Anorexia nervosa (AN) is a complex and heritable eating disorder characterized by dangerously low body weight. Neither candidate gene studies nor an initial genome-wide association study (GWAS) have yielded significant and replicated results. We performed a GWAS in 2907 cases with AN from 14 countries (15 sites) and 14 860 ancestrally matched controls as part of the Genetic Consortium for AN (GCAN) and the Wellcome Trust Case Control Consortium 3 (WTCCC3). Individual association analyses were conducted in each stratum and meta-analyzed across all 15 discovery data sets. Seventy-six (72 independent) single nucleotide polymorphisms were taken forward for in silico (two data sets) or de novo (13 data sets) replication genotyping in 2677 independent AN cases and 8629 European ancestry controls along with 458 AN cases and 421 controls from Japan. The final global meta-analysis across discovery and replication data sets comprised 5551 AN cases and 21 080 controls. AN subtype analyses (1606 AN restricting; 1445 AN binge-purge) were performed. No findings reached genome-wide significance. Two intronic variants were suggestively associated: rs9839776 (P=3.01 × 10(-7)) in SOX2OT and rs17030795 (P=5.84 × 10(-6)) in PPP3CA. Two additional signals were specific to Europeans: rs1523921 (P=5.76 × 10(-)(6)) between CUL3 and FAM124B and rs1886797 (P=8.05 × 10(-)(6)) near SPATA13. Comparing discovery with replication results, 76% of the effects were in the same direction, an observation highly unlikely to be due to chance (P=4 × 10(-6)), strongly suggesting that true findings exist but our sample, the largest yet reported, was underpowered for their detection. The accrual of large genotyped AN case-control samples should be an immediate priority for the field.

] Altrecht Eating Disorders Rintveld Zeist The Netherlands [2] Department of Child and Adolescent Psychiatry University Medical Center Utrecht Utrecht The Netherlands

] Brain Center Rudolf Magnus Department of Translational Neuroscience University Medical Center Utrecht Utrecht The Netherlands [2] Altrecht Eating Disorders Rintveld Zeist The Netherlands

] Center for Eating Disorders Ursula Leidschendam The Netherlands [2] Department of Psychiatry Leiden University Medical Centre Leiden The Netherlands

] Center for Eating Disorders Ursula Leidschendam The Netherlands [2] Molecular Epidemiology Section Department of Medical Statistics Leiden University Medical Centre Leiden The Netherlands

] Center for Neurobehavioral Genetics University of California Los Angeles Los Angeles CA USA [2] Department of Psychiatry Brain Center Rudolf Magnus University Medical Center Utrecht Utrecht The Netherlands

] Centre for Addiction and Mental Health Toronto ON Canada [2] Department of Psychiatry University of Toronto Toronto ON Canada

] Department of Biological and Medical Psychology University of Bergen Bergen Norway [2] Kavli Research Centre for Aging and Dementia Haraldsplass Deaconess Hospital Bergen Norway [3] K G Jebsen Centre for Research on Neuropsychiatric Disorders University of Bergen Bergen Norway

] Department of Child and Adolescent Psychiatry University Hospital Carl Gustav Carus Dresden University of Technology Dresden Germany [2] Athinoula A Martinos Center for Biomedical Imaging Psychiatric Neuroimaging Research Program Massachusetts General Hospital Harvard Medical School Charlestown MA USA

] Department of Clinical Science K G Jebsen Centre for Psychosis Research Norwegian Centre For Mental Disorders Research University of Bergen Bergen Norway [2] Dr Einar Martens Research Group for Biological Psychiatry Center for Medical Genetics and Molecular Medicine Haukeland University Hospital Bergen Norway

] Department of Genetics Environment and Mental Health Norwegian Institute of Public Health Oslo Norway [2] Institute of Clinical Medicine University of Oslo Oslo Norway

] Department of Genomics Life and Brain Center Institute of Human Genetics University of Bonn Bonn Germany [2] Division of Medical Genetics Department of Biomedicine University of Basel Basel Switzerland

