Subject(s)
Abdominal Pain/diagnostic imaging , Anorexia Nervosa/diet therapy , Emphysema/diagnostic imaging , Enteral Nutrition , Malnutrition/diet therapy , Pneumatosis Cystoides Intestinalis/diagnostic imaging , Abdominal Pain/etiology , Abdominal Pain/therapy , Adult , Anorexia Nervosa/complications , Computed Tomography Angiography , Emphysema/therapy , Enteral Nutrition/adverse effects , Female , Gastritis/diagnostic imaging , Humans , Intubation, Gastrointestinal/adverse effects , Pneumatosis Cystoides Intestinalis/therapy , Portal Vein/diagnostic imaging , Treatment OutcomeABSTRACT
BACKGROUND: Follow-up visits of patients recovering from anorexia nervosa (AN) have shown that some patients do not resume menstrual cycles despite returning to the normal weight for their age and height. AIM: To verify whether leptin, insulin-like growth factor 1 (IGF-1) or another hormonal marker could be a good predictor of the return of menses. PATIENTS AND METHODS: This prospective study included female adolescents diagnosed with AN or eating disorders not otherwise specified (EDNOS) and who were being treated in an ambulatory care unit during nutritional recovery. Body mass index and leptin, luteinizing hormone, estradiol and IGF-1 levels of these patients were evaluated. Blood samples were collected in the 1st (T1), 5th (T2), 10th (T3), 15th (T4) and 20th (T5) weeks of treatment. The hormone levels during nutritional recovery and at the time of the resumption of menses were analyzed. RESULTS: The hormonal profiles improved after nutritional recovery, with IGF-1 correlating the most with the resumption of menses and nutritional recovery (p = 0.0001). At the resumption of menstruation, the patients showed IGF-1 levels >342.8 ng/ml. CONCLUSION: IGF-1 was the best predictor of the return of menses in female adolescents with AN or EDNOS.
Subject(s)
Anorexia Nervosa/blood , Body Mass Index , Insulin-Like Growth Factor I/metabolism , Menstrual Cycle , Adolescent , Anorexia Nervosa/diet therapy , Anorexia Nervosa/physiopathology , Child , Female , Follow-Up Studies , Humans , Leptin/blood , Luteinizing Hormone/blood , Prospective StudiesABSTRACT
OBJECTIVE: To examine gastric function, as well as the presence of somatic complaints, anxiety symptoms, and functional gastrointestinal disorders (FGIDs), in adolescents with anorexia nervosa (AN) before and after nutritional rehabilitation. STUDY DESIGN: Sixteen females with AN and 22 healthy controls with similar demographic profiles were included. Gastric emptying (measured as residual gastric volume) and gastric accommodation (measured as postprandial antral diameter) were assessed with abdominal ultrasonography. Participants completed the Children's Somatization Inventory (CSI), the Screen for Child Anxiety-Related Emotional Disorders, and the Questionnaire on Pediatric Gastrointestinal Symptoms-Rome III version. All testing was repeated 3-4 months later. RESULTS: Body mass index in the AN group improved over time (P = .012). Fasting gastric parameters were similar in the 2 groups. Maximum postprandial antral diameter was significantly greater in controls compared with the AN group (P = .008). Only adolescents with AN demonstrated a significant increase in maximum postprandial diameter at repeat testing (P = .009). There was no difference in residual gastric volume between the 2 groups. Initial CSI scores were higher in adolescents with AN (P < .0001), including higher scores for nausea and abdominal pain. CSI scores were significantly lower in adolescents with AN (P = .035). Initial scores on the Screen for Child Anxiety-Related Emotional Disorders were significantly higher in adolescents with AN (P = .0005), but did not change over time. Adolescents with AN met significantly more criteria for FGIDs (P = .003). CONCLUSION: Adolescents with AN have impaired gastric accommodation that improves after nutritional rehabilitation, have significantly more somatic complaints, and meet more criteria for anxiety disorders and FGIDs. After nutritional rehabilitation, somatization improves and FGIDs become less common, but symptoms of anxiety persist.
