Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment

BMC Psychiatry

Walter H Kaye¹  Pei-an Betty Shih¹  Sami A Hashim⁴  Jennifer A Nasser³  Enrica Marzola² 

[1] UCSD Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C – 207 La Jolla, 92037 San Diego, CA, USA;Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy;Department of Nutrition Sciences, Drexel University, 19102 Philadelphia, PA, USA;Department of Medicine, St. Luke's/Roosevelt Hospital Center, 10025 New York, NY, USA

关键词: Refeeding syndrome;    Caloric requirements;    Weight maintenance;    Weight restoration;    Refeeding;    Nutritional rehabilitation;    Treatment resistance;    Anorexia nervosa;   

Others  :  1123905
DOI  :  10.1186/1471-244X-13-290

 received in 2013-04-12, accepted in 2013-08-08,  发布年份 2013

【 摘 要 】

Restoration of weight and nutritional status are key elements in the treatment of anorexia nervosa (AN). This review aims to describe issues related to the caloric requirements needed to gain and maintain weight for short and long-term recovery for AN inpatients and outpatients.

We reviewed the literature in PubMed pertaining to nutritional restoration in AN between 1960–2012. Based on this search, several themes emerged: 1. AN eating behavior; 2. Weight restoration in AN; 3. Role of exercise and metabolism in resistance to weight gain; 3. Medical consequences of weight restoration; 4. Rate of weight gain; 5. Weight maintenance; and 6. Nutrient intake.

A fair amount is known about overall caloric requirements for weight restoration and maintenance for AN. For example, starting at 30–40 kilocalories per kilogram per day (kcal/kg/day) with increases up to 70–100 kcal/kg/day can achieve a weight gain of 1–1.5 kg/week for inpatients. However, little is known about the effects of nutritional deficits on weight gain, or how to meet nutrient requirements for restoration of nutritional status.

This review seeks to draw attention to the need for the development of a foundation of basic nutritional knowledge about AN so that future treatment can be evidenced-based.

【 授权许可】

   
2013 Marzola et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 5.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

