Body fluid retention and body weight change in anorexia nervosa patients during refeeding.

BACKGROUND & AIMS: Body weight gain is an important goal in anorexia nervosa (AN) patients, but inflation in body fluids could artificially increase body weight during refeeding. METHODS: 42 malnourished adult AN patients were refed using a normal-sodium diet, then 176 other malnourished adult AN patients received a refeeding low-sodium diet (BMI of the 218 patients: 13.4 ± 1.9 kg/m(2)). Sodium balance, body composition by a 2-electrode impedance method (BIA, for assessment of total and extracellular water, fat-free mass, FFM), resting energy expenditure and energy intake were calculated. RESULTS: In the patients on normal-sodium diet, body weight, and total and extracellular water gains were higher than those of the low-sodium diet patients (P<0.01). Edema occurred more often in the former group (21% vs 6%; P<0.05). In almost all patients, BMI reached a plateau around 15-16 kg/m(2), then increased again. During this plateau, an increase in intracellular water and in "active FFM" was observed with BIA, together with a similar decrease in extracellular water. CONCLUSION: In AN patients, who are always afraid of gaining too much weight, in regard to their food intake, it will be useful to give a low-sodium diet until a 15-16 kg/m(2) BMI. This should be integrated into the cognitive behavioral therapy.

Comparison of field methods to estimate fat mass in children.

BACKGROUND: Reliable field methods to measure fat mass (FM) in children may contribute to primary prevention of childhood obesity. AIM: The objective was to compare the accuracy of existing field methods (skinfold thickness (SF), leg-to-leg bioelectrical impedance analysis (BIA), anthropometrics for FM measurement in prepubertal European children. SUBJECTS AND METHODS: Reference FM was measured in 55 French children (30 boys, 25 girls; mean age 8.7 years) using a three-compartment model: body volume (BV) was assessed by air displacement plethysmography (ADP) and total body water (TBW) was assessed by deuterium dilution. Agreement between field methods and the reference method was assessed using Bland-Altman analyses. Since field methods for FM measurement are reported to be population-dependent, adjustment to the study population was performed using stepwise multiple linear regressions modelling. RESULTS: Even after adjustment, field methods exhibited a high correlation (R(2) = 0.71-0.84) but a moderate agreement (+/-3.32 to +/-4.47 kg for fat mass) with the reference model. Methods based on BIA or SF performed slightly better than those based on anthropometry. CONCLUSIONS: Field methods for FM measurement may be recommended for epidemiological applications, but not for individual follow-up. New field equipment is required to improve accuracy of FM measurement in children and make individual follow-up possible.

Family dietary coaching to improve nutritional intakes and body weight control: a randomized controlled trial.

OBJECTIVE: To test the hypothesis that family dietary coaching would improve nutritional intakes and weight control in free-living (noninstitutionalized) children and parents. DESIGN: Randomized controlled trial. SETTING: Fifty-four elementary schools in Paris, France. PARTICIPANTS: One thousand thirteen children (mean age, 7.7 years) and 1013 parents (mean age, 40.5 years). INTERVENTION: Families were randomly assigned to group A (advised to reduce fat and to increase complex carbohydrate intake), group B (advised to reduce both fat and sugar and to increase complex carbohydrate intake), or a control group (given no advice). Groups A and B received monthly phone counseling and Internet-based monitoring for 8 months. OUTCOME MEASURES: Changes in nutritional intake, body mass index (calculated as weight in kilograms divided by height in meters squared), fat mass, physical activity, blood indicators, and quality of life. RESULTS: Compared with controls, participants in the intervention groups achieved their nutritional targets for fat intake and to a smaller extent for sugar and complex carbohydrate intake, leading to a decrease in energy intake (children, P < .001; parents, P = .02). Mean changes in body mass index were similar among children (group A, + 0.05, 95% confidence interval [CI], - 0.06 to 0.16; group B, + 0.10, 95% CI, - 0.03 to 0.23; control group, + 0.13, 95% CI, 0.04-0.22; P = .45), but differed in parents (group A, + 0.13, 95% CI, - 0.01 to 0.27; group B, - 0.02, 95% CI, - 0.14 to 0.11; control group, + 0.24, 95% CI, 0.13-0.34; P = .001), with a significant difference between group B and the control group (P = .01). CONCLUSIONS: Family dietary coaching improves nutritional intake in free-living children and parents, with beneficial effects on weight control in parents. Trial Registration clinicaltrials.gov Identifier: NCT00456911.