Caloric intake necessary for weight maintenance in anorexia nervosa: nonbulimics require greater caloric intake than bulimics

Dietary caloric restriction, as a means to induce weight loss, is seldom used as a treatment of obesity in infancy for fear that permanent stunting of growth may result.1-4 Thus, there is little information on controlled weight loss as the treatment for infant obesity or, more importantly, its effect on growth in length, head circumference, and fat-free body mass during weight loss.5 We present a case of an obese infant who, secondary to a metabolic disorder, required nutritional support both intravenously and by nasogastric tube. During 15 months, the patient's resting energy expenditure (REE) was measured to determine an appropriate caloric intake to promote weight loss and later weight maintenance.

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Unexpected Association of Desacyl-Ghrelin with Physical Activity and Chronic Food Restriction: A Translational Study on Anorexia Nervosa

Journal of Clinical Medicine ◽

10.3390/jcm9092782 ◽

2020 ◽

Vol 9 (9) ◽

pp. 2782 ◽

Cited By ~ 1

Author(s):

Philibert Duriez ◽

Lauralee Robichon ◽

Roland Dardennes ◽

Guillaume Lavoisy ◽

Dominique Grouselle ◽

...

Keyword(s):

Physical Activity ◽

Anorexia Nervosa ◽

Food Restriction ◽

Plasma Concentrations ◽

Caloric Intake ◽

Positive Association ◽

Recovery Process ◽

Post Discharge ◽

Ad Libitum ◽

Energy Deprivation

Anorexia nervosa (AN) is a severe metabopsychiatric disorder characterised by caloric intake restriction and often excessive physical exercise. Our aim is to assess in female AN patients and in a rodent model, the co-evolution of physical activity and potential dysregulation of acyl—(AG) and desacyl—(DAG) ghrelin plasma concentrations during denutrition and weight recovery. AN inpatients were evaluated at inclusion (T0, n = 29), half—(T1) and total (T2) weight recovery, and one month after discharge (T3, n = 13). C57/Bl6 mice with access to a running wheel, were fed ad libitum or submitted to short—(15 days) or long—(50 days) term quantitative food restriction, followed by refeeding (20 days). In AN patients, AG and DAG rapidly decreased during weight recovery (T0 to T2), AG increased significantly one-month post discharge (T3), but only DAG plasma concentrations at T3 correlated negatively with BMI and positively with physical activity. In mice, AG and DAG both increased during short- and long-term food restriction. After 20 days of ad libitum feeding, DAG was associated to persistence of exercise alteration. The positive association of DAG with physical activity during caloric restriction and after weight recovery questions its role in the adaptation mechanisms to energy deprivation that need to be considered in recovery process in AN.

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The influence of homeostatic mechanisms on neural regulation of food craving in anorexia nervosa

Psychological Medicine ◽

10.1017/s0033291719003970 ◽

2020 ◽

pp. 1-9

Author(s):

Marion A. Stopyra ◽

Hans-Christoph Friederich ◽

Esther Mönning ◽

Nora Lavandier ◽

Martin Bendszus ◽

...

Keyword(s):

Anorexia Nervosa ◽

Cognitive Control ◽

Caloric Intake ◽

Normal Weight ◽

Food Craving ◽

Glucose Load ◽

Neural Regulation ◽

Viewing Condition ◽

Cephalic Phase ◽

Specific Reactions

Abstract Background Restrictive food intake in anorexia nervosa (AN) has been related to an overactive cognitive control network inhibiting intuitive motivational responses to food stimuli. However, the influence of short-term homeostatic signaling on the neural regulation of cue-induced food craving in AN is still unclear. Methods Twenty-five women with AN and 25 matched normal-weight women were examined on two occasions after receiving either glucose or water directly into their stomach using a nasogastric tube. Participants were blinded to the type of infusion. An event-related functional magnetic resonance imaging paradigm was used to investigate the effect of intestinal glucose load on neural processing during either simple viewing or distraction from food stimuli. Results Neural differences between patients with AN and normal-weight participants were found during the distraction from food stimuli, but not during the viewing condition. When compared to controls, patients with AN displayed increased activation during food distraction in the left parietal lobule/precuneus and fusiform gyrus after water infusion and decreased activation in ventromedial prefrontal and cingulate regions after intestinal glucose load. Conclusions Independent of the cephalic phase and the awareness of caloric intake, homeostatic influences trigger disorder-specific reactions in AN. Food distraction in patients with AN is associated with either excessive higher-order cognitive control during physiological hunger or decreased internally directed attention after intestinal glucose load. These findings suggest that food distraction plays an important role in the psychopathology of AN. This study was registered on clinicaltrials.gov with identifier: NCT03075371.