【 参考文献 】

• [1]Hudson J, Hiripi E, Pope H, Kessler R: The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biol Psych 2007, 61:348-358.
• [2]Fitzpatrick K, Lock J: Anorexia nervosa. Clin Evid (Online) 2011. April 11
• [3]Swanson S, Crow S, Le Grange D, Swendsen J, Merikangas K: Prevelance and correlates of eating disorders in adolecents: results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry 2011, 68(7):714-723.
• [4]American Psychiatric Association: Treatment of patients with eating disorders, 3rd ed. Am J Psychiatry 2006, 163(Suppl):4-54.
• [5]Mehler PS, Krantz M: Anorexia nervosa medical issues. J Womens Health 2003, 12(4):331-340.
• [6]Bruch H: Anorexia nervosa: therapy and theory. Am J Psychol 1982, 139:1531-1538.
• [7]Fassino S, Piero A, Tomba E, Abbate-Daga G: Factors associated with dropout from treatment for eating disorders: a comprehensive literature review. BMC Psychiatry 2009, 9:67. BioMed Central Full Text
• [8]Steinhausen HC: The outcome of anorexia nervosa in the 20th century. Am J Psychiatry 2002, 159(8):1284-1293.
• [9]Pike K: Long-term course of anorexia nervosa: response, relapse, remission, and recovery. Clin Psychol Rev 1998, 18:447-475.
• [10]Steinglass J, Sysko R, Mayer L, Berner L, Schebendach J, Wang Y, Chen H, Albano A, Simpson H, Walsh B: Pre-meal anxiety and food intake in anorexia nervosa. Appetite 2010, 55(2):214-218.
• [11]Kaye W, Fudge J, Paulus M: New insight into symptoms and neurocircuit function of anorexia nervosa. Nat Rev Neurosci 2009, 10(8):573-584.
• [12]Bardone-Cone A, Fitzsimmons-Craft E, Harney M, Maldonado C, Lawson M, Smith R, Robinson D: The inter-relationships between vegetarianism and eating disorders among females. J Acad Nutr Diet 2012, 112(8):1247-1252.
• [13]Gwirtsman H, Kaye W, Curtis S, Lyter L: Energy intake and dietary macronutrient content in women with anorexia nervosa and volunteers. J Am Diet Assoc 1989, 89(1):54-57.
• [14]Holman R, Adams C, Nelson R, Grater S, Jaskiewicz J, Johnson S, Erdman JJ: Patients with anorexia nervosa demonstrate deficiencies of selected essential fatty acids, compensatory changes in nonessential fatty acids and decreased fluidity of plasma lipids. J Nutr 1995, 125(4):901-907.
• [15]Schebendach J, Mayer L, Devlin M, Attia E, Cotento I, Wolf R, Walsh B: Dietary energy density and diet variety as predictors of outcome in anorexia nervosa. Am J Clin Nutr 2008, 87(4):810-816.
• [16]Kaye W, Gwirtsman H, Obarzanek E, George T, Jimerson DC, Ebert MH: Caloric intake necessary for weight maintenance in anorexia nervosa: nonbulimics require greater caloric intake than bulimics. Am J Clin Nutr 1986, 44:435-443.
• [17]Walker J, Roberts S, Halmi K, Goldberg S: Caloric requirements for weight gain in anorexia nervosa. Am J Clin Nutr 1979, 32(7):1396-1400.
• [18]Weltzin TE, Fernstrom MH, Hansen D, McConaha C, Kaye WH: Abnormal caloric requirements for weight maintenance in patients with anorexia and bulimia nervosa. Am J Psychiatry 1991, 148(12):1675-1682.
• [19]Nova E, Varela P, Lopez-Vidriero I, Toro O, Cenal M, Casas J, Marcos A: A one-year follow-up study in anorexia nervosa. dietary pattern and anthropometrical evolution. Eur J Clin Nutr 2001, 55(7):547-554.
• [20]Misra M, Tsai P, Anderson E, Hubbad J, Gallagher K, Soyka L, Miller K, Herzog D, Klibanski A: Nutrient intake in community-dwelling adolescent girls with anorexia nervosa and in healthy adolescents. Am J Clin Nutr 2006, 84(4):698-706.
• [21]Affenito S, Dohm F, Crawford P, Daniels S, Striegel-Moore R: The national heart, lung, and blood institute growth and health study. J Pediatr 2002, 141(5):701-705.
• [22]Fernstrom M, Weltzin T, Neuberger S, Srinivasagam N, Kaye W: Twenty-four hour food intake in patients with anorexia nervosa and in healthy control subjects. Biol Psych 1994, 36:696-702.
• [23]Hadigan C, Anderson E, Miller K, Hubbard J, Herzog D, Klibanski A, Grinspoon S: Assessment of macronutrient and micronutrient intake in women with anorexia nervosa. Int J Eat Disord 2000, 28:284-292.