Subject(s)
Anorexia Nervosa/diet therapy , Anxiety/etiology , Gastric Emptying , Gastrointestinal Diseases/etiology , Somatoform Disorders/etiology , Adolescent , Anorexia Nervosa/complications , Anorexia Nervosa/physiopathology , Anorexia Nervosa/psychology , Anxiety/diagnosis , Case-Control Studies , Child , Female , Follow-Up Studies , Gastrointestinal Diseases/diagnosis , Humans , Linear Models , Logistic Models , Prospective Studies , Psychological Tests , Self Report , Single-Blind Method , Somatoform Disorders/diagnosis , Stomach/diagnostic imaging , Stomach/physiopathology , Surveys and Questionnaires , Treatment Outcome , Ultrasonography , Young AdultABSTRACT
While numerous studies have highlighted the need to approach anorexia nervosa from a multidisciplinary perspective, the dietary and nutritional aspects of the disorder are rarely considered in depth. Basic guidelines to monitor food intake of patients, are available. A literature review was performed in Medline, searching for articles related to the dietary and nutritional management of anorexia nervosa and published over the last five years. The final analysis focused on 102 articles. This review summarizes the different therapeutic contexts and objectives, nutritional support, the use of dietary supplements, the role of artificial nutrition, refeeding syndrome, involuntary treatment and nutritional education.
Subject(s)
Anorexia Nervosa/diet therapy , Nutritional Support/methods , Anorexia Nervosa/psychology , Dietary Supplements , HumansABSTRACT
While numerous studies have highlighted the need to approach anorexia nervosa from a multidisciplinary perspective, the dietary and nutritional aspects of the disorder are rarely considered in depth. Basic guidelines to monitor food intake of patients, are available. A literature review was performed in Medline, searching for articles related to the dietary and nutritional management of anorexia nervosa and published over the last five years. Thefinal analysis focused on 102 articles. This review summarizes the different therapeutic contexts and objectives, nutritional support, the use of dietary supplements, the role of artificial nutrition, refeeding syndrome, involuntary treatment and nutritional education.
Subject(s)
Humans , Anorexia Nervosa/diet therapy , Nutritional Support/methods , Anorexia Nervosa/psychology , Dietary SupplementsABSTRACT
La prevalencia entre los adolescentes, de trastornos de la conducta alimentaria como anorexia nerviosa (AN), bulimia nerviosa (BN) y otro (obesidad, alimentación compulsiva, o no especificados), viene creciendo día a día de modo sostenido y a gran velocidad; y siendo la alimentación una necesidad básica, importante y vital para el crecimiento y desarrollo, debe entenderse que este acto ejerce una conducta poderosa influencia en la estructura y funcionamiento del organismo por lo tanto una conducta alimentaria adecuada hace posible que esto se desarrolle de manera adecuada y óptima. Cada sociedad tiene formas habituales de alimentarse según sus costumbres y características socioculturales y religiosas; cuando un individuo se aparta de los límites racionales presentando características anormales tanto en la calidad como en la cantidad o distribución de las comidas a esto se le llama ôTrastornos en la Conducta Alimentariaõ. El tratamiento de los trastornos en la conducta alimentaria representa todo un desafío de Salud Pública por su alta incidencia, gravedad y evolución clínica prolongada con propensión a la cronicidad y por el grupo etáreo afectado, por lo tanto, es indispensable buscar las herramientas que permitan una detección temprana y una intervención especializada con un equipo multidisciplinario que incluya médico, psicólogo, nutricionista, psiquiatría, de modo que el pronóstico de recuperación sea el mejor posible.
Subject(s)
Humans , Anorexia Nervosa/diet therapy , Anorexia Nervosa/drug therapy , Bulimia Nervosa/diet therapy , Bulimia Nervosa/drug therapy , Nutritional Status , Feeding and Eating Disorders , Nutrition TherapyABSTRACT
Pacientes com transtornos alimentares possuem inadequaçäes profundas no consumo, padrão e comportamento alimentar, além de diversas crenças equivocadas sobre alimentação, o que geralmente acarreta piora do estado nutricional. O tratamento nutricional visa a reverter tais alteraçäes e promover hábitos alimentares saudáveis e melhor relação para com o alimento. Os objetivos e características do tratamento diferem para a anorexia nervosa e a bulimia nervosa, contudo, usualmente, a abordagem é dividida em duas fases: a educacional, cujas principais metas são a regularização do hábito alimentar e o aumento do conhecimento nutricional, e a experimental, que visa a propiciar maior reabilitação nutricional e mudanças mais profundas no comportamento alimentar. As evidências existentes sugerem que o tratamento nutricional promove a melhora de tais parâmetros, porém, alguns comportamentos alimentares, como a sensação de incompetência ao lidar com os alimentos, permanecem. Desta forma, mais estudos são necessários para que se possa de fato avaliar a eficácia da abordagem nutricional.
