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Fatigue and chronic fatigue syndrome-like complaints in the general population

Dolphin

Senior Member
Messages
17,567
(I'm not recommending this as particularly important. I just want to make a couple of points)

Free full text at: http://eurpub.oxfordjournals.org/content/20/3/251.long or http://eurpub.oxfordjournals.org/content/20/3/251.full.pdf+html

Fatigue and chronic fatigue syndrome-like complaints in the general population.

Eur J Public Health. 2010 Jun;20(3):251-7. Epub 2009 Aug 18.

van't Leven M, Zielhuis GA, van der Meer JW, Verbeek AL, Bleijenberg G.

Source
Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, the Netherlands.

Abstract

BACKGROUND:

Most knowledge on chronic fatigue (CF) and chronic fatigue syndrome (CFS) is based on clinical studies, not representative of the general population.

This study aimed to assess the prevalence of fatigue in an adult general population and to identify associations with lifestyle factors.

METHODS:

Total 22,500 residents of Nijmegen were selected at random and interviewed by questionnaire.

Data on 9062 respondents (43% response) were analysed, taken into account age, gender and concomitant disease.

Subjects were classified into four groups: not fatigued (NF, reference group), short-term fatigue (SF, <6 months), chronic fatigue (CF, >or=6 months) and CFS-like fatigue (in accordance with the Center for Disease Control criteria for CFS, without clinical confirmation).

RESULTS:

Our study population showed the following breakdown: NF 64.4% (95% CI 63.6-65.6%), SF 4.9% (95% CI 4.5-5.4%), CF 30.5% (95% CI 29.5-31.4%) and CFS-like fatigue 1.0% (95% CI 0.8-1.2%).

Compared with the NF group, more of the CFS respondents were female [odds ratio (OR) = 1.9], obese (OR = 4.1), using analgesics (OR = 7.8), had a low alcohol intake (OR = 0.4), were eating less healthy food (OR = 0.5) and were physically less active (OR = 0.1).

These associations largely applied to the SF and CF group.

The fatigue could have been due to a concomitant disease in 34 and 55.5% of the SF and CF cases, respectively.

CONCLUSION:

The prevalence of CF in the general population appears to be much higher than previously indicated.

Even with strict criteria for CFS, it is estimated that approximately 1% of the adult population experiences this condition.

Interestingly, a large part of this group remains unrecognized by the general practitioner.

A striking similarity in lifestyle pattern between SF, CF and CFS calls for further research.

PMID: 19689970 [PubMed - in process]
I've given each line its own paragraph
 

Dolphin

Senior Member
Messages
17,567
Contrast the findings with this study, also from the Netherlands (and both involved Gijs Bleijenberg):
CFS patients tend to lead a healthier lifestyle compared to the general Dutch population.


The lifestyle of patients with chronic fatigue syndrome and the effect on fatigue and functional impairments.

J Hum Nutr Diet. 2009 Jun;22(3):226-31. Epub 2009 Feb 17.

Goedendorp MM, Knoop H, Schippers GM, Bleijenberg G.

Expert Centre for Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. m.goedendorp@nkcv.umcn.nl

Abstract

BACKGROUND:

Little is known about the lifestyle of patients with chronic fatigue syndrome (CFS) and its influence on symptoms of CFS.

The present study aimed to investigate the lifestyle of patients with CFS, and to assess whether lifestyle factors are related to fatigue and functional impairments.

METHODS:

Two hundred and forty-seven patients fulfilling the Center for Disease Control criteria for CFS were included.

Validated questionnaires were used to collect data on lifestyle factors, smoking, intake of alcohol, fat, fibres, fruit and vegetables, body mass index (BMI), fatigue severity and functional impairments.

RESULTS:

Of the CFS patients, 23% smoked, 32% had an unhealthy BMI, and none had an unhealthy alcohol intake.

A majority had an unhealthy food intake: 70% had unhealthy fat, fruit and vegetable intake, and 95% had unhealthy fibre intake.

Compared with the general Dutch population, significantly fewer CFS patients were overweight.

Significantly more female CFS patients abstained from alcohol, and fewer male CFS patients smoked.

Unhealthy lifestyle factors were not significantly associated with fatigue severity or functional impairments.

CONCLUSIONS:

CFS patients tend to lead a healthier lifestyle compared to the general Dutch population.

However, no relationship was found between lifestyle factors and fatigue severity and functional impairments in CFS.

