ENERGY REQUIREMENTS IN ANOREXIA NERVOSA: A NUTRITIONAL APPROACH TO MANAGEMENT

We investigated the nutritional requirements of four adolescent females with anorexia nervosa, and describe a management approach based on nutritional principles. The median age of presentation was 14.15 years (range 14-16.1 years). The median weight loss in the preceding six months was 27% (range 21-33%). At presentation the median energy intake was 2710 Kj per day (range 2083-4166 Kj) and represented a median of 26% of that expected. Energy requirements to reverse the state of severe malnutrition were 14634 kj per day. In addition to voluntary intake, energy was delivered via nasogastric tube using energy dense defined formulae in order to ensure a minimum intake of 150-200% RDA, until 50% of lost weight had been regained. The median time to regain 50% of lost weight was 44 days. Continued weight gain occurred during 1 year follow up. Energy deficits in patients with anorexia nervosa are considerable and can be safely and rapidly restored by an enteral feeding programme which is well tolerated by the patient.