] Department of Genomics Life and Brain Center Institute of Human Genetics University of Bonn Bonn Germany [2] Institute of Neuroscience and Medicine Research Center Jülich Jülich Germany [3] Division of Medical Genetics Department of Biomedicine University of Basel Basel Switzerland

] Department of Psychiatry and CIBERON University Hospital of Bellvitge IDIBELL Barcelona Spain [2] Department of Clinical Sciences School of Medicine University of Barcelona Barcelona Spain

] Department of Psychiatry University of Naples SUN Naples Italy [2] Chair of Psychiatry University of Salerno Salerno Italy

] Department of Psychiatry University of North Carolina at Chapel Hill Chapel Hill NC USA [2] Centre for Addiction and Mental Health Toronto ON Canada

] Department of Psychiatry University of North Carolina at Chapel Hill Chapel Hill NC USA [2] Department of Genetics The University of North Carolina at Chapel Hill Chapel Hill NC USA

] Department of Psychiatry University of North Carolina at Chapel Hill Chapel Hill NC USA [2] Department of Nutrition The University of North Carolina at Chapel Hill Chapel Hill NC USA

] Department of Psychosomatic Medicine and Psychotherapy Hannover Medical School Hannover Germany [2] Department of Psychosomatic Medicine and Psychotherapy University of Erlangen Nuremberg Erlangen Germany

] Department of Psychosomatic Research National Institute of Mental Health NCNP Tokyo Japan [2] School of Health Sciences at Fukuoka International University of Health and Welfare Fukuoka Japan

] Estonian Genome Center University of Tartu Tartu Estonia [2] Institute of Molecular and Cell Biology University of Tartu Tartu Estonia

] Genomics and Disease Group Centre for Genomic Regulation Barcelona Spain

] Hjelt Institute University of Helsinki Helsinki Finland [2] Department of Adolescent Psychiatry Helsinki University Central Hospital Helsinki Finland

] Hjelt Institute University of Helsinki Helsinki Finland [2] Institute of Molecular Medicine University of Helsinki Helsinki Finland [3] Department of Mental Health and Substance Abuse Services National Institute for Health and Welfare Helsinki Finland

] Inserm U1061 Université Montpellier 1 Montpellier France [2] Department of Emergency Psychiatry CHU Montpellier Montpellier France

] INSERM U894 Centre of Psychiatry and Neuroscience Paris France [2] Sainte Anne Hospital University of Paris Descartes Paris France

] Institute of Epidemiology Helmholtz Zentrum München German Research Center for Environmental Health Neuherberg Germany [2] Institute of Medical Informatics Biometry and Epidemiology Ludwig Maximilians University Munich Germany

] Institute of Molecular and Cell Biology University of Tartu Tartu Estonia [2] Center for Integrative Genomics University of Lausanne Lausanne Switzerland

] Molecular Epidemiology Section Department of Medical Statistics Leiden University Medical Centre Leiden The Netherlands [2] Netherlands Consortium for Healthy Ageing Leiden University Medical Center Leiden The Netherlands

] NORMENT K G Jebsen Centre for Psychosis Research Division of Mental Health and Addiction Oslo University Hospital and Institute of Clinical Medicine University of Oslo Oslo Norway [2] Department of Psychology University of Oslo Oslo Norway

] Social Genetic and Developmental Psychiatry Centre Institute of Psychiatry King's College London London UK [2] Department of Genetics Evolution and Environment University College London UCL Genetics Institute London UK

] Social Genetic and Developmental Psychiatry Centre Institute of Psychiatry King's College London London UK [2] Eli Lilly and Company Erl Wood Manor Windlesham UK

] The Center for Applied Genomics The Children's Hospital of Philadelphia Philadelphia PA USA [2] The Division of Human Genetics Department of Pediatrics The Perelman School of Medicine University of Pennsylvania Philadelphia PA USA