Subject(s)
Feeding and Eating Disorders/diet therapy , Nutrition Therapy/psychology , Nutrition Disorders/etiology , Anorexia Nervosa/diet therapy , Bulimia/diet therapy , Feeding Behavior , Patient Care Team , Feeding and Eating Disorders/pathologyABSTRACT
OBJECTIVE: To examine whether circadian rhythm of blood pressure (BP) is altered in patients with anorexia nervosa (AN), and if so, to determine whether it is reversible after refeeding. STUDY DESIGN: Ambulatory BP monitoring was performed on 17 female inpatients with AN (mean age, 13.3 +/- 1.9 years) at the time of admission and serially during refeeding; 17 age-matched normal weight, normotensive female inpatients served as control subjects. RESULTS: Patients with AN had lost an average of 23.4% +/- 11.5% of body weight before the illness. Weight after refeeding was 105.6% +/- 9. 2% of that before illness. Mean 24-hour systolic BP (SBP) (96.5 +/- 8.6 mm Hg) and diastolic BP (DBP) (53.4 +/- 5.8 mm Hg) were significantly lower in patients with AN compared with those of control subjects (SBP, 106.1 +/- 6.5 mm Hg; DBP, 60.2 +/- 5.8 mm Hg). Although awake SBP and DBP were also lower in patients with AN, asleep SBP and DBP were not statistically different from those of control subjects. Night/day BP ratio in the control group was 0.93 +/- 0.06 in systolic and 0.92 +/- 0.09 in diastolic. Those values were significantly elevated in patients with AN (systolic 1.00 +/- 0. 09 and diastolic 1.00 +/- 0.09). After refeeding, the ratio decreased to 0.88 +/- 0.09 and 0.90 +/- 0.08,respectively (both P <. 05 vs baseline). CONCLUSIONS: In patients with AN, circadian variation of BP is absent. This reverts to normal after refeeding.
Subject(s)
Anorexia Nervosa/physiopathology , Blood Pressure , Circadian Rhythm , Adolescent , Analysis of Variance , Anorexia Nervosa/diet therapy , Blood Pressure Monitoring, Ambulatory/instrumentation , Blood Pressure Monitoring, Ambulatory/methods , Blood Pressure Monitoring, Ambulatory/statistics & numerical data , Child , Female , HumansABSTRACT
Introducción: la atención interdisciplinaria de pacientes con trastornos de la alimentación, nos lleva a evaluar los diferentes tipos de urgencias que se presentan en éstas patologías complejas y multifactoriales. Material y métodos: pacientes adolescentes y adultas que son atendidas en consultorios externos o como ingreso agudo en la internación. Resultados: de los 325 casos atendidos, 22 han requerido internación clínica o psiquiátrica de ingreso o intratratamiento, con buena evolución debido al abordaje de cada una de las áreas involucradas en la patología. Conclusión: la complejidad de dichas patologías nos llevan a plantearnos diferentes tipos de urgencias, que pueden presentarse en forma aguda, tanto al ingreso como durante el tratamiento de las mismas. La detección y abordaje de éstas situaciones solo podrán ser elaboradas con un trabajo conjunto que abarque todas las áreas afectadas (AU)
Subject(s)
Humans , Adolescent , Adult , Female , Anorexia Nervosa/diagnosis , Bulimia/diagnosis , Feeding and Eating Disorders/diagnosis , Anorexia Nervosa/therapy , Anorexia Nervosa/diet therapy , Bulimia/therapy , Bulimia/diet therapy , Feeding and Eating Disorders/therapy , Feeding and Eating Disorders/diet therapy , Practice Guidelines as Topic , EmergenciesABSTRACT
La anorexia nerviosa es una enfermedad crónica, potencialmente fatal, de etiología desconocida que predomina en el sexo femenino (relación 9/1) entre los 18 y 25 años. Se presenta como un síndrome de autodesnutrición (pérdida de la masa corporal mayor del 15 por ciento), con una prevalencia de apróximadamente el 5 por ciento en la sociedad occidental y una mortalidad del 3 por ciento de origen principalmente cardiovascular. Con estos antecedentes se evaluaron con eco-doppler en forma prospectiva 57 pacientes de sexo femenino con síndrome de anorexia nerviosa (que cumplieran los criterios diagnósticos del D.S.M. IV y que no presentaran antecedentes cardiovasculares), con una edad promedio de 20,8 años (entre 15 y 35 años) y un grupo control de 21 casos de sexo femenino con una media de edad comparable con el grupo anoréxico (20,6 años). Con Edo-Doppler cardíaco se analizaron los siguientes parámetros: diámetros y espesor de cavidades cardíacas, masa ventricular izquierda, función sistólica, diastólica y presencia de prolapso de válvula mitral. Los principales hallazgos con Eco-Doppler fueron: 1) Descenso significativo de la masa ventricular izquierda, a expensas de un adelgazamiento del espesor parietal de dicho ventrículo. 2) Alteración de la relajación de ventrículo izquierdo-. 3) Mayor incidencia de prolapso de válvula mitral (19,5 por ciento). 4) Disminución del volumen minuto, el que acompañó al descenso de la masa corporal y no como índice de disfunción sistólica. De acuerdo a estos hallazgos, se considera que el compromiso miocárdico subclínico en la anorexia nerviosa es frecuente, lo que plantea la necesidad de profundizar la evaluación de estos pacientes, especialmente en períodos de desnutrición severa, como en el período de realimentación.