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Modification of Caloric Intake in Anorexia Nervosa: An Experimental Analysis

Psychological Reports ◽

10.2466/pr0.1973.32.1.75 ◽

1973 ◽

Vol 32 (1) ◽

pp. 75-78 ◽

Cited By ~ 10

Author(s):

Thomas E. Elkin ◽

Michel Hersen ◽

Richard M. Eisler ◽

James G. Williams

Keyword(s):

Anorexia Nervosa ◽

Experimental Analysis ◽

Single Case ◽

Caloric Intake ◽

Food Presentation ◽

Single Case Design ◽

Reinforcement System ◽

Weight Gains ◽

Effects Of Feedback ◽

Case Design

The effects of feedback, reinforcement, and increased food presentation on caloric intake were sequentially examined in an experimental single-case design with an anorexia nervosa patient. Although feedback on weight and a point-reinforcement system for weight gains led to increased consumption, augmenting the amount of food presented in combination with feedback and reinforcement resulted in the most dramatic change in caloric intake.

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The association between leptin and weight maintenance outcome in anorexia nervosa

International Journal of Eating Disorders ◽

10.1002/eat.23407 ◽

2020 ◽

Author(s):

Youngjung Kim ◽

Jonathan Hersch ◽

Lindsay P. Bodell ◽

Janet Schebendach ◽

Tom Hildebrandt ◽

...

Keyword(s):

Anorexia Nervosa ◽

Weight Maintenance

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A case of refeeding syndrome in pregnancy with anorexia nervosa

Obstetric Medicine ◽

10.1177/1753495x17726478 ◽

2017 ◽

Vol 11 (2) ◽

pp. 95-97 ◽

Cited By ~ 2

Author(s):

Hiroaki Soyama ◽

Morikazu Miyamoto ◽

Takahiro Natsuyama ◽

Masashi Takano ◽

Hidenori Sasa ◽

...

Keyword(s):

Anorexia Nervosa ◽

Cesarean Section ◽

Calorie Restriction ◽

Caloric Intake ◽

Primiparous Woman ◽

Refeeding Syndrome ◽

Additional Risk ◽

Severe Fatigue ◽

Electrolyte Replacement ◽

In Pregnancy

Refeeding syndrome very rarely develops during pregnancy. A 35-year-old primiparous woman pregnant with twins complained of severe fatigue at 19 weeks’ gestation. She was admitted to our hospital in a malnourished condition because of repeated self-induced vomiting due to anorexia nervosa. Just after hospitalization, she voluntarily increased her caloric intake significantly above the recommended prescribed diet, without medical permission. Nine days later, she developed refeeding syndrome. Electrolyte replacement and calorie restriction were started and her condition gradually improved. The healthy twin babies were born by cesarean section at 36 weeks’ gestation. Acute increases in caloric intake by previously malnourished pregnant women with anorexia nervosa may induce refeeding syndrome. Women with the binge eating/purging subtype of anorexia nervosa may be at additional risk due to alternating phases of starvation and overeating.

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Anorexia Nervosa—What Has Changed in the State of Knowledge about Nutritional Rehabilitation for Patients over the Past 10 Years? A Review of Literature

Nutrients ◽

10.3390/nu13113819 ◽

2021 ◽

Vol 13 (11) ◽

pp. 3819

Author(s):

Katarzyna Jowik ◽

Marta Tyszkiewicz-Nwafor ◽

Agnieszka Słopień

Keyword(s):

Anorexia Nervosa ◽

Healing Process ◽

Caloric Intake ◽

Current Treatment ◽

Review Of Literature ◽

Nutritional Rehabilitation ◽

Long Term Effects ◽

Refeeding Syndrome ◽

The Past ◽

Potential Benefits

Anorexia nervosa (AN) is a psycho-metabolic disorder with a high risk of somatic complications such as refeeding syndrome (RFS) and carries the highest mortality rate of all psychiatric illnesses. To date, the consensus on the care for patients with AN has been based on recommendations for a combination of alimentation and psychotherapy. It is important to establish an initial caloric intake that will provide weight gain and minimize the risk of complications in the treatment of undernourished patients. Research over the past few years suggests that current treatment recommendations may be too stringent and should be updated. The aim of this paper is to systematize the current reports on nutritional rehabilitation in AN, to present the results of studies on the safe supplementation of patients and its potential impact on improving prognosis and the healing process. This review of literature, from 2011–2021, describes the changing trend in the nutritional protocols used and the research on their efficacy, safety, and long-term effects. In addition, it presents previous reports on the potential benefits of introducing vitamin, pro-and prebiotic and fatty acid supplementation.

