Systematic Review and Meta-Analysis of Mortality in Patients With Anorexia Nervosa.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of longitudinal observational cohort studies
PubMed 41277145 · doi:10.1111/eat.70002
What was done
Researchers conducted a systematic review and random-effects meta-analysis of longitudinal studies published through May 2025 searching MEDLINE, PsycINFO, EMBASE, Web of Science, Dissertations and Theses A&I, and Google Scholar. The study assessed all-cause standardized mortality ratios (SMR) for anorexia nervosa (AN) relative to the general population, evaluated study bias using the Newcastle-Ottawa Scale, and conducted subgroup and meta-regression analyses comparing male- and female-specific cohorts.
What was found
Across 30 included studies involving 33,176 patients, the pooled all-cause SMR calculated from 22 studies was 5.06 (95% CI [3.47, 7.38]). Suicide and cardiac complications accounted for 21% and 19% of deaths, respectively. Lower mean baseline BMI was linked to higher SMR prior to multiple testing correction (p = 0.018; adjusted p = 0.252). Male-specific cohorts had a pooled SMR of 3.47 (95% CI [1.60, 7.52]), comparable to female-specific cohorts at 3.86 (95% CI [1.82, 8.20]).
Why it matters
This meta-analysis quantifies the severe excess mortality in anorexia nervosa as approximately five times that of the general population, emphasizing the need for targeted clinical monitoring of suicide risk and cardiac complications.
Limits
Studies reporting zero deaths were excluded, which could bias SMR estimates upward. The synthesized data exhibited substantial heterogeneity, relied primarily on specialist clinic samples rather than broad community populations, and underrepresented male and non-Western individuals.