Eating disorders (EDs) are known to be associated with high mortality and often chronic and severe course, but a recent comprehensive systematic review of their outcomes is currently missing. In the present systematic review and meta-analysis, we examined cohort studies and clinical trials published between 1980 and 2021 that reported, for DSM/ICD-defined EDs, overall ED outcomes (i.e., recovery, improvement and relapse, all-cause and ED-related hospitalization, and chronicity); the same outcomes related to purging, binge eating and body weight status; as well as mortality. We included 415 studies (N=88,372, mean age: 25.7±6.9 years, females: 72.4%, mean follow-up: 38.3±76.5 months), conducted in persons with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified feeding and eating disorders (OSFED), and/or mixed EDs, from all continents except Africa. In all EDs pooled together, overall recovery occurred in 46% of patients (95% CI: 44-49, n=283, mean follow-up: 44.9±62.8 months, no significant ED-group difference). The recovery rate was 42% at <2 years, 43% at 2 to <4 years, 54% at 4 to <6 years, 59% at 6 to <8 years, 64% at 8 to <10 years, and 67% at ≥10 years. Overall chronicity occurred in 25% of patients (95% CI: 23-29, n=170, mean follow-up: 59.3±71.2 months, no significant ED-group difference). The chronicity rate was 33% at <2 years, 40% at 2 to <4 years, 23% at 4 to <6 years, 25% at 6 to <8 years, 12% at 8 to <10 years, and 18% at ≥10 years. Mortality occurred in 0.4% of patients (95% CI: 0.2-0.7, n=214, mean follow-up: 72.2±117.7 months, no significant ED-group difference). Considering observational studies, the mortality rate was 5.2 deaths/1,000 person-years (95% CI: 4.4-6.1, n=167, mean follow-up: 88.7±120.5 months; significant difference among EDs: p<0.01, range: from 8.2 for mixed ED to 3.4 for BN). Hospitalization occurred in 26% of patients (95% CI: 18-36, n=18, mean follow-up: 43.2±41.6 months; significant difference among EDs: p<0.001, range: from 32% for AN to 4% for BN). Regarding diagnostic migration, 8% of patients with AN migrated to BN and 16% to OSFED; 2% of patients with BN migrated to AN, 5% to BED, and 19% to OSFED; 9% of patients with BED migrated to BN and 19% to OSFED; 7% of patients with OSFED migrated to AN and 10% to BN. Children/adolescents had more favorable outcomes across and within EDs than adults. Self-injurious behaviors were associated with lower recovery rates in pooled EDs. A higher socio-demographic index moderated lower recovery and higher chronicity in AN across countries. Specific treatments associated with higher recovery rates were family-based therapy, cognitive-behavioral therapy (CBT), psychodynamic therapy, and nutritional interventions for AN; self-help, CBT, dialectical behavioral therapy (DBT), psychodynamic therapy, nutritional and pharmacological treatments for BN; CBT, nutritional and pharmacological interventions, and DBT for BED; and CBT and psychodynamic therapy for OSFED. In AN, pharmacological treatment was associated with lower recovery, and waiting list with higher mortality. These results should inform future research, clinical practice and health service organization for persons with EDs.

中文翻译：

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饮食失调患者的结果：跨诊断和特定疾病的系统评价、荟萃分析和多变量荟萃回归分析


众所周知，饮食失调 (ED) 与高死亡率相关，而且往往是慢性和严重的病程，但目前缺乏对其结果的最新全面系统评价。在本系统回顾和荟萃分析中，我们检查了 1980 年至 2021 年间发表的队列研究和临床试验，这些研究报告了 DSM/ICD 定义的 ED 的总体 ED 结果（即恢复、改善和复发、全因和 ED） -相关的住院治疗和慢性病）；与清除、暴饮暴食和体重状况相关的相同结果；以及死亡率。我们纳入了 415 项研究（N=88,372，平均年龄：25.7±6.9 岁，女性：72.4%，平均随访时间：38.3±76.5 个月），研究对象为神经性厌食症 (AN)、神经性贪食症 (BN)、暴食症患者饮食失调 (BED)、其他特定喂养和饮食失调 (OSFED) 和/或混合 ED，来自除非洲以外的所有大陆。在所有 ED 汇总中，46% 的患者总体康复（95% CI：44-49，n=283，平均随访时间：44.9±62.8 个月，ED 组无显着差异）。 <2年恢复率为42%，2至<4年恢复率为43%，4至<6年恢复率为54%，6至<8年恢复率为59%，8至<10年恢复率为64%，67%为≥10年。 25% 的患者出现总体慢性化（95% CI：23-29，n=170，平均随访时间：59.3±71.2 个月，ED 组无显着差异）。慢性病发生率在<2年时为33%，在2至<4年时为40%，在4至<6年时为23%，在6至<8年时为25%，在8至<10年时为12%，在8至<10年时为12%，以及18%。 ≥10年。 0.4% 的患者死亡（95% CI：0.2-0.7，n=214，平均随访时间：72.2±117.7 个月，ED 组无显着差异）。考虑到观察性研究，死亡率为 5.2 例死亡/1,000 人年（95% CI：4.4-6.1，n=167，平均随访：88.7±120。5个月; ED 之间的显着差异：p<0.01，范围：从混合 ED 的 8.2 到 BN 的 3.4。 26% 的患者住院（95% CI：18-36，n=18，平均随访时间：43.2±41.6 个月；急诊科之间的显着差异：p<0.001，范围：AN 的 32% 到 AN 的 4%国阵）。关于诊断迁移，8% 的 AN 患者迁移至 BN，16% 迁移至 OSFED； 2% BN 患者迁移至 AN，5% 迁移至 BED，19% 迁移至 OSFED； 9% 的 BED 患者迁移至 BN，19% 迁移至 OSFED； 7% 的 OSFED 患者迁移至 AN，10% 迁移至 BN。儿童/青少年在急诊科内和急诊科内的结果比成人更有利。自残行为与合并急诊科的较低康复率相关。较高的社会人口指数减缓了各国 AN 的恢复速度较低和长期性较高的情况。与较高康复率相关的具体治疗方法包括针对 AN 的家庭治疗、认知行为治疗 (CBT)、心理动力学治疗和营养干预；自助、CBT、辩证行为疗法（DBT）、心理动力学疗法、BN的营养和药物治疗； CBT、营养和药物干预以及针对 BED 的 DBT； OSFED 的 CBT 和心理动力学治疗。在 AN 中，药物治疗与较低的康复率相关，而等待名单则与较高的死亡率相关。这些结果应该为未来的研究、临床实践和针对 ED 患者的健康服务组织提供信息。