largely unknown whether electrolyte abnormalities before the acute presentation of an eating disorder are associated with the future diagnosis of an eating disorder. eating disorder.

To investigate, the researchers used administrative health data to match 6,970 people (mean age, 28 years; 13% male) with an eating disorder diagnosis to 27,878 controls without a disorder diagnosis. food.

They found that people with an eating disorder were more likely to have a previous electrolyte abnormality than their peers without an eating disorder (18.4% versus 7.5%).

An outpatient electrolyte abnormality present 3 years to 30 days before diagnosis was associated with an approximately two-fold increased odds of later diagnosis of an eating disorder (adjusted odds ratio, 2.12; 95% CI, 1. 86 – 2.41).

The median time from first electrolyte abnormality to diagnosis of an eating disorder was 386 days (range 157 to 716 days).

Hypokalemia was the most common electrolyte abnormality (present in 12% of cases versus 5% of controls), while hyponatremia, hypernatremia, hypophosphatemia, and metabolic alkalosis were the most specific for diagnosis. subsequent eating disorder.

Severe hypokalemia (serum potassium level 3.0 mmol/L or less) and severe hyponatremia (serum sodium 128 mmol/L or less) were associated with more than seven-fold and five-fold increased odds for diagnosis of an eating disorder, respectively.

As previously reported by Medscape Medical NewsThe US Preventive Services Task Force (USPSTF) released its first-ever statement on eating disorder screening earlier this year.

The task force concluded that there is insufficient evidence to assess the balance between the benefits and harms of screening for eating disorders in adolescents and adults with no signs or symptoms of eating disorders. an eating disorder or concerns about their eating and who have not previously been diagnosed with an eating disorder. disorder.

Hundemer and his colleagues believe that an accidental electrolyte abnormality can identify high-risk candidates for an underlying eating disorder, many of whom benefit from screening.

Several screening tools of varying complexity have been developed that are validated and accurate in identifying people with a potential eating disorder.

They include the SCOFF questionnaire, the Eating Disorder Screen for Primary Care, the Eating Attitudes Test and the Primary Care Evaluation of Mental Disorders Patient Health Questionnaire.

Underdiagnosed, undertreated

Offering perspective on the findings, Kamryn T. Eddy, PhD, co-director, Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, said the notion “that a physical sign can help promote the assessment of eating disorders is important, especially since early detection can improve outcomes.”

“But this finding appears in the current context of eating disorders that are vastly under-detected, under-diagnosed, and under-treated in medical and psychiatric settings,” said Eddy, associate professor, Department of Psychiatry, Harvard Medical School.

“Indeed, eating disorders are widespread and cut across age, gender, gender, weight, race, ethnicity and socioeconomic strata and yet many providers do not assess eating disorders consistently,” Eddy said.

“I might suggest that perhaps in addition to letting electrolyte abnormalities be a signal to screen for eating disorders, an even more powerful shift towards routine screening and assessment of eating disorders by providers medical be done,” Eddy said. Medscape Medical News.

This study was supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and the Ministry of Health and Long-Term Care (MOHLTC). Hundemer and Eddy did not disclose any relevant financial relationship.

JAMA Netw Open. 2022;5(11):e2240809. Full Text

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