Our aim is to present clinical results achieved with an intensive treatment programme for severe anorexia nervosa (AN) patients at risk of severe disability or death. Aims of the treatment are to remove life threatening conditions, physical and nutritional rehabilitation, and psychological and relational rehabilitation.
We present an observational retrospective study of a cohort of 99 consecutive patients affected by severe AN [according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR)] and a body mass index (BMI) <or=13.5 kg/m2 treated by a multidisciplinary comprehensive medical, nutritional, psychological treatment. Intensive treatment (inpatient day and night and day hospital care) of variable length, with resort to enteral nutrition if needed, ends by achieving a BMI of at least 18 kg/m2. Outpatient care phase follows. Main goals were the recovery of BMI and the ability to maintain it.
Ninety-nine patients affected by severe Protein- Energy-Malnutritrion (PEM) due to AN were eligible in the study. Mean BMI was 12.5+/-0.9 kg/m2, mean age 21.9+/-8.6 yrs. Of 99 patients, 75 (75.5%) completed the planned treatment (completer subgroup). Eighteen patients prematurely interrupted their treatment before achieving complete weight restoration (dropout subgroup); on average they were older and ill for a longer time before admission. Six patients asked to be transferred to other eating disorder units closer to their towns. Seventy-five completer AN patients continued to undergo intensive inpatient treatment till the achievement of BMI 18.3+/-0.8 kg/m2 and then they have been in follow-up outpatient for a mean period of 17.4+/-1.6 months with an average extra increase of their BMI until to 19.1+/-1.6 kg/m2. In 32 patients with a more severe malnutrition we had to resort to nasogastric enteral feeding for 4.4+/-2.5 months, with a mean caloric supply of 1375+/-211 Kcal until the patients were no longer at life risk and they started to co-operate to treatment, increasing oral food amounts.
Our results seem to provide strong support for using a highly structured program for treating patients with severe AN, including inpatient care and multidisciplinary medical and psychological teams specialized in eating disorder treatment.
[Show abstract][Hide abstract] ABSTRACT: The treatment of eating disorders demands a comprehensive medical approach, where a dietitian has an important role, primarily due to numerous instances of malnutrition. The objective of this paper was to recapitulate the research findings and clinical evidence which show the importance of medical nutrition therapy in the treatment of eating disorders; furthermore, they present significant guidelines for clinical practice. The research methods have entailed a thorough exploration of literature available at research data bases. The results of the research studies published so far have unambiguously pointed out that, when eating disorders are concerned, there is an urgent need for a diet therapy in order for the patient to restore the appropriate body weight as well as normal eating habits. On the one hand, certain authors suggest returning to normal nutritional habits immediately, whereas, on the other hand, certain others advocate a diet therapy program, that is, a gradual process of recovery. Patients incapable of oral food intake receive enteral nutrition. Parenteral nutrition is applied for recovering the lost electrolytes and fluids, but it should be applied rarely, primarily in states of urgency. For patients suffering from eating disorders the increase in weight indicates good chances of recovery; therefore, the patient’s nutritional status should be carefully and continuously noted. Finally, it is important that our country, too, should adopt a carefully prescribed and conducted diet therapy as an obligatory step in the treatment of patients with eating disorders.
[Show abstract][Hide abstract] ABSTRACT: Refeeding severely malnourished patients with Anorexia nervosa requires specialized in-patient treatment to reduce medical risks, to avoid refeeding syndrome and other life-threatening situations.
The authors present a retrospective cohort nutritional rehabilitation study of 33 very severe Anorexia nervosa in-patients, aged 22.8 ± 7.6 years (mean ± SD) and with an initial body mass index ≤ 12 kg/m(2), treated in a specialized Eating Disorders Unit.
Thirty-three female patients were included and treated. Mean BMI increased from 11.3 ± 0.7 Kg/m(2), to 13.5 ± 1 Kg/m(2), and mean body weight from 29.1 ± 3.2 Kg to 34.5 ± 3.3 Kg, after 60 days of intensive in-patient treatments (p < 0.0001). Feeding was carefully instituted; caloric intake levels were established after measuring REE by indirect calorimetry. Nutritional support was initiated with temporary nasogastric feeding in 30 patients, and with oral supplementation in 3 patients. Vitamins, potassium and phosphate supplements were administered during refeeding. All patients achieved a significant increase in body weight, none developed refeeding syndrome as far as laboratory and clinical investigations were concerned.
Our findings show that, even in cases of extreme undernutrition, if feeding is performed cautiously and in a specialized unit, it is possible to avoid the refeeding syndrome.
[Show abstract][Hide abstract] ABSTRACT: Anorexia nervosa is an eating disorder. It is a severe and sometimes long-term or chronic mental illness associated with significant morbidity and mortality. The majority of medical consequences observed in anorexia nervosa, including physiological and metabolic changes, are present in starvation states or are a direct result of purging behaviors. Children who are still growing may fail to make expected increases in weight and height. Anorexia nervosa occurs mainly in women, with approximately 5-8% of patients being male. It occurs in every socioeconomic and cultural background, at least in Western countries. Accurate weight and height measurements are fundamental for the diagnosis of anorexia nervosa. Calculation of body mass index may facilitate risk level evaluation and orientation to treatment type. Evidence for effective anorexia nervosa treatment is still weak but guidelines and position papers agree in defining the best treatment as a multidisciplinary, comprehensive and rigorous process conducted by a team of medical, nutritional, mental health and nursing professionals experienced in the evolution and treatment of eating disorders. Various levels of care should be available: outpatient care, partial hospitalization (day hospital), day-and-night inpatient care, and residential treatment. Together with psychological therapy, nutrition rehabilitation is a goal of anorexia nervosa treatment, to prevent and/or correct medical complications and reduce psychological symptoms.
Nutritional Therapy and Metabolism 10/2010; 28(4):185-192.
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