Subject(s)
Humans , Female , Adolescent , Adult , Anorexia Nervosa/complications , Anorexia Nervosa/diet therapy , Anorexia Nervosa/etiology , Anorexia Nervosa/physiopathology , Cardiovascular System/physiopathology , Echocardiography, Doppler/statistics & numerical data , Mitral Valve Prolapse/diagnosis , Hemodynamics , Nutrition Disorders/complications , Nutrition Disorders/diet therapyABSTRACT
La anorexia nerviosa es una enfermedad crónica, potencialmente fatal, de etiología desconocida que predomina en el sexo femenino (relación 9/1) entre los 18 y 25 años. Se presenta como un síndrome de autodesnutrición (pérdida de la masa corporal mayor del 15 por ciento), con una prevalencia de apróximadamente el 5 por ciento en la sociedad occidental y una mortalidad del 3 por ciento de origen principalmente cardiovascular. Con estos antecedentes se evaluaron con eco-doppler en forma prospectiva 57 pacientes de sexo femenino con síndrome de anorexia nerviosa (que cumplieran los criterios diagnósticos del D.S.M. IV y que no presentaran antecedentes cardiovasculares), con una edad promedio de 20,8 años (entre 15 y 35 años) y un grupo control de 21 casos de sexo femenino con una media de edad comparable con el grupo anoréxico (20,6 años). Con Edo-Doppler cardíaco se analizaron los siguientes parámetros: diámetros y espesor de cavidades cardíacas, masa ventricular izquierda, función sistólica, diastólica y presencia de prolapso de válvula mitral. Los principales hallazgos con Eco-Doppler fueron: 1) Descenso significativo de la masa ventricular izquierda, a expensas de un adelgazamiento del espesor parietal de dicho ventrículo. 2) Alteración de la relajación de ventrículo izquierdo-. 3) Mayor incidencia de prolapso de válvula mitral (19,5 por ciento). 4) Disminución del volumen minuto, el que acompañó al descenso de la masa corporal y no como índice de disfunción sistólica. De acuerdo a estos hallazgos, se considera que el compromiso miocárdico subclínico en la anorexia nerviosa es frecuente, lo que plantea la necesidad de profundizar la evaluación de estos pacientes, especialmente en períodos de desnutrición severa, como en el período de realimentación. (AU)
Subject(s)
Humans , Female , Adolescent , Adult , Anorexia Nervosa/etiology , Anorexia Nervosa/physiopathology , Anorexia Nervosa/complications , Anorexia Nervosa/diet therapy , Cardiovascular System/physiopathology , Echocardiography, Doppler/statistics & numerical data , Mitral Valve Prolapse/diagnosis , Nutrition Disorders/complications , Nutrition Disorders/diet therapy , HemodynamicsABSTRACT
We evaluated seven female adolescents with anorexia nervosa to determine whether calcium metabolism was affected by their disorder. We measured calcium absorption, urinary calcium excretion, and calcium kinetics, using a dual-tracer, stable-isotope technique during the first weeks of an inpatient nutritional rehabilitation program. Results were compared with those from a control group of seven healthy adolescent girls of similar ages. The percentage of absorption of calcium was lower in subjects with anorexia nervosa than in control subjects (16.2% +/- 6.3% vs 24.6% +/- 7.2%; p < 0.05). Urinary calcium excretion was greater in subjects with anorexia nervosa than in control subjects (6.4 +/- 2.5 vs 1.6 +/- 0.7 mg.kg-1 x day-1; p < 0.01) and was associated with bone resorption rather than calcium hyper-absorption. Calcium kinetic studies demonstrated a decreased rate of bone formation and an increased rate of bone resorption. These results suggest marked abnormalities in mineral metabolism in patients with anorexia nervosa. From these results, we hypothesize that improvement in bone mineralization during recovery from anorexia nervosa will require resolution of hormonal abnormalities, including hypercortisolism, in addition to increased calcium intake.
