{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T15:31:35Z","timestamp":1770910295232,"version":"3.50.1"},"reference-count":29,"publisher":"BMJ","issue":"2","license":[{"start":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T00:00:00Z","timestamp":1770768000000},"content-version":"unspecified","delay-in-days":10,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004885","name":"Ume\u00e5 University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004885","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100014689","name":"Region V\u00e4sternorrland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100014689","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,1,28]]},"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To investigate the incidence, prevalence and mortality of anorexia nervosa (AN) among individuals with childhood-onset type 1 diabetes (T1D) compared with matched controls in Sweden.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective nationwide cohort study using linked registry data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Nationwide, Sweden; population-based registers (covering the period 1977\u20132019).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>12\u2009202 individuals diagnosed with T1D before age 15 years (5618 females; 6584 males) and 48\u2009484 age-matched, sex-matched and municipality-matched controls without diabetes (23\u2009618 females; 24\u2009866 males).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>AN diagnoses (International Classification of Diseases-10 codes F50.0 and F50.1) identified via the National Patient Register. Outcomes were period prevalence, point prevalence at ages 15 and 20 years, 10-year incidence rates and proportional mortality ratios (PMR), stratified by sex. ORs and incidence rate ratios (IRR) with 95% CIs were estimated using Mantel-Haenszel methods; Kaplan-Meier analysis compared time to AN diagnosis between groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The period prevalence of AN among females with T1D was 1.9% compared with 1.1% in controls (OR 1.64, 95%\u2009CI 1.31 to 2.06; p&lt;0.001). The 10-year incidence rate for females with T1D was 74.7 per 100\u2009000 person-years vs 45.2 per 100\u2009000 person-years in controls (IRR 1.77, 95%\u2009CI 1.35 to 2.32). Point prevalence at age 15 years was 0.87% (T1D) vs 0.53% (controls) (IRR 1.65, 95%\u2009CI 1.16 to 2.35), and at age 20 years was 1.73% (T1D) vs 1.11% (controls) (IRR 1.55, 95%\u2009CI 1.20 to 1.99). The PMR for females with both T1D and AN compared with controls without either condition was 20.4 (95% CI 6.6 to 47.6). Male cases were few (n=4 in the T1D group; n=12 in controls).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Females with childhood-onset T1D in Sweden have an elevated risk of AN and markedly higher mortality when both conditions are present. Despite the increased relative risk, the absolute risk of AN in females with T1D remained below 2%. These findings support routine screening for eating disorders in the T1D population, particularly among adolescent and young adult females.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-109015","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T14:40:31Z","timestamp":1770907231000},"page":"e109015","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Incidence, prevalence and mortality of anorexia nervosa in individuals with childhood-onset type 1 diabetes: a nationwide retrospective cohort study in Sweden"],"prefix":"10.1136","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2060-1914","authenticated-orcid":false,"given":"Magnus","family":"Sj\u00f6gren","sequence":"first","affiliation":[{"name":"National Highly Specialized Care for Severe Eating Disorders, Region V\u00e4sternorrland, Sundsvall, Sweden"},{"name":"Clinical Science, Psychiatry, Ume\u00e5 university, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erling","family":"Englund","sequence":"additional","affiliation":[{"name":"Department of Patient Safety, Development and Research, Region V\u00e4sternorrland, Sundsvall, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Axel \u00c5ke Elias","family":"Erlandsson","sequence":"additional","affiliation":[{"name":"Ume\u00e5 universitet Klinisk vetenskap, Umea, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"M\u00f6llsten","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Pediatrics, Ume\u00e5 University, Ume\u00e5, Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"key":"2026021206401871000_16.2.e109015.1","doi-asserted-by":"crossref","DOI":"10.1038\/s41467-025-60813-2","article-title":"Stable heritability of type 1 diabetes in a Swedish Nationwide Cohort Study","volume":"16","author":"Wei","year":"2025","journal-title":"Nat Commun"},{"key":"2026021206401871000_16.2.e109015.2","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-014-3225-9"},{"key":"2026021206401871000_16.2.e109015.3","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-022-05816-0"},{"key":"2026021206401871000_16.2.e109015.4","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1001\/jamapsychiatry.2015.2737","article-title":"Familial Liability for Eating Disorders and Suicide Attempts: Evidence From a Population Registry in Sweden","volume":"73","author":"Yao","year":"2016","journal-title":"JAMA Psychiatry"},{"key":"2026021206401871000_16.2.e109015.5","doi-asserted-by":"publisher","DOI":"10.1001\/archgenpsychiatry.2011.74"},{"key":"2026021206401871000_16.2.e109015.6","doi-asserted-by":"crossref","first-page":"675","DOI":"10.1007\/s40519-017-0406-9","article-title":"Diabetes, eating