Anorexia nervosa mortality in Northeast Scotland, 1965-1999.

OBJECTIVE: Most previous studies of mortality in anorexia nervosa patients have shown an increased risk of premature death but have been limited by methodological constraints. This study aimed to overcome some of these constraints by having a large original sample size, diagnosis confirmed by case note review, a long duration of follow-up, and a clear base population. METHOD: The authors identified 524 anorexia nervosa cases seen in specialist services in Northeast Scotland; anorexia nervosa diagnosis was confirmed by scrutinizing case notes. Those who had died were identified from the National Health Service register or register of deaths. The death rates and causes of death were analyzed. RESULTS: Twenty-three patients died, giving a crude death rate of 4.4% and a standardized mortality rate of 3.3 (95% CI=2.2-4.9). In only one-third of the cases was anorexia nervosa on the death certificate, but an eating disorder or other psychiatric pathology probably contributed to several of the other deaths. Older age at the time the patient was seen at the specialist service was the only identifiable risk factor in the group of patients who died. The median length of time between diagnosis and death was 11 years. CONCLUSIONS: Anorexia nervosa is associated with increased risk of premature death. It is possible that death rates could be reduced by early diagnosis and by long-term specialist care.

Predictors of micronutrient status in men and women over 75 years old living in the community.

Serum ferritin, serum vitamin B12, erythrocyte folate, plasma vitamin C and plasma 25-hydroxycholecalciferol levels were measured in 208 men and 197 women, >75 years old and living in the community, in order to assess micronutrient status. Anthropometric measurements (height, weight, demispan and mid-upper arm circumference) were made and a 114-item questionnaire covering a wide range of health and diet-related topics was administered by an interviewer. Only 4 % of subjects had a BMI <20, but the prevalence of marginal deficiency of the micronutrients ranged from 7 % for Fe to 47 % for vitamin D. There was no association between low micronutrient status (defined as being in the lowest third of the distribution of micronutrient status) and having BMI or mid-upper arm circumference in the lowest third of the distribution for any of the nutrients. Leaving food on the plate was strongly associated with both low Fe status and low vitamin D status. Having breakfast cereal less than once per week was strongly associated with low folate status, while having fresh fruit juice less than once per week, having had less than two portions of fruits and vegetables the previous day and believing that food is not important for health were strongly associated with low vitamin C status. Low vitamin D status was strongly associated with a wide range of general health and disability measures. Having a weekly household income of less than pound 150 was associated with low status of Fe, folate, vitamin C and vitamin D.