HeartSmart: development and evaluation of a culturally tailored, theory-based cardiovascular health promotion programme for university students in a North-Central Nigerian university - a quasi-experim

Anorexia nervosa (AN) is one of the most severe psychiatric disorders, ranking as the third most common chronic illness among adolescents and exhibiting the highest morbidity and mortality rates among all mental health conditions [, ]. Eating disorders (EDs) primarily emerge during adolescence and predominantly affect females []. Effective treatment for EDs remains challenging, with limited psychological and pharmacological interventions available, and their therapeutic efficacy is often suboptimal [–]. Epidemiological studies have suggested a potential link between autoimmune diseases and AN. A growing body of evidence from large-scale register-based studies indicates a bidirectional relationship between EDs and a range of autoimmune diseases (e.g., type 1 diabetes, celiac disease, Crohn’s disease, rheumatoid arthritis) [–]. For instance, compared to healthy controls, individuals with AN exhibit evidence of altered humoral immune responses, lipid metabolism, and plasma cell activity []. Furthermore, the pro-inflammatory phenotype observed in AN patients has been associated with hypothalamic antigen-specific autoantibodies, with inflammatory status potentially diminishing over the course of the illness []. The presence of anti-hypothalamic autoantibodies in AN patients, along with reduced serum uric acid levels and decreased total antioxidant capacity (TAC), further indicates increased oxidative stress []. These findings underscore a significant knowledge gap in this field, highlighting the urgent need to identify common genetic risk loci underlying both conditions. Traditional clinical or epidemiological studies often face challenges in ensuring statistical robustness when examining such associations, including potential confounding by factors such as age, sex, socioeconomic status, and surveillance bias, as well as difficulties in establishing temporal sequence and ensuring sufficient sample size for rare conditions [, ]. Recently, linkage disequilibrium (LD) score regression (LDSC) has been developed to assess genetic correlations between traits and diseases []. However, it remains unclear whether overall genetic correlations arise from a few specific loci or are dispersed across the genome. To date, few studies have systematically evaluated the genetic overlap, shared susceptibility genes, and causal relationships between autoimmune disorders and AN.