Pediatric Nutrition in Practice

3 Nutritional Challenges in Special Conditions and Diseases

Key Words

Eating disorders · Malnutrition · Oral nutritional

supplements · Nasogastric tube feeding ·

Refeeding syndrome

Key Messages

• Anorexia nervosa (AN) is an eating disorder charac-
  terized by a fear of weight gain, unusual eating hab-
  its and restricted food consumption


• AN predominantly manifests in adolescent females


• AN patients tend to restrict their energy intake,
  avoid energy-dense and fatty foods, choose a nar-
  row range of foods and consume vegetarian diets
  with a low energy density


• Severe malnutrition develops regularly, with mark-
  edly reduced body weight, BMI and body fat con-
  tent as well as numerous complications (e.g. sec-
  ondary amenorrhoea, osteopenia, short stature,
  bradycardia and a high mortality risk)
  © 2015 S. Karger AG, Basel

Introduction

Anorexia nervosa (AN) is a complex and usually
chronic disorder characterized by a fear of weight
gain, unusual eating habits and restricted food in-

take. AN typically manifests predominantly in

adolescent females and may affect up to 0.7% of

this age group [1]. AN patients tend to restrict

their energy intake, avoid energy-dense and fatty

foods, choose a narrow range of foods and con-

sume vegetarian diets with a low energy density

[1]. As a result, AN patients often consume no

more than 10–20 kcal/kg per day and develop se-

vere malnutrition with markedly reduced body

weight, BMI and body fat content, which can re-

sult in numerous complications (e.g. secondary

amenorrhoea, osteopenia, short stature, brady-

cardia and a high mortality risk). Treatment must

address psychological and medical issues. It is

based on inpatient or outpatient psychiatric treat-

ment but regularly needs to involve several medi-

cal professions, including experts in nutritional

rehabilitation [2].

Nutritional Rehabilitation

Guidelines for nutritional rehabilitation of AN

have been published by the American Psychiatric

Association [3] ( table 1 ) and the UK National In-

stitute for Health and Clinical Excellence [4] ( ta-

ble  2 ). Both guidelines advise aiming for only a

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 259–265
DOI: 10.1159/000375192

3.22 Nutrition Rehabilitation in Eating Disorders

Berthold Koletzko

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