Abstract
This study extrapolates data from the Adolescent Brain Cognitive Development (ABCD) study to estimate the prevalence of eating disorders in US preadolescent children.
Eating disorders (EDs) are associated with significant morbidity and mortality.1 The prevalence of early-onset EDs has increased in the past several decades, with younger children more likely than adolescents to experience psychiatric comorbidity. The single nationally representative study that has reported 12-month prevalence rates of EDs among children aged 8 to 15 years found 0.1% total for children aged 8 to 11 years, with 0.3% for girls and 0.1% for boys aged 8 to 15 years old.2 However, this previous study used Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria and did not report the prevalence of specific ED diagnoses. The aims of the present study were to report the prevalence rates of anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding and eating disorders (OSFED) in addition to a global “any ED” diagnosis, using Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) criteria among a US representative sample of children aged 9 and 10 years. Prevalence rates were tested by participant sex.
Methods
The present study used baseline data collected in 2016 and 2017 from the Adolescent Brain Cognitive Development (ABCD) study.3 Participants were a US representative sample of 4524 children aged 9 to 10 years and 1 of their caregivers. Participants in the ABCD cohort will be followed up for 10 years, with annual on-site assessments. Eating disorder diagnoses were determined using parent or guardian responses to the computerized Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS) based on DSM-5 criteria.4 The KSADS categorized ED diagnoses into 5 clinical subtypes: AN, BN, BED, other specified feeding or eating disorders of the BN type (OSFED BN type) and OSFED BED type. In addition, global “any ED” and “any OSFED” variables were created. The San Diego State University institutional review board waived approval for our analyses. Parents and guardians provided written informed consent as part of the ABCD study. Statistical analysis was performed using SPSS Software (IBM). Poststratification sociodemographic weights were included in analyses to mirror the 2010 US Census. Results are therefore presented based on population-level estimates. Significant sex differences in ED diagnoses was determined by the adjusted F, a variant of the second-order Rao-Scott adjusted χ2 statistic.5
Results
Among the total population of 8 080 738 participants, 51.5% were boys, 76.0% were white, and 24.0% were Hispanic. Across all ED diagnoses, boys and girls did not have statistically significant differences in prevalence rates (Table). Across all ED diagnoses, the overall prevalence rate was 1.4% (95% CI, 1.0%-1.8%). The prevalence of any OSFED diagnosis was 0.7% (95% CI, 0.5%-1.0%). The prevalence of AN was 0.1% (95% CI, 0.0%-0.3%). No cases of BN were present in this sample. Finally, the prevalence of BED was 0.6% (95% CI, 0.4%-0.9%).
Table. Prevalence of Eating Disorders Among 4524 Nine- and 10-Year-Old US Children.
| Diagnosis and Subsample | Unweighted Count | Population Estimate | Prevalence (95% CI), % | Adjusted Fa | OR (95% CI) | P Value |
|---|---|---|---|---|---|---|
| AN | ||||||
| Total | 3 | 6922 | 0.1 (0.0-0.3) | 2.37 | NA | .12 |
| Boys | 3 | 6922 | 0.2 (0.0-0.6) | NA | NA | NA |
| Girls | 0 | 0 | 0.0 (0.0-0.0) | NA | NA | NA |
| BN, Total | 0 | 0 | 0.0 (0.0-0.0) | NA | NA | NA |
| BED | ||||||
| Total | 23 | 48 704 | 0.6 (0.4-0.9) | 0.81 | 1.52 (0.61-3.82) | .37 |
| Boys | 14 | 30 048 | 0.7 (0.4-1.2) | NA | NA | NA |
| Girls | 9 | 18 655 | 0.5 (0.2-1.0) | NA | NA | NA |
| OSFED (BN) | ||||||
| Total | 5 | 8216 | 0.1 (0.0-0.3) | 1.10 | 3.10 (0.33-28.98) | .30 |
| Boys | 4 | 6302 | 0.2 (0.1-0.4) | NA | NA | NA |
| Girls | 1 | 1913 | 0.0 (0.0-0.3) | NA | NA | NA |
| OSFED (BED) | ||||||
| Total | 21 | 46 891 | 0.6 (0.4-0.9) | 0.10 | 0.87 (0.35-2.14) | .76 |
| Boys | 9 | 22 491 | 0.5 (0.3-1.1) | NA | NA | NA |
| Girls | 12 | 24 399 | 0.6 (0.3-1.1) | NA | NA | NA |
| Global OSFED | ||||||
| Total | 26 | 55 107 | 0.7 (0.5-1.0) | 0.005 | 1.03 (0.46-2.32) | .94 |
| Boys | 13 | 28 793 | 0.7 (0.4-1.2) | NA | NA | NA |
| Girls | 13 | 26 313 | 0.7 (0.4-1.2) | NA | NA | NA |
| Global ED | ||||||
| Total | 52 | 110 734 | 1.4 (1.0-1.8) | 1.16 | 1.38 (0.77-2.5) | .28 |
| Boys | 30 | 65 765 | 1.6 (1.1-2.3) | NA | NA | NA |
| Girls | 22 | 44 969 | 1.1 (0.7-1.8) | NA | NA | NA |
Abbreviations: AN, anorexia nervosa; BED, binge eating disorder; BN, bulimia nervosa; ED, eating disorder; NA, not applicable; OR, odds ratio; OSFED, other specified feeding and eating disorder.