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Energy expenditure in humans: effects of dietary fat and carbohydrate

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.1990.258.2.e347 ◽

1990 ◽

Vol 258 (2) ◽

pp. E347-E351 ◽

Cited By ~ 5

Author(s):

W. G. Abbott ◽

B. V. Howard ◽

G. Ruotolo ◽

E. Ravussin

Keyword(s):

Energy Expenditure ◽

Dietary Fat ◽

Weight Maintenance ◽

Caloric Intake ◽

Insulin Dependent Diabetes Mellitus ◽

Whole Body ◽

Dependent Diabetes Mellitus ◽

Pima Indians ◽

High Fat ◽

High Carbohydrate

A high-dietary fat intake may be an important environmental factor leading to obesity in some people. The mechanism could be either a decrease in energy expenditure and/or an increase in caloric intake. To determine the relative importance of these mechanisms we measured 24-h energy expenditure in a whole body calorimeter in 14 nondiabetic subjects and in six subjects with non-insulin-dependent diabetes mellitus, eating isocaloric, weight-maintenance, high-fat, and high-carbohydrate diets. All subjects were Pima Indians. In nondiabetics, the mean total 24-h energy expenditure was similar (2,436 +/- 103 vs. 2,359 +/- 82 kcal/day) on high-fat and high-carbohydrate diets, respectively. The means for sleeping and resting metabolic rates, thermic effect of food, and spontaneous physical activity were unchanged. Similar results were obtained in the diabetic subjects. In summary, using a whole body calorimeter, we found no evidence of a decrease in 24-h energy expenditure on a high-fat diet compared with a high-carbohydrate diet.

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Disrupted Oxytocin-Appetite Signaling in Females With Anorexia Nervosa

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2019-00926 ◽

2019 ◽

Vol 104 (10) ◽

pp. 4931-4940 ◽

Cited By ~ 4

Author(s):

Anna Aulinas ◽

Franziska Plessow ◽

Reitumetse L Pulumo ◽

Elisa Asanza ◽

Christopher J Mancuso ◽

...

Keyword(s):

Body Weight ◽

Anorexia Nervosa ◽

Caloric Intake ◽

Mixed Meal ◽

Cross Sectional ◽

Visual Analog Scales ◽

Clinical Research Center ◽

Postprandial Response ◽

Endogenous Estrogen ◽

Healthy Females

Abstract Context In healthy females, oxytocin levels decrease postmeal, corresponding to increased satiety. The postprandial response of oxytocin in females with anorexia nervosa (AN)/atypical AN is unknown. Objectives To determine the pattern of postprandial serum oxytocin levels in females with AN/atypical AN, relationship with appetite, and effect of weight, eating behavior, and endogenous estrogen status. Design Cross-sectional. Setting Clinical research center. Participants 67 women (36 with AN [<85% expected body weight (EBW)]; 31 with atypical AN [≥ 85% EBW)]), age 22.4 ± 0.9 (mean ± SEM) years, categorized by weight, restricting vs binge/purge behavior, and estrogen status. Interventions Standardized mixed meal. Main Outcome Measurements Blood sampling for oxytocin occurred fasting and 30, 60, and 120 minutes postmeal. Subjective appetite was assessed using visual analog scales. Results In females with AN/atypical AN, oxytocin levels decreased from fasting to 60 (P = 0.002) and 120 (P = 0.005) minutes postmeal. The decrease in oxytocin from fasting to 120 minutes was greater in females with atypical AN than AN (P = 0.027) and did not differ by restricting vs binge/purge behavior or estrogen status. Controlling for caloric intake, the decrease in oxytocin was inversely related to the decrease in hunger postmeal in females with atypical AN (P = 0.04). Conclusions In females with AN/atypical AN, oxytocin levels decrease postmeal, as established in healthy females. Weight, but not restricting vs binge/purging nor endogenous estrogen status, affects postprandial oxytocin levels. The postprandial change in serum oxytocin levels is related to appetite in females with atypical AN only, suggesting a disconnect between oxytocin secretion and appetite in the undernourished state.

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