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1、CeliacDiseaseandAnorexiaNervosa:ANationwideStudyKarlMårild,MD,PhD,a,bKetilStørdal,MD,PhD,a,cCynthiaM.Bulik,PhD,d,e,fMarianRewers,MD,PhD,bAndersEkbom,MD,PhD,gEdwinLiu,MD,bJonasF.Ludvigsson,MD,PhDd,h,i,jBACKGROUNDANDOBJECTIVE:Previousresearchsuggestsanassociationofceliacdisease(CD)
2、withabstractanorexianervosa(AN),butdataaremostlylimitedtocasereports.WeaimedtodeterminewhetherCDisassociatedwiththediagnosisofAN.METHODS:Register-basedcohortandcase-controlstudyincludingwomenwithCD(n=17 959)andsex-andage-matchedpopulation-basedcontrols(n=89 379).CD(villousatrophy
3、)wasidentifiedthroughthehistopathologyrecordsofSweden’s28pathologydepartments.Inpatientandhospital-basedoutpatientrecordswereusedtoidentifyAN.HazardratiosforincidentANdiagnosiswereestimatedbyusingstratifiedCoxregressionwithCDdiagnosisasatime-dependentexposurevariable.Intheseconda
4、ryanalyses,weusedconditionallogisticregressiontoestimateoddsratiosforbeingdiagnosedwithANbeforeCD.RESULTS:MedianageofCDdiagnosiswas28years.During1 174 401person-yearsoffollow-up,54patientswithCDwerediagnosedwithAN(27/100 000person-years)comparedwith180matchedcontrols(18/100 000pe
5、rson-years).ThehazardratioforlaterANwas1.46(95%confidenceinterval[CI],1.08–1.98)and1.31beyondthefirstyearafterCDdiagnosis(95%CI,0.95–1.81).ApreviousANdiagnosiswasalsoassociatedwithCD(oddsratio,2.18;95%CI,1.45–3.29).Estimatesremainedlargelyunchangedwhenadjustedforsocioeconomicchar
6、acteristicsandtype1diabetes.CONCLUSIONS:ThebidirectionalassociationbetweenANdiagnosisandCDwarrantsattentionintheinitialassessmentandfollow-upoftheseconditionsbecauseunderdiagnosisandmisdiagnosisofthesedisorderslikelycauseprotractedandunnecessarymorbidity.WhaT’sKnOWnOnThIssubjecT:
7、CasereportsaDivisionofEpidemiology,NorwegianInstituteofPublicHealth,Oslo,Norway;bBarbaraDavisCenter,UniversityofColorado,Aurora,Colorado;cDepartmentofPediatrics,ØstfoldHospitalTrust,Grålum,Norway;dDepartmentsuggestanassociationofceliacdiseasewithofMedicalEpidemiologyandBiostatist
8、icsandgClinicalEpidemiologyUnit,Departme