• [24]Drewnowski A, Pierce B, Halmi K: Fat aversion in eating disorders. Appetite 1988, 10:119-131.
• [25]Sunday S, Halmi K: Energy intake and body composition in anroexia and bulimia nervosa. Physiol Behav 2003, 78(1):11-17.
• [26]Huse DM, Lucas AR: Dietary patterns in anorexia nervosa. Am J Clin Nutr 1984, 40(2):251-254.
• [27]Micali N, Northstone K, Emmett P, Naumann U, Treasure J: Nutritional intake and dietary patterns in pregnancy: a longitudinal study of women with lifetime eating disorders. Br J Nutr 2012, 108(11):2093-2099.
• [28]Van Binsbergen C, Hulshof K, Wedel M, Odink J, Coelingh Bennink H: Food preferences and aversions and dietary pattern in anorexia nervosa patients. Eur J Clin Nutr 1988, 42(8):671-678.
• [29]Yackobovich-Gavan M, Golan M, Valevski A, Kreitler S, Bachar E, Lieblich A, Mitrani E, Weizman A, Stein D: An integrative quantitative model of factors influencing the course of anorexia nervosa over time. Int J Eat Disord 2009, 42:306-317.
• [30]Fontana L, Klein S, Holloszy J, Premachandra B: Effect of long-term calorie restriction with adequate protein and micronutrients on thyroid hormones. J Clin Endocrinol Metab 2006, 91(8):3232-3235.
• [31]Beaumont P, Chambers T, Rouse L, Abraham S: The diet composition and nutritional knowledge of patients with anorexia nervosa. J Human Nutr 1981, 35:265-273.
• [32]Russell G: The nutritional disorder in anorexia nervosa. J Psychosom Res 1967, 11:141-149.
• [33]Jauregui Lobera I, Bolanos Rios P: Choice of diet in patients with anorexia nervosa. Nutr Hosp 2009, 24(6):682-687.
• [34]Schenbendach J, Mayer L, Devlin M, Attia E, Walsh B: Dietary energy density and diet variety as risk factors for relapse in anorexia nervosa: a replication. Int J Eat Disord 2012, 45(1):79-84.
• [35]Petersen R, Kaye W, Gwirtsman H: Comparison of calculated estimates and laboratory analysis of food offered to hospitalized eating disorder patients. J Am Diet Assoc 1986, 86(4):490-492.
• [36]Mehanna H, Nankivell P, Moledina J, Travis J: Refeeding syndrome–awareness, prevention and management. Head Neck Oncol 2009, 26:1-4.
• [37]Adkins S: Recognizing and preventing refeeding syndrome. Dimens Crit Care Nurs 2009, 28(2):53-58. quiz 59–60
• [38]Yantis M: Velander r: how to recognize and respond to refeeding syndrome. Nursing 2008, 38(5):34-39. quiz 39–40
• [39]NICE: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders (Clinical Guideline 9). London: National Collaborating Centre for Medical Health; 2004.
• [40]Guarda A: Treatment of anorexia nervosa: insights and obstacles. Physiol Behav 2008, 94(1):113-120.
• [41]Halmi K: Pragmatic informtion on the eating disorders. Psychiatr Clin North Am 1982, 5(2):371-377.
• [42]Rock C, Curran-Celentano J: Nutritional managment of eating disorders. Psychitr Clin N orth Am 1996, 19(4):701-713.
• [43]Gaudiani J, Sabel A, Mascolo MM, PS : Severe anorexia nervosa: outcomes from a medical stabilization unit. Int J Eat Disord 2012, 45(1):85-92.
• [44]Gentile M: Enteral nutrition for feeding severely underfed patients with anorexia nervosa. Nutrients 2012, 4(9):1293-1303.
• [45]Kaye W, Gwirtsman H, Obarzanek E, George D: Relative importance of calorie intake needed to gain weight and level of physical activity in anorexia nervosa. Am J Clin Nutr 1988, 47:989-994.
• [46]Setnick J: Micronutrient deficiencies and supplementation in anorexia and bulimia nervoa: a review of literature. Nutr Clin Pract 2010, 25(2):137-142.
• [47]Kohn MR, Golden N: Eating disorders in children and adolescents: epidemiology, diagnosis and treatment. Paediatr Drugs 2001, 3(2):91-99.
• [48]Seidenfeld M, Sosin E, Rickert V: Nutrition and eating disorders in adolescents. Mt Sinai J Med 2004, 71:155-161.
• [49]Whitelaw M, Gilbertson H, Lam P, Sawyer S: Does aggressive refeeding in hospitalized adolescents with anorexia nervosa result in increased hypophosphatemia? J Adolesc Health 2010, 46(6):577-582.
• [50]Katzman D: Refeeding hospitalized adolescents with anorexia nervosa: is "start low, advance slow" urban legend or evidence based? J Adolesc Health 2012, 50(1):1-2.
