Family history, weight gain predict anorexia course

NEW YORK (Reuters Health) - European researchers have identified five key factors that help predict whether a person with anorexia nervosa will need to be rehospitalized after undergoing inpatient treatment for the eating disorder.

Poor weight gain during the first hospital stay and a lower body mass index (BMI) at hospital discharge strongly predicted whether or not the patient would require another round of inpatient care, the researchers found.

And study participants with alcoholic fathers, those who had disordered eating during infancy, or those who engaged in excessive activity to control their weight were all more than twice as likely to require readmission to the hospital.

Many individuals with anorexia nervosa require repeated in-patient treatment, and there is evidence that shorter hospital stays and poor weight gain upon leaving the hospital could help drive the need for readmission, Dr. Hans-Christoph Steinhausen of the University of Zurich in Switzerland and colleagues note.

To further investigate factors that might predict rehospitalization, the researchers followed 212 patients treated at hospitals in former East and West Berlin; Zurich; Sofia, Bulgaria; and Bucharest, Romania. The patients were between 10 and 18 years old at their first hospital admission. During follow-up, which lasted an average of 8.3 years, about 45 percent required rehospitalization.

A family history of anorexia, having an alcoholic father, eating disorder in infancy, overactivity, lower weight gain during first hospital admission and lower BMI at first discharge were all associated with an increased risk of being rehospitalized, the researchers found.

By using five of these factors (all but a family history of anorexia), they were able to correctly classify whether or not 69 percent of the study participants would require readmission. Patients who had repeated admissions to the hospital had a worse long-term outcome, as well as more persistent psychological problems, the researchers found.

It's possible, Steinhausen and colleagues suggest, that paternal alcoholism and a family history of anorexia nervosa could indicate a genetic predisposition to more severe disease.

While the findings underscore the importance of adequate weight gain during hospitalization for treatment success, they write, they also show that weight gain alone may not be enough to keep patients with anorexia nervosa out of the hospital.

SOURCE: International Journal of Eating Disorders, January 2008.