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