Pediatric Nutrition in Practice

Nutrition Rehabilitation in Eating Disorders 261

3

moderate rate of weight gain up to ∼ 1 kg/week.
However, the implementation of increased nutri-
ent intakes from foods, oral nutritional supple-
ments or tube feedings is often made difficult by
the denial of illness and resistance to treatment
that is frequently found in AN patients, who tend
to drop out of recommended treatment pro-
grammes.
While healthy women without an eating dis-
order require 20–40 kcal/kg per day to maintain
their weight, the energy intake of AN patients
needs to be increased stepwise to about 60–100
kcal/kg per day to achieve a sustained weight gain

[1]. This rat her high energ y need ref lects a hy per-

metabolic state, which in part may be due to ex-

cessive physical activity and exercise – a common

behaviour in AN. Increasing energy and nutrient

intake to achieve nutritional rehabilitation can be

approached either by increased intakes of regular

foods, energy-dense oral nutritional supplements

w it h an energ y densit y of ≥ 1 kcal/ml, nasogastric

tube feeding or a combination thereof. There is

broad agreement that parenteral nutrition should

generally be avoided unless a severely impaired

gut function prevents the use of oral or enteral

nutrition.

Ta b l e 2. Guidelines of the UK National Institute for Health and Clinical Excellence for nutritional

rehabilitation in AN

Managing weight gain in AN

In most patients with AN, an average weekly weight gain of 0.5 – 1 kg in inpatient settings

and 0.5 kg in outpatient settings should be an aim of treatment. This requires about

3,500 – 7,000 extra calories a week.

C

Regular physical monitoring, and in some cases treatment with a multivitamin/

multimineral supplement in oral form, is recommended for people with AN during

both inpatient and outpatient weight restoration.

C

Total parenteral nutrition should not be used for people with AN, unless there is

significant gastrointestinal dysfunction.

C

Managing risk in AN

Health care professionals should monitor physical risks in patients with AN. If this leads

to the identification of increased physical risks, the frequency and the monitoring and

nature of the investigations should be adjusted accordingly.

C

People with AN and their carers should be informed if the risk to their physical health is

high.

C

The involvement of a physician or paediatrician with expertise in the treatment of

physically at-risk patients with AN should be considered for all individuals who are

physically at risk.

C

Pregnant women with either current or remitted AN may need more intensive prenatal

care to ensure adequate prenatal nutrition and fetal development.

C

Oestrogen administration should not be used to treat bone density problems in children

and adolescents as this may lead to premature fusion of the epiphyses.

C

Evidence C: this grading indicates that directly applicable clinical studies of good quality are

absent or not readily available. Modified from National Institute for Health and Clinical Excellence

[4].

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