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Nutrients
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Nutritional Management and Outcomes in Anorexia Nervosa
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Nutritional Management and Outcomes in Anorexia Nervosa

A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Clinical Nutrition".

Deadline for manuscript submissions: closed (20 April 2022) | Viewed by 13723

Special Issue Editors

Dr. Chantal Stheneur

E-Mail Website
Guest Editor
1. Adolescent Medicine Department, Fondation Santé des Etudiants de France, 91480 Varennes Jarcy, France
2. UFR des Sciences de la Santé Simone Veil, Université de Versailles Saint-Quentin-en-Yvelines, 78000 Versailles, France
Interests: anorexia nervosa;adolescent medicine;marfan syndrome; child health;psychosomatic medicine;psychiatry;young adults;child development
Dr. Mouna Hanachi

E-Mail Website
Guest Editor
Nutrition Unit, Paul Brousse University Hospital, Assistance Publique–Hôpitaux de Paris, 94800 Villejuif, France
Interests: nutrition;metabolic syndrome;nutritional status;malnutrition;metabolism;nutrition assessment

Special Issue Information

Dear Colleagues,

Anorexia Nervosa (AN) is a serious eating disorder that affects 1–2.2% of young women. Its mortality rate is high, ranging between 6 and 16 times higher than the general population. Somatic complications are the first mortality causes, before suicide, and these can be the consequences of either undernourishment, pathological behaviors such as vomiting, potomania, problematic physical activity, or adverse effects of refeeding. To avoid these complications, nutrition should be monitored precisely, from being in a life-threatening condition in intensive care to long-term follow up even after weight restoration.

The aim of this Special Issue is to provide an overview of the latest advances in the pathophysiology of AN and its complications and treatment pathways, as well as early renutrition, in order to avoid refeeding syndrome while allowing a fast weight recovery, restoring nutritional status, treating pathological nutritional behaviour, and preventing relapses.

Dr. Chantal Stheneur
Dr. Mouna Hanachi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Nutrients is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • somatic complication
  • undernutrition
  • anorexia nervosa
  • enteral nutrition
  • refeeding syndrome
  • weight recovery
  • eating behaviors

Published Papers (6 papers)

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Editorial

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3 pages, 192 KiB  
Editorial
Somatic Outcomes and Nutritional Management of Anorexia Nervosa
by Chantal Stheneur and Mouna Hanachi
Nutrients 2023, 15(11), 2541; https://doi.org/10.3390/nu15112541 - 30 May 2023
Viewed by 995
Abstract
This Special Issue of Nutrients, entitled “Nutritional Management and Outcomes in Anorexia Nervosa”, aims to advance aspects of the scientific understanding of some serious or frequent somatic involvements and of the precocious nutrition management of severe forms of the disease in order [...] Read more.
This Special Issue of Nutrients, entitled “Nutritional Management and Outcomes in Anorexia Nervosa”, aims to advance aspects of the scientific understanding of some serious or frequent somatic involvements and of the precocious nutrition management of severe forms of the disease in order to assist clinicians in the management of such patients [...] Full article
(This article belongs to the Special Issue Nutritional Management and Outcomes in Anorexia Nervosa)

