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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Breithaupt L, Köhler-Forsberg O, Petersen L. Reconsidering the Association Between Infection-Related Health Care Use and Occurrence of Eating Disorders: Chicken or Egg?—Reply. JAMA Psychiatry. 2019;76(11):1212–1213. doi:10.1001/jamapsychiatry.2019.2189
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