] The Finnish Institute of Molecular Medicine Finland University of Helsinki Helsinki Finland [2] Finnish Institute of Occupational Health Helsinki Finland

] University Health Network Toronto General Hospital Toronto ON Canada [2] Mount Sinai Hospital Samuel Lunenfeld Research Institute Toronto ON Canada

] Wellcome Trust Sanger Institute Wellcome Trust Genome Campus Hinxton Cambridge UK [2] European Molecular Biology Laboratory European Bioinformatics Institute Wellcome Trust Genome Campus Hinxton Cambridge

] Wellcome Trust Sanger Institute Wellcome Trust Genome Campus Hinxton Cambridge UK [2] The Finnish Institute of Molecular Medicine Finland University of Helsinki Helsinki Finland [3] The Program for Human and Population Genetics The Broad Institute of MIT and Harvard Cambridge MA USA

] Wellcome Trust Sanger Institute Wellcome Trust Genome Campus Hinxton Cambridge UK [2] University of Split School of Medicine Split Croatia

] Wellcome Trust Sanger Institute Wellcome Trust Genome Campus Hinxton Cambridge UK [2] Wellcome Trust Centre for Human Genetics Oxford UK

] Wellcome Trust Sanger Institute Wellcome Trust Genome Campus Hinxton Cambridge UK [2] William Harvey Research Institute Barts and The London School of Medicine and Dentistry Queen Mary University of London John Vane Science Centre Charterhouse Square London UK

1st Department of Psychiatry Athens University Medical School Athens Greece

Adolescent Health Unit 2nd Department of Pediatrics Medical School University of Athens 'P and A Kyriakou' Children's Hospital Athens Greece

Altrecht Eating Disorders Rintveld Zeist The Netherlands

Brain Center Rudolf Magnus Department of Translational Neuroscience University Medical Center Utrecht Utrecht The Netherlands

Centre de Psychiatrie et Neurosciences Inserm U894 Paris France

Clinical Genetics Unit Department of Woman and Child Health University of Padova Padova Italy

CNRS 8090 Institute of Biology Pasteur Institute Lille France

Department of Cancer Epidemiology and Genetics Masaryk Memorial Cancer Institute Brno Czech Republic

Department of Child and Adolescent Psychiatry Institute of Psychiatry and Neurology Warsaw Poland

Department of Child and Adolescent Psychiatry Psychosomatics and Psychotherapy Charité Berlin Germany

Department of Child and Adolescent Psychiatry Psychosomatics and Psychotherapy Universitätsklinikum Essen University of Duisburg Essen Essen Germany

Department of Child and Adolescent Psychiatry Psychosomatics and Psychotherapy University Clinics RWTH Aachen Aachen Germany

Department of Child and Adolescent Psychiatry Psychosomatics and Psychotherapy University Würzburg Würzburg Germany

Department of Clinical Nutrition Institute of Public Health and Clinical Nutrition University of Eastern Finland Kuopio Finland

Department of Epidemiology Institute of Occupational Medicine Department of Epidemiology Lodz Poland

Department of Genetics Environment and Mental Health Norwegian Institute of Public Health Oslo Norway

Department of Genetics The University of North Carolina at Chapel Hill Chapel Hill NC USA

Department of Internal Medicine 6 Psychosomatic Medicine and Psychotherapy University Medical Hospital Tübingen Tübingen Germany

Department of Medical Epidemiology and Biostatistics Karolinska Institutet Stockholm Sweden

Department of Medical Genetics University Medical Center Utrecht Utrecht The Netherlands

Department of Molecular and Experimental Medicine and The Scripps Translational Science Institute The Scripps Research Institute La Jolla CA USA

Department of Molecular Life Sciences Tokai University School of Medicine Kanagawa Japan

Department of Molecular Physiology and Biophysics Vanderbilt University School of Medicine Nashville TN USA

