Implementing High Energy Liquid Nutrition, Omega-3 Fatty Acids and Nutritional Supplements for the Treatment of Anorexia Nervosa

Abstract

<jats:p>Objective: To assess the effect of different treatment approaches on the course of anorexia nervosa (AN) over time. Methods: The subjects were 27 hospitalized AN patients. In our retrospective analysis we compared weight gain in two groups. While one group was treated with a standard oral refeeding protocol (historical control) through January 2013 (N=16), the second group (highly standardized refeeding protocol) received a high energy liquid nutrition and nutritional supplements including omega-3 fatty acids (N=11). Results: On admission, the two groups were comparable in terms of height, weight, age and heart rate. At the end of our monitoring time frame of 25 days, weight gain was 121.4% higher in the highly standardized refeeding protocol group than in the historical control group (66.5 ±52.4 vs 147.3 ±55.7 grams/day; t-Test p=0.004; CI95%: 29.3-132.2). A carbohydrate rich diet clearly improved weight gain if high energy liquid nutrition was replaced by the diet according the patient’s own wishes. About 45% of our patients stated they were vegetarians at admission. However, we could not identify a vegetarian diet as a statistically significant negative prognostic factor for weight gain. Conclusion: The highly standardized refeeding protocol seems to be helpful in malnourished AN patients to improve weight gain without enhancing the risk of a refeeding syndrome. However, further studies with greater number of patients are needed to confirm the effectiveness of our standardized treatment protocol.</jats:p>

Heart rate regulation in patients with anorexia nervosa

“…Moreover, we observed a significant increase of heart rates and decrease of HRV during refeeding which could explain the discomfort due to this "autonomic switch" and the massive resistance against this therapy from the patients [6]. Based on this pathophysiological understanding, we changed our therapeutic concepts and can significantly improve weight gain during in-hospital refeeding [7]. Within the last 13 years and more than 100 Holter ECG's in patients with AN that include longtime follow up data, we increasingly began to doubt our primary assumption that the HRV changes are caused solely by the autonomic nervous system.…”

The Development of Heart Rate Variability in Childhood-Insights into the Biology of Heart Rate Regulation

“…Within the last 10 years, we have found that children with anorexia nervosa have learned to modulate their hyperactive stress response by starvation. During in-hospital refeeding, we reactivate the hyperactive stress response, which is indicated by highly significant increases in mean heart rates and postural orthostatic tachycardia syndrome [13]. In patients with anorexia nervosa, the increase in resting energy expenditure during…”