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Approved: Oct 2004
Published: Jul 2005
Status: under review
Number of pages: 42
Review by: 2008
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Good nutritional management is essential to the treatment of
anorexia nervosa. However, there is relatively little guidance on
nutrition available to professionals treating this serious
disorder. This report was produced by a multidisciplinary group
which included specialists in eating disorders in adults and
children, dietitians and experts in clinical nutrition.
Nutrition should always be considered in its psychological context.
Patients require comprehensive physical, nutritional and laboratory
assessment. Aggressive attempts to drive weight gain early in
treatment are potentially dangerous. The first stage of treatment
includes correction of hypoglycaemia, electrolyte disturbance and
dehydration and stabilization of cardiovascular function. The
second stage is the correction of nutrient deficiencies and the
third is correction of body composition. Biochemical disturbances
are common but measurements of electrolytes in the blood may mask a
significant deficit. Electrolyte supplementation is often required
and micronutient supplementation is recommended. Iron supplements
may be dangerous during the early stages of treatment.
A weekly weight gain of 0.5 – 1.0 kg is suggested for in-patients
and 0.5 kg for out-patients. The amount of food should be limited
at first, and increased slowly. The early stages of refeeding are a
high-risk period and close medical monitoring is required.
Refeeding can unmask hidden biochemical deficiencies and
hypophosphataemia may develop rapidly.
Enteral feeding has a limited role. The decision to use it should
be considered carefully as it may be very distressing to the
patient. It may be needed as a life-saving measure but should be
used for the minimum length of time. Enteral feeding requires a
clinical team skilled in its use; detailed advice is
Eating disorders services for children and adolescents should be
staffed by clinicians experienced in work with this group. Anorexia
nervosa can develop without weight loss during a stage of expected
growth. Weight loss may be underestimated if calculated on the BMI
alone and we recommend the use of BMI centiles up to the age of 20.
The management plan should always be presented in an
age-appropriate manner and the patient’s co-operation should gained
if possible. The involvement of parents is vital.
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