Research

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10 pages, 451 KiB  
Article
The Fitter I Am, the Larger I Feel—The Vicious Circle of Physical Exercise in Anorexia Nervosa
by Laura Di Lodovico, Mouna Hanachi, Philibert Duriez and Philip Gorwood
Nutrients 2022, 14(21), 4507; https://doi.org/10.3390/nu14214507 - 26 Oct 2022
Cited by 2 | Viewed by 1783
Abstract
Introduction: Body image distortion is a core symptom of anorexia nervosa (AN), embodying dissatisfaction and overvaluation of body appearance and weight. Body image distortion is an important factor in the maintenance of weight loss behaviours such as compulsive physical exercise. Conversely, physical exercise [...] Read more.
Introduction: Body image distortion is a core symptom of anorexia nervosa (AN), embodying dissatisfaction and overvaluation of body appearance and weight. Body image distortion is an important factor in the maintenance of weight loss behaviours such as compulsive physical exercise. Conversely, physical exercise seems to have an aggravating effect on body image in patients with AN, but the evidence is still poor. The aim of this study was to examine the relationship between body image distortion and physical exercise in AN in order to understand whether physical exercise may play a specific role in body image distortion beyond psychopathological severity. Methods: Forty patients with AN and 21 healthy controls were tested for body image distortion and different proxies of physical exercise. Univariate correlations tested the relationship between body image distortion and physical exercise in AN and control groups. Then, to experimentally assess the effect of exercise on body image distortion, participants were invited to rate their body image before and after a standardised effort test. Results: In the AN group, a correlation was found between physical activity and body image distortion (p < 0.01), which was still significant after controlling for psychopathological severity. No correlation was found in healthy controls. After a standardised effort, patients with AN had higher increases in body image distortion than healthy controls (almost 4 kg/m2 vs. 0.8 kg/m2) (p < 0.01). Discussion: Physical exercise may contribute to the distortion of body image in anorexia nervosa and explain the paradoxical augmentation of unhealthy exercise despite ongoing weight loss. Full article
(This article belongs to the Special Issue Nutritional Management and Outcomes in Anorexia Nervosa)
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16 pages, 816 KiB  
Article
Clinical Correlates of Measured and Predicted Resting Energy Expenditure in Patients with Anorexia Nervosa: A Retrospective Cohort Study
by Rami Bou Khalil, Ariane Sultan, Maude Seneque, Sami Richa, Patrick Lefebvre, Eric Renard, Philippe Courtet, Laurent Maimoun and Sebastien Guillaume
Nutrients 2022, 14(13), 2727; https://doi.org/10.3390/nu14132727 - 30 Jun 2022
Cited by 3 | Viewed by 1598
Abstract
Resting energy expenditure (REE; i.e., the calorie amount required for 24 h during a non-active period) is an important parameter in nutritional rehabilitation of patients with anorexia nervosa (AN). This study determined whether age, body mass index, AN duration/subtype/specific symptoms/clinical severity, cognitive function [...] Read more.
Resting energy expenditure (REE; i.e., the calorie amount required for 24 h during a non-active period) is an important parameter in nutritional rehabilitation of patients with anorexia nervosa (AN). This study determined whether age, body mass index, AN duration/subtype/specific symptoms/clinical severity, cognitive function alterations, and psychiatric comorbidities influenced REE or the difference between the calculated and estimated REE. Patients with AN who were followed at a daycare treatment facility between May 2017 and January 2020 (n = 138) underwent a complete assessment that included the MINI, Eating Disorder Examination Questionnaire, d2 test of attention, body fat composition by bioelectrical impedance analysis (BIA) and REE measurement by indirect calorimetry (REEIC). AN subtype (N = 66 for restrictive subtype and N = 69 for non-restrictive subtype; p = 0.005), free-fat mass (<0.001), and fat mass (<0.001) were associated with REEIC. Age (p < 0.001), height (p = 0.003), and AN duration (N = 46 for <3 years and N = 82 for ≥3 years; p = 0.012) were associated with the difference between estimated REE (using the Schebendach equation) and measured REEIC. Therefore, the Schebendach equation was adjusted differently in the two patients’ subgroups (AN duration ≤ or >3 years). Overall, REE was higher in patients with restrictive than non-restrictive AN. In the absence of BIA measures, REE-estimating equations should take into account AN duration. Full article
(This article belongs to the Special Issue Nutritional Management and Outcomes in Anorexia Nervosa)
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12 pages, 818 KiB  
Article
Physiologic Transdermal Estradiol Replacement Mimics Effects of Endogenous Estrogen on Bone Outcomes in Hypoestrogenic Women with Anorexia Nervosa
by Vibha Singhal, Supritha Nimmala, Meghan Slattery, Kamryn T. Eddy, Karen K. Miller, Anne Klibanski and Madhusmita Misra
Nutrients 2022, 14(13), 2557; https://doi.org/10.3390/nu14132557 - 21 Jun 2022
Cited by 2 | Viewed by 1949
Abstract
Background: While physiologic estrogen replacement results in increases in areal bone mineral density (aBMD) in hypoestrogenic adolescent girls and young adult women with AN, data are lacking regarding its impact on measures of volumetric BMD (vBMD), bone geometry, and structure. Methods: 23 young [...] Read more.
Background: While physiologic estrogen replacement results in increases in areal bone mineral density (aBMD) in hypoestrogenic adolescent girls and young adult women with AN, data are lacking regarding its impact on measures of volumetric BMD (vBMD), bone geometry, and structure. Methods: 23 young women with anorexia nervosa (AN) and 27 normal-weight healthy controls (HC) between 14–25 years old were followed for 12 months. AN participants received transdermal 17β-estradiol (continuously) with 10 days of cyclic oral progesterone (100 mg daily) every month for the study duration (AN-E+). DXA was used to measure aBMD and body composition, high resolution peripheral quantitative CT (HRpQCT) to assess vBMD, bone geometry and structure at the distal radius and tibia, and microfinite element analysis to estimate strength. Results: Groups did not differ for age. Median baseline BMI z-scores were −1.13 (−1.58, −0.38) in AN-E+ vs. 0.08 (−0.40, 0.84) in HC (p < 0.0001). For most HRpQCT parameters and strength estimates, young women with AN receiving physiologic estrogen replacement demonstrated similar changes over 12 months as did normoestrogenic HC. Additionally, radial cortical tissue mineral density, cortical vBMD, and failure load increased (p = 0.01; p = 0.02; p = 0.004 respectively) over 12 months in AN-E+ compared to HC. Conclusions: With physiologic estrogen replacement, bone accrual improved in AN to approximate changes observed in normoestrogenic controls followed without any intervention, with additional benefits observed for cortical tissue mineral density, cortical vBMD, and failure load at the radius in AN vs. controls. Thus, this strategy for estrogen replacement effectively mimics the effects of endogenous estrogen on bone structure and estimated strength. Full article
(This article belongs to the Special Issue Nutritional Management and Outcomes in Anorexia Nervosa)
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10 pages, 985 KiB  
Article
Liver Damage Is Related to the Degree of Being Underweight in Anorexia Nervosa and Improves Rapidly with Weight Gain
by Ulrich Cuntz and Ulrich Voderholzer
Nutrients 2022, 14(12), 2378; https://doi.org/10.3390/nu14122378 - 08 Jun 2022
Cited by 5 | Viewed by 2708
Abstract
Background: The present study investigates the relationship between hypertransaminasemia and malnutrition on the basis of a very large number of patients. We assume that the level of transaminases not only reflects the extent of underlying liver cell damage but also provides information about [...] Read more.
Background: The present study investigates the relationship between hypertransaminasemia and malnutrition on the basis of a very large number of patients. We assume that the level of transaminases not only reflects the extent of underlying liver cell damage but also provides information about the metabolic situation under conditions of energy deficiency. Methods: We present an observational study in two different samples. The first sample consists of 3755 patients (mean age 22.7 years, Range 12–73 years; mean BMI 15.4 kg/m2, range 8.1–25.7) out of a total of 4212 patients with anorexia nervosa treated in the Roseneck Clinic within five years for whom a complete admission laboratory was available. The second sample was obtained from a special ward for medically at-risk patients with eating disorders. During the period in question, four hundred and ten patients with anorexia nervosa were treated. One hundred and forty-two female patients (mean age 26.4 years, Range 18–63 years; mean BMI 11.5 kg/m2, range 8.4–13) had a BMI of thirteen or less and a complete data set was obtained at admission and weekly in the following four weeks after admission. Results: The increase in liver transaminases shows a very high correlation with weight in sample one (N = 3755). The analysis of variance shows highly significant (<0.001) correlations with an F-value of 55 for GOT/AST and 63 for GPT/ALT. Nevertheless, the variance within the groups with the same BMI is quite high. With re-nutrition in sample two, GOT/AST decreased on average from 71 U/L to 26 U/L (MANOVA F 10.7, p < 0.001) and GPT/ALT from 88 to 41 U/L (F = 9.9, p < 0.001) within four weeks. Discussion: Below a BMI of about 13, the nutritional status of the patients becomes so critical that the energy supply of the patient is increasingly dependent on the autophagy of the liver, which can be seen in the very strong increase in transaminases here. Refeeding leads very quickly to the normalisation of the transaminases and, thus, a stabilisation of the metabolism leading also to a decrease in autophagy. Full article
(This article belongs to the Special Issue Nutritional Management and Outcomes in Anorexia Nervosa)
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Review

