饮食失调对健康的影响复杂且持久。

　　

一项发表在开放获取期刊《BMJ Medicine》上的大型追踪研究发现，厌食症、贪食症和暴食症等饮食失调症对健康的影响不仅复杂，会影响许多不同的器官系统，而且是长期的。 

研究人员总结道，确诊后的前12个月内，发生糖尿病、肾衰竭、肝衰竭、骨折和过早死亡等严重疾病的风险尤其高。但这些风险会持续数年，因此，及时提供综合性的多学科医疗服务和持续监测以改善治疗效果至关重要。

研究人员指出，自新冠疫情限制措施实施以来，英国饮食失调症的发病率显著上升。他们补充说，虽然饮食失调症对身心健康的危害众所周知，但其长期影响却鲜为人知。

为了加强证据基础，研究人员仔细审查了 临床实践研究数据链接中的匿名医疗记录，这些记录与英格兰各地 20 年期间（1998 年至 2018 年）的医院就诊统计数据和死亡证明数据相关联。

研究人员对 24,709 名年龄在 10 至 44 岁之间、被诊断患有饮食失调症的人，按年龄、性别和全科医生诊所，与最多 20 名未患此类疾病的人（总共 493,001 人）进行匹配，并对他们的精神和身体健康状况进行了 10 年的跟踪研究。

样本中绝大多数（89%）为女性。在患有饮食障碍的人群中，14.5%（3577人）患有厌食症；20.5%（5085人）患有贪食症；5%（1215人）患有暴食症；60%（14832人）的饮食障碍类型未明确。

数据分析表明，饮食失调与身体和心理健康状况不佳以及过早死亡的风险显著升高有关。

在确诊后的第一年内，患有饮食失调症的人被诊断出肾衰竭的可能性是其他人的 6 倍，被诊断出肝病的可能性是其他人的近 7 倍，同时患骨质疏松症（风险高出 6 倍）、心力衰竭（风险高出 2 倍）和糖尿病（风险高出 3 倍）的风险也显著升高。

5 年后，肾衰竭和肝病的风险仍然高出 2.5 到近 4 倍，10 年后每 10,000 人中分别有 110 例和 26 例比预期多出。

Similarly, the risks of poor mental health were significantly higher 12 months after an eating disorder diagnosis: the risks of depression were 7 times higher, with 596 additional cases per 10,000 people, while those of self-harm were more than 9 times as high, with an additional 309 cases/10,000. And although they were lower, these heightened risks persisted after 5 years.

The risk of death from any cause within the first 12 months of diagnosis was also more

than 4 times as high, and for unnatural deaths, including suicide, it was 5 times as high. After 5 years, these risks were still 2 and 3 times higher, corresponding to 43/10,000 extra deaths from all causes and 184/100,000 extra deaths from unnatural causes.

And 10 years after diagnosis, the equivalent figures for additional deaths amounted to

95/10,000 and 341/100,000, respectively. The risk of suicide was nearly 14 times higher in the first year but was still nearly 3 times higher after 10 years, accounting for 169 additional deaths/100,000 people.

The researchers acknowledge that the medical records data didn’t include the severity of the eating disorder, making it impossible to link severity to worse outcomes.

But they say: “Our data describe the substantial long term effects of eating disorders and emphasise the potential opportunity for primary care to have a greater role in offering support and long term monitoring for individuals who are recovering from an eating disorder.”

They suggest: “A closer and more cohesive management approach in primary and specialist care may also be needed, for both physical (nephrology, cardiology, and endocrinology) and mental health services to provide this support.”

They add: “A potential gap exists in provision where patients' difficulties are too complex for low intensity brief interventions, but not complex enough for specialist teams.”

And they conclude:”Raising awareness among healthcare providers about the lasting effects of eating disorders and the need for ongoing support in managing current symptoms and recovery is essential.”

In a linked editorial, Dr Jennifer Couturier and Ethan Nella of McMaster University, Ontario, Canada, point out that despite the high prevalence of eating disorders, “their consequences are under-recognised.”

They add: “Earlier studies have illustrated the limited education given during medical training on the topic of eating disorders, and the current study emphasises the importance of disseminating this knowledge to all healthcare professionals.

“Medical education should place greater emphasis on the recognition and management of eating disorders, to equip primary care providers, specialists, and allied health professionals with the tools to identify early warning signs and monitor ongoing risks associated with eating disorders.”

他们总结道：“饮食失调会影响多个器官系统，因此需要整合各种护理才能充分治疗患者。这种情况使得初级保健提供者在领导和协调[他们的]护理方面处于理想的位置，并表明初级保健机构适合进行早期和持续的干预。”