Abstract：
BACKGROUND: Eating disorders (ED) are severe psychiatric disorders, commonly debuting early. Aberrances in the intrauterine environment and at birth have been associated with risk of ED. Here, we explore if, and at what effect size, a variety of such exposures associate with offspring ED, that is, anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS).
METHODS: This population-based cohort study, conducted from September 2021 to August 2023, used Finnish national registries of all live births in 1996-2014 (N = 1,097,753). Cox proportional hazards modeling was used to compare ED risk in exposed versus unexposed offspring, adjusting for potential confounders and performing sex-stratified analyses.
RESULTS: A total of 6614 offspring were diagnosed with an ED; 3668 AN, 666 BN, and 4248 EDNOS. Lower risk of offspring AN was seen with young mothers, continued smoking, and instrumental delivery, while higher risk was seen with older mothers, inflammatory disorders, prematurity, small for gestational age, and low Apgar. Offspring risk of BN was higher with continued smoking and prematurity, while lower with postmature birth. Offspring risk of EDNOS was lower with instrumental delivery, higher for older mothers, polycystic ovary syndrome, insulin-treated pregestational diabetes, antibacterial treatment, prematurity, and small for gestational age. Sex-specific associations were found.
CONCLUSIONS: Several prenatal and at birth exposures are associated with offspring ED; however, we cannot exclude confounding by maternal BMI. Nevertheless, several exposures selectively associate with risk of either AN, BN, or EDNOS, and some are sex-specific, emphasizing the importance of subtype- and sex-stratified analyses of ED.
UNASSIGNED: We define environmental factors involved in the development of different ED, of importance as preventive measure, but also in order to aid in defining the molecular pathways involved and thus in the longer perspective contribute to the development of pharmacological treatment of ED.
METHODS: This population-based cohort study, conducted from September 2021 to August 2023, used Finnish national registries of all live births in 1996-2014 (N = 1,097,753). Cox proportional hazards modeling was used to compare ED risk in exposed versus unexposed offspring, adjusting for potential confounders and performing sex-stratified analyses.
RESULTS: A total of 6614 offspring were diagnosed with an ED; 3668 AN, 666 BN, and 4248 EDNOS. Lower risk of offspring AN was seen with young mothers, continued smoking, and instrumental delivery, while higher risk was seen with older mothers, inflammatory disorders, prematurity, small for gestational age, and low Apgar. Offspring risk of BN was higher with continued smoking and prematurity, while lower with postmature birth. Offspring risk of EDNOS was lower with instrumental delivery, higher for older mothers, polycystic ovary syndrome, insulin-treated pregestational diabetes, antibacterial treatment, prematurity, and small for gestational age. Sex-specific associations were found.
CONCLUSIONS: Several prenatal and at birth exposures are associated with offspring ED; however, we cannot exclude confounding by maternal BMI. Nevertheless, several exposures selectively associate with risk of either AN, BN, or EDNOS, and some are sex-specific, emphasizing the importance of subtype- and sex-stratified analyses of ED.
UNASSIGNED: We define environmental factors involved in the development of different ED, of importance as preventive measure, but also in order to aid in defining the molecular pathways involved and thus in the longer perspective contribute to the development of pharmacological treatment of ED.
摘要：
背景：进食障碍（ED）是严重的精神疾病，通常在早期首次亮相。宫内环境和出生时的异常与ED的风险有关。这里,我们探索，在什么影响大小下，各种这样的暴露与后代ED有关，也就是说,神经性厌食症（AN），神经性贪食症（BN），和饮食失调没有另有规定（EDNOS）。
方法：这项基于人群的队列研究，从2021年9月至2023年8月进行，使用了1996-2014年所有活产的芬兰国家登记册(N=1,097,753)。Cox比例风险模型用于比较暴露和未暴露后代的ED风险。调整潜在的混杂因素并进行性别分层分析。
结果：共有6614个后代被诊断患有ED；3668AN，666BN,和4248EDNOS。年轻母亲的后代AN风险较低，继续吸烟,和仪器输送，虽然老年母亲的风险更高，炎症性疾病，早产,小于胎龄，低Apgar持续吸烟和早产的后代BN风险较高，而早产较低。EDNOS的后代风险在器械递送下较低，对于年长的母亲来说更高，多囊卵巢综合征,胰岛素治疗的孕前糖尿病，抗菌治疗,早产,而且小于胎龄。发现了性别特异性关联。
结论：几种产前和出生时暴露与后代ED有关；然而，我们不能排除孕妇BMI的混淆.然而，几种风险敞口选择性地与任一AN的风险相关联，BN,或者EDNOS,有些是性别特定的，强调对ED进行分类和性别分层分析的重要性。
■我们定义了参与不同ED发展的环境因素，作为预防措施的重要性，而且为了帮助定义所涉及的分子途径，因此从长远来看，有助于ED的药理治疗的发展。
方法：这项基于人群的队列研究，从2021年9月至2023年8月进行，使用了1996-2014年所有活产的芬兰国家登记册(N=1,097,753)。Cox比例风险模型用于比较暴露和未暴露后代的ED风险。调整潜在的混杂因素并进行性别分层分析。
结果：共有6614个后代被诊断患有ED；3668AN，666BN,和4248EDNOS。年轻母亲的后代AN风险较低，继续吸烟,和仪器输送，虽然老年母亲的风险更高，炎症性疾病，早产,小于胎龄，低Apgar持续吸烟和早产的后代BN风险较高，而早产较低。EDNOS的后代风险在器械递送下较低，对于年长的母亲来说更高，多囊卵巢综合征,胰岛素治疗的孕前糖尿病，抗菌治疗,早产,而且小于胎龄。发现了性别特异性关联。
结论：几种产前和出生时暴露与后代ED有关；然而，我们不能排除孕妇BMI的混淆.然而，几种风险敞口选择性地与任一AN的风险相关联，BN,或者EDNOS,有些是性别特定的，强调对ED进行分类和性别分层分析的重要性。
■我们定义了参与不同ED发展的环境因素，作为预防措施的重要性，而且为了帮助定义所涉及的分子途径，因此从长远来看，有助于ED的药理治疗的发展。
