Eating disorders are complex heritable conditions influenced by both genetic and environmental factors. Given the progress of genomic discovery in anorexia nervosa, with the identification of the first genome-wide significant locus, as well as animated discussion of epigenetic mechanisms in linking environmental factors with disease onset, our goal was to conduct a systematic review of the current body of evidence on epigenetic factors in eating disorders to inform future directions in this area. Following PRISMA guidelines, two independent authors conducted a search within PubMed and Web of Science and identified 18 journal articles and conference abstracts addressing anorexia nervosa (n = 13), bulimia nervosa (n = 6), and binge-eating disorder (n = 1), published between January 2003 and October 2017. We reviewed all articles and included a critical discussion of field-specific methodological considerations. The majority of epigenetic analyses of eating disorders investigated methylation at candidate genes (n = 13), focusing on anorexia and bulimia nervosa in very small samples with considerable sample overlap across published studies. Three studies used microarray-based technologies to examine DNA methylation across the genome of anorexia nervosa and binge-eating disorder patients. Overall, results were inconclusive and were primarily exploratory in nature. The field of epigenetics in eating disorders remains in its infancy. We encourage the scientific community to apply methodologically sound approaches using genome-wide designs including epigenome-wide association studies (EWAS), to increase sample sizes, and to broaden the focus to include all eating disorder types.
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Dr. Bulik acknowledges funding from the Swedish Research Council (VR Dnr: 538-2013-8864). This study represents independent research part funded by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health. We gratefully thank the artist Vinícius Gaio, London, UK, for the design of Figure 1.
Conflict of interest
Dr. Bulik reports: Shire (grant recipient, Scientific Advisory Board member) and Pearson and Walker (author, royalty recipient) (unrelated to the content of this manuscript). Dr. Breen has received grant funding from and served as a consultant to Eli Lilly and has received honoraria from Illumina (all unrelated to the content of this manuscript). The remaining authors declare that they have no conflict of interest.
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Hübel, C., Marzi, S.J., Breen, G. et al. Epigenetics in eating disorders: a systematic review. Mol Psychiatry 24, 901–915 (2019). https://doi.org/10.1038/s41380-018-0254-7
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