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Risks and Benefits of Severe Caloric Restriction
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To the Editor: Drs Michels and Ekbom1 concluded that severe caloric restriction in humans may confer protection from invasive breast cancer. I am concerned, however, that these findings may inadvertently imply that anorexia nervosa can have health benefits. Anorexia nervosa is a serious illness, with as many as 15.6% of patients dying from disease-related causes within 21 years of first hospitalization.2
I am also concerned that Michels and Ekbom did not provide mortality information about their participants, which could introduce significant lead-time bias. If more women from this cohort died at younger ages from causes related to anorexia nervosa, they would not have as great an opportunity to develop breast cancer compared with the general population; therefore, they would seem to have less risk for developing invasive breast cancer.
Jun James Mao, MD
maoj@uphs.upenn.edu
Department of Family Practice and Community Medicine
University of Pennsylvania
Philadelphia
1. Michels KB, Ekbom A. Caloric restriction and incidence of breast cancer. JAMA. 2004;291:1226-1230.
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2. Zipfel S, Lowe B, Reas DL, et al. Long-term prognosis in anorexia nervosa: lessons from a 21-year follow-up study. Lancet. 2000;355:721-722.
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Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.
JAMA. 2004;291:2704.
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