title: The risk of eating disorders comorbid with attention-deficit/hyperactivity disorder: A systematic review and meta-analysis.
abstract: OBJECTIVE
  There has been interest in whether people with Attention-Deficit/Hyperactivity Disorder (ADHD) are at higher risk of developing an Eating Disorder (ED). The aim of this study was estimate the size of this association with a meta-analysis of studies.
  
  
  METHODS
  We retrieved studies following PRISMA guidelines from a broad range of databases.
  
  
  RESULTS
  Twelve studies fitted our primary aim in investigating ED in ADHD populations (ADHD = 4,013/Controls = 29,404), and five exploring ADHD in ED populations (ED = 1,044/Controls = 11,292). The pooled odds ratio of diagnosing any ED in ADHD was increased significantly, 3.82 (95% CI:2.34-6.24). A similar level of risk was found across all ED syndromes [Anorexia Nervosa = 4.28 (95% CI:2.24-8.16); Bulimia Nervosa = 5.71 (95% CI: 3.56-9.16) and Binge Eating Disorder = 4.13 (95% CI:3-5.67)]. The risk was significantly higher if ADHD was diagnosed using a clinical interview [5.89 (95% CI:4.32-8.04)] rather than a self-report instrument [2.23 (95% CI:1.23-4.03)]. The pooled odds ratio of diagnosing ADHD in participants with ED was significantly increased, 2.57 (95% CI:1.30-5.11). Subgroup analysis of cohorts with binge eating only yielded a risk of 5.77 (95% CI:2.35-14.18). None of the variables examined in meta-regression procedures explained the variance in effect size between studies.
  
  
  CONCLUSIONS
  People with ADHD have a higher risk of comorbidity with an ED and people with an ED also have higher levels of comorbidity with ADHD. Future studies should address if patients with this comorbidity have a different prognosis, course and treatment response when compared to patients with either disorder alone.
  Ha habido interés en saber si la gente con Trastorno por Déficit de Atención e Hiperactividad (TDAH) están en mayor riesgo de desarrollar un Trastorno de la Conducta Alimentaria (TCA). El objetivo de este estudio fue estimar el tamaño de esta asociación con un meta-análisis de los estudios. Métodos: Recuperamos estudios de una amplia gama base de datos,  que siguen los lineamientos PRISMA. Resultados: Doce estudios encajaron con nuestro objetivo primario de investigar los TCA en poblaciones con TDAH (TDAH = 4,013/Controles = 29,404), y 5 exploraron TDAH en poblaciones con TCA (TCA = 1,044/Controles = 11,292). El odds ratio (OR) agrupado de diagnosticar cualquier TCA en el TDAH se incrementó significativamente, 3.82 (95% CI:2.34-6.24). Un nivel de riesgo similar fue encontrado en todos los síndromes de TCA [Anorexia Nervosa = 4.28 (95% CI:2.24-8.16); Bulimia Nervosa = 5.71 (95% CI:3.56-9.16) y Trastorno por Atracón = 4.13 (95% CI: 3-5.67)]. El riesgo fue significativamente mayor si el TDAH fue diagnosticado utilizando una entrevista clínica [5.89 (95% CI:4.32-8.04)] en lugar de un instrumento de auto-reporte [2.23 (95% CI:1.23-4.03)]. El odds ratio (OR) agrupado de diagnosticar TDAH en participantes con TCA fue significativamente incrementado, 2.57 (95% CI:1.30-5.11). El análisis de los subgrupos de cohort con atracones solamente produjo un riesgo de 5.77 (95% CI:2.35-14.18). Ninguna de las variables examinadas en los procedimientos de meta-regresión explicaron la varianza en el tamaño del efecto entre los estudios. Discusión: La gente con TDAH tiene un mayor riesgo de comorbilidad con un TCA y la gente con un TCA también tiene niveles altos de comorbilidad con TDAH. Los estudios futuros deberán abordar si los pacientes con esta comorbilidad tienen diferente pronóstico, curso y respuesta a tratamiento cuando son comparados con pacientes que solamente tienen uno de los trastornos.  © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016) © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:1045-1057).
authors.affiliation: Institute of Psychiatry (IPUB-UFRJ), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.|Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), King's College, London.
authors.forename: Bruno Palazzo
authors.initials: BP
authors.lastname: Nazar
authors.affiliation: D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil.
authors.forename: Camila
authors.initials: C
authors.lastname: Bernardes
authors.affiliation: South London and the Maudsley National Health Trust (SLaM - NHS), London.
authors.forename: Gemma
authors.initials: G
authors.lastname: Peachey
authors.affiliation: Vrjie Universiteit, Amsterdam, The Netherlands.
authors.forename: Joseph
authors.initials: J
authors.lastname: Sergeant
authors.affiliation: Institute of Psychiatry (IPUB-UFRJ), Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.|D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Mattos
authors.affiliation: Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IOPPN), King's College, London.|South London and the Maudsley National Health Trust (SLaM - NHS), London.
authors.forename: Janet
authors.initials: J
authors.lastname: Treasure
mesh_terms: D000293:Adolescent; D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications*; D016022:Case-Control Studies; D002648:Child; D015897:Comorbidity; D001068:Feeding and Eating Disorders / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D012307:Risk Factors; D055815:Young Adult
keywords: ADHD; anorexia nervosa; attention deficit-hyperactivity disorder; binge eating; bulimia nervosa; comorbidity; eating disorders; impulsivity; obesity; reward