• [51]Norrington A, Stanley R, Tremlett M, Birrell G: Medical management of acute severe anorexia nervosa. Arch Dis Child Educ Pract Ed 2012, 92(2):48-54.
• [52]Mehler P, Weiner K: Anorexia nervosa and total parenteral nutrition. Int J Eat Disord 1993, 14(3):297-304.
• [53]Golden N, Meyer W: Nutritional rehabilitation of anorexia nervosa. goals and dangers. Int J Adolesc Med Health 2004, 16(2):131-144.
• [54]Kohn M, Madden S, Clarke S: Refeeding in anorexia nervosa: increased safety and efficiency through understanding the pathophysiology of protein calorie malnutrition. Curr Opin Pediatr 2011, 23(4):390-394.
• [55]Dempsey DT, Crosby LO, Pertschuk MJ, Feurer ID, Buzby GP, Mullen JL: Weight gain and nutritional efficacy in anorexia nervosa. Am J Clin Nutr 1984, 39(2):236-242.
• [56]Newman M, Halmi K, Marchi P: Relationship of clinical factors to caloric requirements in subtypes of eating disorders. Biol Psychiatry 1987, 22:1253-1263.
• [57]Forbes G, Kreipe R, Lipinski B: Body composition and the energy cost of weight gain. Hum Nutr Clin Nutr 1982, 36(6):485-487.
• [58]Russell G, Mezey A: An analysis of weight gain in patients with anorexia nervosa treated with high calorie diets. Clin Sci 1962, 23:449-461.
• [59]Mehler P, Winkelman A, Andersen DG, JL : Nutritional rehabilitation: practical guidelines for refeeding the anorectic patient. J Nutr Metab 2010.
• [60]Rosenbaum M, Hirsch J, Gallagher D, Eibel R: Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight. Am J Clin Nutr 2008, 88(4):906-912.
• [61]Rosenbaum MK, HR , Mayer L, Hirsch J, Leibel R: Energy intake in weight reduced humans. Brain Res 2010, 1350:95-102.
• [62]Reiter C, Graves L: Nutrition therapy for eating disorders. Nutr Clin Pract 2010, 25(2):122-136.
• [63]Moukaddem M, Boulier A, Apfelbaum M, Rigaud D: Increase in diet-induced thermogenesis at the start of refeeding in severely malnourished anorexia nervosa patients. Am J Clin Nutr 1997, 66(1):133-140.
• [64]Kron L, Katz JL, Gorzynski G, Weiner H: Hyperactivity in anorexia nervosa: a fundamental clinical feature. Compr Psychiatry 1978, 19(5):433-440.
• [65]Vaisman N, Rossi M, Corey M, Clarke R, Goldberg E, Pencharz P: Effect of refeeding on the energy metabolism of adolescent girls who have anorexia nervosa. Eur J Clin Nutr 1991, 45(11):527-537.
• [66]Kurpad A, Kulkarni R, Shetty P: Reduced thermoregulatory thermogenesis in undernutrition. Eur J Clin Nutr 1989, 43(1):27-33.
• [67]Rigaud D, Verges B, Colas-Linhart N, Petiet A, Moukkaddem M, Van Wymelbeke V, Brondel L: Hormonal and psychological factors linked to the increased thermic effect of food in malnourished fasting anorexia nervosa. J Clin Endocrinol Metab 2007, 92(5):1623-1629.
• [68]Stordy BM, V , Kalucy RC, AH : Weight gain, thermic effect of glucose and resting metabolic rate during recovery from anorexia nervosa. Am J Clin Nutr 1977, 30(2):138-146.
• [69]Kaye WH, Gwirtsman HE, Lake CR, Siever LJ, Jimerson DC, Ebert MH, Murphy DL: Disturbances of norepinephrine metabolism and alpha-2 adrenergic receptor activity in anorexia nervosa: relationship to nutritional state. Psychopharmacol Bull 1985, 21(3):419-423.
• [70]Landsberg LY, JB : The role of the sympathetic nervous system and catecholamines in the regulation of energy metabolism. Am J Clin Nutr 1983, 38(6):1018-1024.
• [71]O'Dea K, Esler M, Leonard P, Stockigt J, Nestel P: Noradrenaline turnover during under- and overeating in normal weight subjects. Metabolism 1982, 31:869-896.
• [72]Casper R: Carbohydrate metabolism and its regulatory hormones in anorexia nervosa. Psy Res 1996, 62(1):85-96.
• [73]Yamashita S, Kawai KY T, Inoo T, Yokoyama H, Morita C, Takii M, Kubo C: BMI, body composition, and the energy requirement for body weight gain in patients with anorexia nervosa. Int J Eat Disord 2010, 43(4):365-371.
• [74]Huas C, Godart N, Foulon C, Pham-Scottez A, Divac S, Fedorowicz V, Peyracque E, Dardennes R, Falissard B, Rouillon F: Predictors of dropout from inpatient treatment for anorexia nervosa: data from a large French sample. Psychiatry Res 2011, 185(3):421-426.