PMID: 19226353 [PubMed - indexed for MEDLINE]
I've given each line its own paragraph .
 

Dolphin

Senior Member
Messages
17,567
In the SF group, 29% of the respondents had consulted their general practitioner (GP) because of fatigue. In the CF and CFS groups, this applied to 55 and 71%, respectively. After stratification for concomitant (chronic) disease, these percentages were 21 (SF), 47 (CF) and 71% (CFS) in the absence of (chronic) disease, versus 40 (SF) and 63.5% (CF) when a chronic disease was present.

In each of the fatigue groups, the only difference between the subjects who consulted their GP because of fatigue and those who did not was that the former were using more prescribed medication.

Given the large number of people who apparently have CF or CFS, the question arises as to why the diagnosis of CFS is underestimated? More than 70% of our CFS group consulted their GP because of complaints of fatigue, only 6.7% (6 out of 89) reported to be diagnosed as having CFS. Although we did not check these answers in the medical files, we infer that physician-related factors (e.g. ignorance, no confidence with the diagnosis, scepticism towards CFS) need to be taken into account.5,9,3235
The low numbers getting a diagnosis are interesting. US population studies have suggested 10-20%. The percentages might higher e.g. 10+ if exclude those with "CFS-explained (by a chronic illness)" (i.e. a physician assessed them and checked them for things - they were excluded if they had some diagnoses in this paper study) but a diagnosis rate of 10%/similar would still be low. The overall prevalence of CFS-like was only 1% so 6.7% is only 67 per 100,000. I think with better diagnostic tests especially if there was an easy blood test, the numbers diagnosed around the world would likely increase a lot - swelling the numbers of the patient community (who might lobby, donate to research/fundraise for research (or have relatives who might donate/fundraise), write letters to journals/newspapers/etc., etc.).

(Study was done in 2003)
 
Messages
15,786
As someone nearly shipped off to Nijmegen, I find the generally contradictory nature of the studies there to be rather fascinating. Are the "sensible" papers the older ones, indicating that at some point the clinic switched from the "real disease" outlook to the "between the ears" approach? Are there different co-authors in common on the good papers versus the stupid papers? It's just too weird. The researchers conclude in one of their own papers that CBT doesn't have any impact on physical symptoms - yet they persist in pushing it as the only proven effective treatment.

Maybe they're relying too much on other sources (the idiots in London) instead of their own results.
 

Snow Leopard

Hibernating
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Location
South Australia

oceanblue

Guest
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Location
UK
I wonder how accurate their CFS diagnosis-by-post was? 1% is quite a lot higher than the US studies of 0.4% (Jason) and 0.25% (Reyes) if I've remembered correctly. Without a clinical evaluation including detailed medical history you can't really make a proper diagnosis, particularly when it comes to excluding other causes of fatigue.

That only 71% of CFS-like patients had consulted their doctors at all about fatigue must cast some doubt on the accuracy of the diagnosis. If the true rate of CFS was only 0.4% or less, it would mean that most of the CFS-like group didn't have CFS, which would make the findings rather suspect.

Did they say how old the sample was?
 

Dolphin

Senior Member
Messages
17,567
Did they say how old the sample was?
They don't give an average age for the CFS-like group, from a quick look. I do give the full text link above if anyone is sufficiently curious.

That only 71% of CFS-like patients had consulted their doctors at all about fatigue must cast some doubt on the accuracy of the diagnosis.
Maybe, maybe not. I consulted my doctor for my muscle problems and the like (and then other symptoms like IBS) over a number of years. I only consulted about the fatigue when I got very severe. I'm not saying that's typical but it can happen.

I wonder how accurate their CFS diagnosis-by-post was? 1% is quite a lot higher than the US studies of 0.4% (Jason) and 0.25% (Reyes) if I've remembered correctly. Without a clinical evaluation including detailed medical history you can't really make a proper diagnosis, particularly when it comes to excluding other causes of fatigue.

That only 71% of CFS-like patients had consulted their doctors at all about fatigue must cast some doubt on the accuracy of the diagnosis. If the true rate of CFS was only 0.4% or less, it would mean that most of the CFS-like group didn't have CFS, which would make the findings rather suspect.
(small correction: Reyes: 0.235%) Yes, there is a big problem knowing what the group would be like without exclusions.

I'm inclined to think 0.4-0.5% (rather than 0.235%) is closer to the real figures - I think the CDC may have been overly strict with its exclusions.