Nutritional Management and Outcomes in Malnourished Medical Inpatients: Anorexia Nervosa

Cuerda, C.; Vasiloglou, Maria F.; Arhip, L.

doi:10.3390/jcm8071042

Cited by 36 publications

(53 citation statements)

References 71 publications

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“…Therefore, prospective studies using sufficiently large sample sizes are warranted in the future. Second, the mean BMI of the sample was lower as compared to other studies (Cuerda et al, 2019) which was the result from the specific clinical setting. As described above, lower weight affects brain structure and functions and these brain alterations may affect personality structure, too.…”

Section: Discussionmentioning

confidence: 55%

Measurement of Personality Structure by the OPD Structure Questionnaire Can Help to Discriminate Between Subtypes of Eating-Disorders

et al. 2019

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BackgroundDifferentiation between purging type (AN-P) and restricting type (AN-R) is common in anorexia nervosa (AN) and relevant for clinical practice. However, differences of personality pathology in eating disorders (ED) and their subtypes, which can be captured by the operationalized psychodynamic diagnosis (OPD) system, have not been systematically investigated to date.ObjectivesThe aim of this study was to explore differences in personality structure between the subtypes of AN and bulimia nervosa (BN) using the OPD structure questionnaire (OPD-SQ). In addition, the ability of the instrument to support the classification of eating disorders was examined.Materials and MethodsWe conducted a retrospective, exploratory study in a subset sample of a larger validation study. The OPD-SQ had been collected from n = 60 patients with AN or BN. Patients were assigned to the ED groups by clinical assessment. Statistical analyses included multivariate analysis of variance (MANOVA) and discriminant analysis.ResultsDifferences between ED groups were observed on 5 OPD-SQ main scales and 9 subscales, as well as on the global scale. AN-P patients demonstrated the lowest personality structure on most of the main scales and subscales, whereas AN-R patients showed a higher personality structure level as compared to both BN and AN-P patients. The OPD-SQ scales with the largest differences include self-perception, object perception, and attachment to internal objects. Discriminant analysis resulted in satisfactory assignment to ED groups by OPD-SQ subscales.ConclusionsPersonality structure was found to be less developed in patients with BN and AN-P as compared to patients with AN-R. Although the results have to be proven in larger prospective studies, these results suggest that the OPD-SQ may be used to support the clinical assessment and classification in patients with EDs.

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Section: Discussionmentioning

confidence: 55%

Measurement of Personality Structure by the OPD Structure Questionnaire Can Help to Discriminate Between Subtypes of Eating-Disorders

et al. 2019

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“…Most inpatients with AN are at high risk for RFS [ 12 ]; refeeding is the first step of the treatment and must be managed very cautiously [ 66 , 69 ]. International guidelines are based mainly on clinical experience, due to the lack of well-designed trials in inpatients with AN [ 70 , 71 ]. At hospital admission, the recommended calorie provision ranges from 5–20 kcal/kg to 30–40 kcal/kg [ 70 , 71 ].…”

Section: Prevention and Treatmentmentioning

confidence: 99%

“…International guidelines are based mainly on clinical experience, due to the lack of well-designed trials in inpatients with AN [ 70 , 71 ]. At hospital admission, the recommended calorie provision ranges from 5–20 kcal/kg to 30–40 kcal/kg [ 70 , 71 ]. A progressive increase of 5–10 kcal/kg/day (if high risk of RFS) or 10–20 kcal/kg/day (if moderate risk of RFS) could be carried out after the stabilization of the clinical conditions (e.g., improvement of electrocardiographic abnormalities, correction of electrolyte imbalance, replacement of thiamine and vitamins, and stabilization of comorbidities) [ 48 , 66 , 72 ].…”

Section: Prevention and Treatmentmentioning

confidence: 99%

The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review

et al. 2020

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The Refeeding Syndrome (RFS) is a potentially serious, but still overlooked condition, occurring in individuals who are rapidly fed after a period of severe undernourishment. RFS derives from an abnormal electrolyte and fluid shifts leading to many organ dysfunctions. Symptoms generally appear within 2–5 days of re-feeding and may be absent/mild or severe and life threating, depending on the pre-existing degree of malnutrition and comorbidities. The lack of a standard definition and the nonspecificity of the symptoms make both incidence estimate and diagnosis difficult. In 2020, the American Society for Parenteral and Enteral Nutrition (ASPEN) proposed a unifying definition for the RFS and its severity classification. The awareness of the condition is crucial for identifying patients at risk, preventing its occurrence, and improving the management. The objectives of this narrative review were to summarize the current knowledge and recommendations about the RFS and to provide useful tips to help physicians to recognize and prevent the syndrome.

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“…Our article highlights the need for alternate clinical management strategies, outside of traditional clinical approaches used in care of this patient. Unfortunately, evidence-based recommendations for preventing recurring malnutrition in AN patients are lacking, and further research is needed in this field as stated in a recent meta-analysis of articles concerning refeeding of malnourished patients [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Severe bronchiectasis and inflammatory lung disease in a patient with anorexia nervosa and severe and enduring malnutrition - a case report

et al. 2020

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Background Persistent structural changes of the lungs in anorexia nervosa (AN) patients are rarely described in contemporary medical literature. The objective of our paper is to report a rare case of severe bronchiectasis and inflammatory changes to the lungs resulting from chronic malnutrition in a AN patient. Case presentation We describe a patient with severe inflammatory lung disease caused by malnutrition, resulting in persistent bronchiectasis accompanying AN. We performed an analysis of the patient’s medical records including radiological findings and laboratory results. A review of available literature shows very little data available on this topic. Conclusion Bronchiectasis and other structural changes of the lungs are rare, but severe complications of severe, chronic malnutrition. As exemplified by our case report, they may require extensive differential diagnosis and pose a significant clinical challenge due to their non-reversible character. A successful treatment relies heavily on the patient’s compliance and may be hard to achieve. Clinicians managing patients with anorexia nervosa should be wary of early respiratory tract dysfunction-related symptoms and always consider malnutrition bronchiectasis as a differential diagnosis option.

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Nutritional Management and Outcomes in Malnourished Medical Inpatients: Anorexia Nervosa

Cited by 36 publications

References 71 publications

Measurement of Personality Structure by the OPD Structure Questionnaire Can Help to Discriminate Between Subtypes of Eating-Disorders

Measurement of Personality Structure by the OPD Structure Questionnaire Can Help to Discriminate Between Subtypes of Eating-Disorders

The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review

Severe bronchiectasis and inflammatory lung disease in a patient with anorexia nervosa and severe and enduring malnutrition - a case report

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