The adjusted F statistic is a variant of the second-order Rao-Scott adjusted χ2 statistic.5
Discussion
Significant sex differences were not found across ED diagnoses. Similarly, past research with adolescents aged 13 to 18 years did not find sex differences in the prevalence of AN; however, differences emerged for BN, BED, and subthreshold AN, with higher prevalence among girls.6 Taken together, sex differences in EDs may not emerge until adolescence. This is consistent with previous research demonstrating a lack of prepubertal sex differences in EDs, with elevated prevalence of EDs in girls during and after puberty.7 Limitations of the study include the exclusion of OSFED AN, which the KSADS operationally defined only by caregivers’ report of emaciation, and no assessment of avoidant and restrictive food intake disorder. Although EDs are not the focus of the ABCD study, use of the KSADS as opposed to a diagnostic tool tailored to EDs is also a limitation. The low prevalence of EDs may have reduced statistical power to detect sex differences. Future researchers may wish to characterize this sample in greater detail, including assessment of race/ethnicity, body mass index, and psychiatric comorbidity. As the ABCD cohort releases additional waves of data, researchers are encouraged to harness this nationally representative, prospective data set to explore developmental risk factors for EDs.
References
- 1.Chesney E, Goodwin GM, Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry. 2014;13(2):153-160. doi: 10.1002/wps.20128 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Merikangas KR, He JP, Brody D, Fisher PW, Bourdon K, Koretz DS. Prevalence and treatment of mental disorders among US children in the 2001-2004 NHANES. Pediatrics. 2010;125(1):75-81. doi: 10.1542/peds.2008-2598 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Volkow ND, Koob GF, Croyle RT, et al. The conception of the ABCD study: from substance use to a broad NIH collaboration. Dev Cogn Neurosci. 2018;32:4-7. doi: 10.1016/j.dcn.2017.10.002 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Barch DM, Albaugh MD, Avenevoli S, et al. Demographic, physical and mental health assessments in the Adolescent Brain and Cognitive Development Study: rationale and description. Dev Cogn Neurosci. 2018;32:55-66. doi: 10.1016/j.dcn.2017.10.010 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Rao JN, Scott AJ. On chi-squared tests for multiway contingency tables with cell proportions estimated from survey data. Ann Stat. 1984;12(1):46-60. doi: 10.1214/aos/1176346391 [DOI] [Google Scholar]
- 6.Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR. Prevalence and correlates of eating disorders in adolescents: results from the National Comorbidity Survey Replication Adolescent Supplement. Arch Gen Psychiatry. 2011;68(7):714-723. doi: 10.1001/archgenpsychiatry.2011.22 [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Klump KL, Culbert KM, Slane JD, Burt SA, Sisk CL, Nigg JT. The effects of puberty on genetic risk for disordered eating: evidence for a sex difference. Psychol Med. 2012;42(3):627-637. doi: 10.1017/S0033291711001541 [DOI] [PMC free article] [PubMed] [Google Scholar]