OBJECTIVE To grade the evidence about risk factors for eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder) with an umbrella review approach. METHODS This was a systematic review of observational studies on risk factors for eating disorders published in PubMed/PsycInfo/Embase until December 11th, 2019. We recalculated random-effect meta-analyses, heterogeneity, small-study effect, excess significance bias and 95% prediction intervals, grading significant evidence (p < 0.05) from convincing to weak according to established criteria. Quality was assessed with the Assessment of Multiple Systematic Reviews 2 (AMSTAR-2) tool. RESULTS Of 2,197 meta-analyses, nine were included, providing evidence on 50 risk factors, 29,272 subjects with eating disorders, and 1,679,385 controls. Although no association was supported by convincing evidence, highly suggestive evidence supported the association between childhood sexual abuse and bulimia nervosa (k = 29, 1,103 cases with eating disorders, 8,496 controls, OR, 2.73, 95%CI 1.96-3.79, p = 2.1 x 10-9, AMSTAR-2 moderate quality) and between appearance-related teasing victimization and any eating disorder (k = 10, 1,341 cases with eating disorders, 3,295 controls, OR 2.91, 95%CI 2.05-4.12, p = 1.8x10-9, AMSTAR-2 moderate quality). Suggestive, weak, or no evidence supported 11, 29, and 8 associations, respectively. CONCLUSIONS The most credible evidence indicates that early traumatic and stressful events are risk factors for eating disorders. Larger collaborative prospective cohort studies are needed to identify risk factors for eating disorders, particularly anorexia nervosa.

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饮食失调的危险因素：对已发表的荟萃分析的总体审查

目的 使用总括审查方法对饮食失调（神经性厌食症、神经性贪食症和暴食症）的危险因素的证据进行分级。方法 这是对发表于 PubMed/PsycInfo/Embase 至 2019 年 12 月 11 日的饮食失调风险因素观察性研究的系统评价。我们重新计算了随机效应荟萃分析、异质性、小研究效应、过度显着性偏倚和 95%预测区间，根据既定标准将重要证据（p < 0.05）从令人信服到弱分级。使用多项系统评价评估 2 (AMSTAR-2) 工具评估质量。结果 在 2,197 项荟萃分析中，纳入了 9 项，提供了关于 50 个风险因素、29,272 名饮食失调受试者和 1,679,385 名对照者的证据。虽然没有令人信服的证据支持相关性，但高度提示性的证据支持儿童期性虐待与神经性贪食症之间的关联（k = 29，1,103 例进食障碍病例，8,496 例对照，OR，2.73，95%CI 1.96-3.79，p = 2.1 x 10-9，AMSTAR-2 中等质量）以及与外表相关的取笑受害与任何饮食失调之间（k = 10，1,341 例进食障碍病例，3,295 例对照，OR 2.91，95%CI 2.05-4.12，p = 1.8x10 -9，AMSTAR-2 质量中等）。提示性证据、弱证据或无证据分别支持 11、29 和 8 个关联。结论 最可信的证据表明，早期的创伤和压力事件是饮食失调的危险因素。需要更大规模的协作前瞻性队列研究来确定饮食失调的危险因素，尤其是神经性厌食症。