Mortality and sudden death in anorexia nervosa

Area of Science:

• Psychiatry
• Neuroscience
• Public Health

Background:

• Mortality rates for anorexia nervosa (AN) are highly variable, ranging from 5% to 20%, with recent meta-analyses indicating a crude rate of 5.9%.
• Causes of death in AN patients are diverse, including suicide and sudden death, but often lack precise definition.
• Methodological issues in data recording and divergent definitions contribute to the variability in reported mortality data.

Purpose of the Study:

• To systematically analyze published findings on the clinical course, follow-up, outcome, prognosis, mortality, and sudden death in AN.
• To investigate the causes of variability in reported mortality rates and causes of death in AN.
• To explore potential etiological relationships between brain alterations and AN through neurohistological studies.

Main Methods:

• Systematic analysis of published literature on AN clinical course, prognosis, and mortality.
• Meta-analysis using linear regression to determine the crude mortality rate.
• Quantitative-neurohistological investigation of the brain in a deceased AN patient.

Main Results:

• A crude mortality rate of 5.9% for all causes of death in AN patients was determined via meta-analysis.
• Precise data on specific causes of death, including sudden death, remain limited.
• Somatic alterations, cardiac arrhythmia, and acute circulatory failure are implicated in sudden deaths in AN.

Conclusions:

• Accurate reporting of all AN deaths is crucial for understanding mortality causes.
• Neuroanatomic, neuropathological, and neurohistological studies, particularly of the right brain hemisphere, are recommended to determine etiological relationships.
• Preliminary neurohistological findings in a young female AN patient who died suddenly are presented.