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18 pages, 325 KiB  
Review
To Improve the Initial Inpatient Management of Adolescents Admitted with Severe Anorexia Nervosa: A Narrative Review and a Convenient Protocol
by Stephanie Proulx-Cabana, Marie-Elaine Metras, Danielle Taddeo, Olivier Jamoulle, Jean-Yves Frappier and Chantal Stheneur
Nutrients 2022, 14(1), 229; https://doi.org/10.3390/nu14010229 - 05 Jan 2022
Cited by 5 | Viewed by 3936
Abstract
Inadequate nutritional rehabilitation of severely malnourished adolescents with Anorexia Nervosa (AN) increases the risk of medical complications. There is no consensus on best practices for inpatient nutritional rehabilitation and medical stabilization for severe AN. This study aimed to elaborate an admission protocol for [...] Read more.
Inadequate nutritional rehabilitation of severely malnourished adolescents with Anorexia Nervosa (AN) increases the risk of medical complications. There is no consensus on best practices for inpatient nutritional rehabilitation and medical stabilization for severe AN. This study aimed to elaborate an admission protocol for adolescents with severe AN based on a comprehensive narrative review of current evidence. A Pubmed search was conducted in July 2017 and updated in August 2020, using the keywords severe AN or eating disorders (ED), management guidelines and adolescent. Relevant references cited in these guidelines were retrieved. A secondary search was conducted using AN or ED and refeeding protocol, refeeding syndrome (RS), hypophosphatemia, hypoglycemia, cardiac monitoring or cardiac complications. Evidence obtained was used to develop the admission protocol. Selective blood tests were proposed during the first three days of nutritional rehabilitation. Higher initial caloric intake is supported by evidence. Continuous nasogastric tube feeding was proposed for patients with a BMI < 12 kg/m2. We monitor hypoglycemia for 72 h. Continuous cardiac monitoring for bradycardia <30 BPM and systematic phosphate supplementation should be considered. Developing protocols is necessary to improve standardization of care. We provide an example of an inpatient admission protocol for adolescents with severe AN. Full article
(This article belongs to the Special Issue Nutritional Management and Outcomes in Anorexia Nervosa)
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