• [75]Mayer L, Roberto C, Glasofer D, Etu S, Gallagher D, Wang J, Heymsfield S, Pierson RJ, Attia E, Devlin M, et al.: Does percent body fat predict outcome in anorexia nervosa? Am J Psychiatry 2007, 164(6):970-972.
• [76]Hebebrand J, Himmelmann G, Herzog W, Herpertz-Dahlmann B, Steinhausen H, Amstein MS, R , Deter H, Remschmidt H, Schafer H: Prediction of low body weight at long-term follow-up in acute anorexia nervosa by low body weight at referral. Am J Psychiatry 1997, 154(4):566-569.
• [77]Mitchell J, Crow S: Medical complications of anorexia nervosa and bulimia nervosa. Curr Opin Psychiatry 2006, 19(4):438-443.
• [78]Vignaud M, Constantin J, Ruivard M, Villemeyre-Plane M, Futier E, Bazin J, Annane D, AZUREA Group (AnorexieRea Study Group): Refeeding syndrome influences outcome of anorexia nervosa patients in intensive care unit: an observational study. Crit Care 2010, 14(5):R172. BioMed Central Full Text
• [79]Langan S, Farrell P: Vitamin E, vitamin A and essential fatty acid status of patients hospitalized for anorexia nervosa. Am J Clin Nutr 1985, 41(5):1054-1060.
• [80]Attia E, Walsh B: Behavioral management for anorexia nervosa. New Eng J Med 2009, 360(5):500-506.
• [81]Hearing S: Refeeding syndrome. BMJ 2004, 328(7445):908-909.
• [82]Helweg-Larsen P, Hoffmeyer H, Kieleir J, Thaysen E, Thaysen J, Thygesen P, Wulff M: Famine disease in German concentration camps: complications and sequels. 144 1952, 274(Suppl):81-92. 178–198
• [83]McLoughlin D, Spargo E, Wassif W, Newham D, Peters T, Lantos P, Russell G: Structural and functional changes in skeletal muscle in anorexia nervosa. Acta Neuropathol 1998, 95(6):632-640.
• [84]Winter T: The effects of undernutrition and refeeding on metabolism and digestive function. Curr Opin Clin Nutr Metab Care 2006, 9(5):596-602.
• [85]Diamanti A, Basso M, Cecchetti C, Monti L, Noto C, De Maria F, Castro M: Digestive complication in severe malnourished anorexia nervosa patient: a case report of necrotizing colitis. Int J Eat Disord 2011, 44(1):91-93.
• [86]Mitrany E, Melamed Y: Compulsory treatment of anorexia nervosa. Is J Psychiatry Relat Sci 2005, 42(3):185-190.
• [87]Tan J, Stewart A, Fitzpatrick R, Hope T: Attitudes of patients with anorexia nervosa to compulsory treatment and coercion. Int J Law Psychiatry 2010, 33(1):13-19.
• [88]Vitousek K, Watson S, Wilson G: Enhancing motivation for change in treatment-resistant eating disorders. Clin Psychol Rev 1998, 18(4):391-420.
• [89]Channon S, DeSilva W: Psychological correlates of weight gain in patients with anoreixa nervosa. J Psychiatr Res 1985, 19:267-271.
• [90]Otten J, Hellwig J, Meyers L: DRI: dietary reference intakes: the essential guide to nutrient requirements. Washington DC: National Academies Press; 2006.
• [91]Lutter C, Rivera J: Nutritional status of infants and young children and characteristics of their diets. J Nutr 2003, 133(9):2941-2949.
• [92]Duerksen D, McCurdy K: Essential fatty acid deficiency in a severely malnourished patient receiving parenteral nutrition. Dig Dis Sci 2005, 50(12):2386-2368.
• [93]Jáuregui-Garrido B, Bolaños-Ríos P, Santiago-Fernandez M, Jauregui-Lobera I: Lipid profile and cardiovascular risk in anorexia nervosa; the effect of nutritional treatment. Nutr Hosp 2012, 27(3):908-913.
• [94]Rosell ML-W, Z , Appleby P, Sanders T, Allen N, Key T: Long-chain n-3 polyunsaturated fatty acids in plasma in British meat-eating, vegetarian, and vegan men. Am J Clin Nutr 2005, 82(2):327-334.
• [95]Ayton AA, A , Horrobin D: A pilot open case series of ethyl-EPA supplementation in the treatment of anorexia nervosa. Prostaglandins Leukot Essent Fatty Acids 2004, 71(4):205-209.
• [96]Abell T, Malagelada J, Lucas A, Brown M, Camilleri M, Go V, Azpiroz F, Callaway C, Kao P, Zinsmeister A: Gastric electromechanical and neurohormonal function in anorexia nervosa. Gastroenterology 1987, 93(5):958-965.
• [97]McCallum R, Grill B, Lange R, Plankly M, Glass E, Greenfeld D: Definition of a gastric emptying abnormality in patients with anorexia nervosa. Dig Dis Sci 1985, 30(8):713-722.