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Comment & Response
August 14, 2019

Reconsidering the Association Between Infection-Related Health Care Use and Occurrence of Eating Disorders: Chicken or Egg?—Reply

Author Affiliations
  • 1Department of Psychology, George Mason University, Fairfax, Virginia
  • 2Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston
  • 3Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
  • 4Psychosis Research Unit, Aarhus University Hospital–Psychiatry, Risskov, Denmark
  • 5Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
  • 6National Centre for Register-Based Research, School of Business and Social Services, Aarhus University, Aarhus, Denmark
  • 7The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus University, Aarhus, Denmark
JAMA Psychiatry. Published online August 14, 2019. doi:10.1001/jamapsychiatry.2019.2189

In Reply We thank Giel et al for reviewing our work1 and sharing their concerns about possible misclassification of infections as eating disorder symptoms. We fully acknowledge that register-based data cannot confirm nor deny the presence of inflammation/infections, that hospitalizations and prescriptions for antibiotics in the current study are used as a proxy for the presence of inflammation, and unmeasured confounding cannot be eliminated in observational studies. However, routine hospitalization protocols in Denmark include measurement of C-reactive protein levels in blood or urine to confirm infection diagnosis. Furthermore, it is also unlikely that anti-infective agents are prescribed without the presence of infection symptoms, although we cannot determine the type or severity of the infection nor the compliance to the anti-infective treatment.

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