disorders and body image in young adults: an exploratory study about \u201cdiabulimia\u201d","volume":"22","author":"Falc\u00e3o","year":"2017","journal-title":"Eat Weight Disord"},{"key":"2026021206401871000_16.2.e109015.7","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1002\/erv.2787","article-title":"Comorbid depression as a negative predictor of weight gain during treatment of anorexia nervosa: A systematic scoping review","volume":"28","author":"Eskild-Jensen","year":"2020","journal-title":"Eur Eat Disord Rev"},{"key":"2026021206401871000_16.2.e109015.8","doi-asserted-by":"publisher","DOI":"10.1097\/01.psy.0000221254.77675.f5"},{"key":"2026021206401871000_16.2.e109015.9","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-017-4517-7"},{"key":"2026021206401871000_16.2.e109015.10","doi-asserted-by":"publisher","DOI":"10.1007\/BF03347221"},{"key":"2026021206401871000_16.2.e109015.11","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464-5491.2012.03771.x"},{"key":"2026021206401871000_16.2.e109015.12","unstructured":"National Guideline A . National institute for health and care excellence: guidelines. eating disorders: recognition and treatment. london: national institute for health and care excellence (nice) copyright national institute for health and care excellence, 2017. 2017."},{"key":"2026021206401871000_16.2.e109015.13","doi-asserted-by":"publisher","DOI":"10.2337\/dc20-2989"},{"key":"2026021206401871000_16.2.e109015.14","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2007.07060951"},{"key":"2026021206401871000_16.2.e109015.15","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.187.6.573"},{"key":"2026021206401871000_16.2.e109015.16","doi-asserted-by":"crossref","first-page":"520","DOI":"10.1002\/eat.23236","article-title":"DSM-5 eating disorders among adolescents and young adults in Finland: A public health concern","volume":"53","author":"Sil\u00e9n","year":"2020","journal-title":"Int J Eat Disord"},{"key":"2026021206401871000_16.2.e109015.17","doi-asserted-by":"crossref","DOI":"10.3390\/nu13114033","article-title":"Why Do Women with Eating Disorders Decline Treatment? A Qualitative Study of Barriers to Specialized Eating Disorder Treatment","volume":"13","author":"Andersen","year":"2021","journal-title":"Nutrients"},{"key":"2026021206401871000_16.2.e109015.18","doi-asserted-by":"publisher","DOI":"10.1093\/ajcn\/nqy342"},{"key":"2026021206401871000_16.2.e109015.19","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.320.7249.1563"},{"key":"2026021206401871000_16.2.e109015.20","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2019.12925","article-title":"Estimation of Eating Disorders Prevalence by Age and Associations With Mortality in a Simulated Nationally Representative US Cohort","volume":"2","author":"Ward","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2026021206401871000_16.2.e109015.21","doi-asserted-by":"crossref","first-page":"1070","DOI":"10.1002\/eat.22467","article-title":"Sex- and age-specific incidence of healthcare-register-recorded eating disorders in the complete swedish 1979-2001 birth cohort","volume":"48","author":"Javaras","year":"2015","journal-title":"Int J Eat Disord"},{"key":"2026021206401871000_16.2.e109015.22","first-page":"15","article-title":"Initiating continuous glucose monitoring is associated with improvements in glycemic control and reduced health care resource utilization for people with diabetes in a large US-insured population: A real-world evidence study","volume":"31","author":"Norman","year":"2025","journal-title":"J Manag Care Spec Pharm"},{"key":"2026021206401871000_16.2.e109015.23","doi-asserted-by":"crossref","DOI":"10.3389\/fcdhc.2022.822233","article-title":"Development and Theoretical Underpinnings of the PRIORITY Intervention: A Parenting Intervention to Prevent Disordered Eating in Children and Young People With Type 1 Diabetes","volume":"3","author":"O\u2019Donnell","year":"2022","journal-title":"Front Clin Diabetes Healthc"},{"key":"2026021206401871000_16.2.e109015.24","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.bp.108.054742"},{"key":"2026021206401871000_16.2.e109015.25","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.25.2.309"},{"key":"2026021206401871000_16.2.e109015.26","doi-asserted-by":"publisher","DOI":"10.2337\/dc14-2646"},{"key":"2026021206401871000_16.2.e109015.27","doi-asserted-by":"publisher","DOI":"10.2337\/dc12-2282"},{"key":"2026021206401871000_16.2.e109015.28","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.jpsychires.2022.03.064","article-title":"Validity of eating disorder diagnoses in the Swedish national patient register","volume":"150","author":"Birgeg\u00e5rd","year":"2022","journal-title":"J Psychiatr Res"},{"key":"2026021206401871000_16.2.e109015.29","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-11-450","article-title":"External review and validation of the Swedish national inpatient register","volume":"11","author":"Ludvigsson","year":"2011","journal-title":"BMC Public Health"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-109015","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T14:40:36Z","timestamp":1770907236000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-109015"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2,12]]},"published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1136\/bmjopen-2025-109015"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-109015","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2]]}}}