Systematic Review and Meta‐Analysis of Mortality in Patients With Anorexia Nervosa

This is the authors' abstract. We don't add key points for this paper.

Objective Anorexia nervosa (AN) has one of the highest mortality rates among psychiatric disorders. This systematic review and meta‐analysis examined the all‐cause mortality of AN patients compared to the general population using the standardized mortality ratio (SMR). Method MEDLINE, PsycINFO, EMBASE, WOS, Dissertations and Theses A&I, and Google Scholar were searched from inception to May 2025 for longitudinal studies reporting all‐cause SMR for AN patients. Risk of bias was assessed using the Newcastle‐Ottawa Scale. Random‐effects meta‐analysis was conducted and presented as a forest plot. Subgroup and meta‐regression analyses were done. SMRs for male‐ and female‐specific samples were compared. Results Thirty studies involving 33,176 patients were identified. The pooled SMR from 22 studies was 5.06 (95% CI [3.47–7.38]). Suicide and cardiac deaths accounted for 21% and 19% of deaths, respectively. Studies with lower mean BMI were associated with higher SMRs before correction for multiple testing ( p = 0.018, adjusted p = 0.252). The pooled SMR of male‐specific samples was 3.47, 95% CI (1.60–7.52), similar to female‐specific samples (3.86, 95% CI [1.82–8.20]). Discussions Our findings confirm that AN remains a severe psychiatric disorder, underscoring the clinical importance of suicide prevention and monitoring cardiac complications. A low BMI is a crucial clinical indicator for high‐risk groups and allocating resources. Limitations include excluding studies with zero deaths, substantial heterogeneity among included studies, the underrepresentation of male and non‐Western populations, and most studies originating from specialist clinics.