Subject(s)
Anorexia Nervosa/metabolism , Calcium, Dietary/pharmacokinetics , Calcium/metabolism , Absorption , Adolescent , Adult , Anorexia Nervosa/complications , Anorexia Nervosa/diet therapy , Bone Density , Bone Resorption/complications , Bone Resorption/metabolism , Female , Humans , Hydrocortisone/metabolismABSTRACT
Changes in body composition were studied in 13 girls with anorexia nervosa before and during 2 months of refeeding. Fat body mass and fat-free body mass were derived from skin-fold measurements. Total body potassium was measured by whole body counter, and intracellular water was calculated from it. Extracellular water was measured as the bromide space after oral bromide administration. A gradual increase was noted in weight, fat body mass, fat-free body mass, and total body potassium during refeeding. Extracellular water was expanded on admission and increased in all patients in the first weeks of treatment; later it fell to normal. Most of the changes in fat-free body mass over the first weeks of refeeding could be accounted for by an expansion in extracellular water. Particular care must therefore be taken with fluid balance during the first few weeks of refeeding.
Subject(s)
Anorexia Nervosa/diet therapy , Body Composition , Adipose Tissue , Adolescent , Body Water , Child , Extracellular Space , Female , Humans , Intracellular Fluid , Potassium/analysisABSTRACT
We assessed whether level of physical activity of anorexia nervosa patients could influence caloric consumption needed to gain weight during hospitalization. Seventy-three percent of patients with anorexia nervosa had higher levels of motor activity than did healthy female volunteers. Anorectics required 8301 +/- 2272 kcal (mean +/- SD) to gain 1 kg body wt. Activity levels and caloric consumption needed to gain 1 kg were significantly correlated; the most active patients needed to consume more calories to gain weight. A median split of anorectic patients by level of activity showed that the group with lower activity levels gained 1 kg every 5.1 +/- 1.2 d, whereas the group with higher activity levels gained 1 kg every 7.2 +/- 1.9 d. These data suggest that the rate of weight gain can be accelerated, and the cost of hospitalization decreased, by restricting exercise in anorectics during refeeding.
Subject(s)
Anorexia Nervosa/diet therapy , Body Weight , Energy Intake , Physical Exertion , Adult , Hospitalization , HumansSubject(s)
Humans , Male , Female , Pregnancy , Child , Adolescent , Adult , Child Nutrition/education , Child Nutrition Disorders , Nutrition Disorders/diagnosis , Nutrition Disorders/diet therapy , Anorexia Nervosa/diet therapy , Diabetes Mellitus/diet therapy , Obesity/diet therapy , Anemia/diet therapy , Alcoholism/diet therapy , Cardiovascular Diseases/diet therapy , Urinary Bladder Diseases/diet therapy , Central Nervous System Diseases/diet therapy , Kidney Diseases/diet therapyABSTRACT
Revisäo da literatura e abordagem dos aspectos clínicos e nutricionais de pacientes com anorexia nervosa, com ênfase no tratamento dietoterápico e na conduta psicoterapêutica