ResearchChanges in resting energy expenditure and body composition in anorexia nervosa patients during refeeding☆
Section snippets
Subjects
Ten consecutively admitted women, aged 19 to 38 years, were recruited for this study. The patients had been admitted voluntarily and consented to the overall treatment regimen. Subjects were nonmedicated, had no endocrinopathic diseases, and met established criteria for anorexia nervosa (1). All were at least 15% below expected weight for height upon admission. Seven reported some bulimic behavior before hospitalization, and three appeared to have controlled their weight primarily through
RESULTS
The refeeding protocol promoted weight gain in all subjects, as predicted. Ten patients completed phases 1, 2, and 3, and six patients remained hospitalized long enough to complete phase 4. The refeeding regimen lasted a mean of 6.3 weeks. None of the patients experienced adverse metabolic or physiologic side effects in response to the regimen.
The Table lists descriptive characteristics of the total group during phases 1, 2, and 3 of the refeeding protocol as well as characteristics of the six
DISCUSSION
Results from our study demonstrate that refeeding to restore weight in anorexia nervosa patients is associated with an increase in REE, even when corrected for increased body mass. At baseline, estimates of REE derived from predictive calculations were found to overestimate basal energy expenditure, but during weight restoration these figures underestimated expenditure substantially.
In a study of 29 patients with anorexia nervosa, Walker et al (18) observed that a mean excess of 5,026 kcal was
APPLICATIONS
Adult patients with anorexia nervosa are a heterogeneous group, although low initial REE has been consistently reported, most likely in response to semistarvation. However, results from this study confirm that REE is likely to be higher than predicted during refeeding, presumably mediated by altered hormonal or metabolic status. High-energy diets may be clinically necessary to promote continued weight gain in these patients.
More importantly, monitoring REE levels and response to refeeding
Acknowledgements
The authors thank the staff of the Clinical Research Center, especially Constance Adair, MS, RD, for support and for obtaining the body composition measures. The authors also thank Robert Bartlett, MD, of the Department of Surgery and Adam Drewnowski, PhD, of the Program in Human Nutrition, University of Michigan, Ann Arbor, for their guidance and support.
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This study was supported by CRC grant 5M01RR00042.
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D. D. Krahn is currently an associate professor in the Department of Psychiatry, University of Wisconsin, Madison, WI 53705.