Department of Neurosciences University of Padova Padova Italy

Department of Nutrition and Dietetics Harokopio University Athens Greece

Department of Pediatrics 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Psychiatry 1st Faculty of Medicine Charles University Prague Czech Republic

Department of Psychiatry and Psychotherapy Medical University of Vienna Vienna Austria

Department of Psychiatry McLean Hospital Harvard Medical School Belmont MA USA

Department of Psychiatry Poznan University of Medical Sciences Poznan Poland

Department of Psychiatry University of Naples SUN Naples Italy

Department of Psychiatry University of North Carolina at Chapel Hill Chapel Hill NC USA

Department of Psychiatry University of Pennsylvania Philadelphia PA USA

Department of Psychology Michigan State University East Lansing MI USA

Department of Psychology University of Oslo Oslo Norway

Department of Psychosomatic Research National Institute of Mental Health NCNP Tokyo Japan

Departments of Psychiatry and Genetics and Genomic Sciences Seaver Autism Center and the Mindich Child Health and Development Institute Mount Sinai School of Medicine New York NY USA

Departments of Psychosocial and Internal Medicine Heidelberg University Heidelberg Germany

Division of Nephrology Department of Internal Medicine and Medical Specialties Columbus Gemelly Hospitals Catholic University Rome Italy

Eating Disorders Unit 1st Department of Psychiatry Athens University Medical School Athens Greece

Eating Disorders Unit Department of Child and Adolescent Psychiatry Medical University of Vienna Vienna Austria

Estonian Genome Center University of Tartu Tartu Estonia

Genetic Epidemiology Group International Agency for Research on Cancer Lyon France

Health Services Research Unit University of Aberdeen Aberdeen UK

Hjelt Institute University of Helsinki Helsinki Finland

INSERM U894 Centre of Psychiatry and Neuroscience Paris France

Institute for Medical Informatics Biometry and Epidemiology Universitätsklinikum Essen University of Duisburg Essen Essen Germany

Institute of Clinical Molecular Biology University of Kiel Kiel Germany

Institute of Hygiene and Epidemiology 1st Faculty of Medicine Charles University Prague Czech Republic

Kartini Clinic Portland OR USA

Klinikum der Medizinischen Fakultät Martin Luther Universität Halle Wittenberg Halle Saale Germany

M Sklodowska Curie Cancer Center and Institute of Oncology Warsaw Poland

McGill University and Genome Quebec Innovation Centre Montreal QC Canada

Molecular Epidemiology Section Department of Medical Statistics Leiden University Medical Centre Leiden The Netherlands

NORMENT K G Jebsen Centre for Psychosis Research Division of Mental Health and Addiction Oslo University Hospital and Institute of Clinical Medicine University of Oslo Oslo Norway

Palacky University Olomouc Czech Republic

Parklandklinik Bad Wildungen Germany

Rheumatology Unit Department of Medicine at the Karolinska University Hospital Solna Sweden

Seattle University College of Nursing Seattle WA USA

Section of Eating Disorders Institute of Psychiatry King's College London London UK

Social Genetic and Developmental Psychiatry Centre Institute of Psychiatry King's College London London UK

The Center for Applied Genomics The Children's Hospital of Philadelphia Philadelphia PA USA

The Centre for Applied Genomics and Program in Genetics and Genome Biology The Hospital for Sick Children Toronto ON Canada

The Institute of Environmental Medicine Karolinska Institutet Stockholm Sweden

Unitat de Recerca de Reumatologia Institut de Recerca Hospital Universitari Vall d'Hebron Barcelona Spain

Virginia Institute for Psychiatric and Behavioral Genetics Department of Psychiatry Virginia Commonwealth University Richmond VA USA

Wellcome Trust Sanger Institute Wellcome Trust Genome Campus Hinxton Cambridge UK

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Genome-wide association studies of binge eating behaviour and anorexia nervosa yield insights into the unique and shared biology of eating disorder phenotypes

Genome-wide association study identifies eight risk loci and implicates metabo-psychiatric origins for anorexia nervosa