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Twelve patients with anorexia nervosa were studied on the Clinical Research Center for periods of 15 to 58 days. Five patients were fed a diet providing 20% of energy from protein and seven patients were fed a diet with only 10% of energy from protein. These patients had a reduced lean body mass in addition to a loss of body fat, and during recovery about two-thirds of the weight gain was lean tissue. The average energy cost of the weight gain was 5.3 kcal/g. There was no significant difference between the two diets for elemental metabolic balance, changes in anthropometric measures, in weight gain, or in potassium-40 counts; nor was there any difference in the energy cost of weight gain, in the rise in basal metabolic rate, or the change in hematocrit, serum albumin, or cholesterol. However, blood urea nitrogen was higher in those patients who received the high protein diet. Satisfactory nutritional rehabilitation of patients with anorexia nervosa does not require a high protein diet.

In adolescents, as in adults, most depressive persons are not suicidal, and many suicidal persons are not depressed. However, accurate diagnosis and treatment of depression in adolescent patients is essential to suicide prevention. Unfortunately, depression and suicidality remain widely undiagnosed and untreated in the adolescent population.

Menstrual dysfunction is a common concomitant of anorexia nervosa and bulimia. Initial investigations emphasized the role of weight loss and lean/fat ratio in amenorrhea. Subsequent studies suggest a more complex interaction between eating disorders and menstrual status. However, in past investigations, menstrual abnormalities have been confounded with low weight. We conducted two studies to ascertain the prevalence of menstrual abnormalities in a group of women with subclinical eating pathology versus an age-, education-, and weight-matched group of normal controls. In Study I, 93.4% of the subclinical subjects reported a history of menstrual abnormality as compared to 11.7% of the normal controls. In Study II, 100% of the subclinical subjects, versus 15.0% of the controls, reported an abnormal menstrual history. These data suggest that menstrual dysfunction often occurs in women with abnormal eating attitudes but without weight loss or diagnosable eating pathology. Several hypotheses for this finding are proposed.

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