Consenso sobre la evaluación y el tratamiento nutricional de los trastornos de la conducta alimentaria: anorexia nerviosa

Abstract

Anorexia nervosa is the most common psychiatric disease among young women and it is assumed to be of multifactorial origin. Diagnostic criteria have recently been modified; therefore amenorrhea has ceased to be a part of them. This disease shows a large variability in its presentation and severity which conditions different therapeutic approaches and the need to individualize the treatment, thus it is indispensable a multidisciplinary approach. The goals are to restore nutritional status (through an individualized diet plan based on a healthy consumption pattern), treat complications and comorbidities, nutritional education (based on healthy eating and nutritional patterns), correction of compensatory behaviors and relapse prevention. The treatment will vary according to the patient's clinical situation, and it may be performed in outpatient clinics (when there is clinical stability), in a day hospital or ambulatory clinic (intermediate mode between traditional outpatient treatment and hospitalization) or hospitalization (when there is outpatient management failure or presence of serious medical or psychiatric complications). Artificial nutrition using oral nutritional supplements, enteral nutrition and exceptionally parenteral nutrition may be necessary in certain clinical settings. In severely malnourished patients the refeeding syndrome should be avoided. Anorexia nervosa is associated with numerous medical complications which determines health status, life quality, and is closely related to mortality. There is little clinical evidence to assess the results of different treatments in anorexia nervosa, when most of the recommendations are being based on expert consensus.

Comparison of the digestive tolerance of an oligomeric versus a polymeric oral nutritional supplement in people with anorexia nervosa. A randomised crossover clinical trial.

“…In one study in hospitalized teenagers with anorexia nervosa, the combination of oral nutritional supplements and nasogastric feeding in addition to natural feeding produced a shorter duration of hospitalization than the combination of natural feeding with either oral nutritional supplement or nasogastric feeding (27). Due to ndings such as these, clinical guidelines state that the expected bene cial effects of nutritional supplementation in pAN are (13): reduction of the known adverse effects associated with malnutrition (increased morbidity and mortality, and reduced quality of life); during the rst half of treatment, better and faster nutritional recovery along with the agreed diet; reduction of hospital stays; shortening of treatment duration; avoidance of early satiety. The latter is because it has been shown that in pAN there is a delayed gastric emptying of solid but not of liquid meals, therefore liquid supplementations can be a well-tolerated intervention, especially at the beginning of the intervention, when gastric emptying is more delayed (14).…”

Autopercepción de una dieta correcta y realización de actividad física en estudiantes universitarios

“…▪ Estado de ánimo: Las personas con depresión y bajo estado de ánimo suelen elegir con mayor frecuencia alimentos poco saludables pero muy palatables con el objetivo de disfrutar más de la comida (Gómez et al, 2018).…”

Trastornos de la conducta alimentaria en adolescentes. Una mirada integral

“…Otras conductas destinadas al control del peso, tales como consumo disminuido o aumentado de líquidos, masticar frecuentemente chicle sin azúcar, abuso de endulzantes, uso de diversas sustancias con el fin de suprimir el apetito o bajar de peso (cafeína, té, tabaco -fumar-, drogas ilegales y suplementos nutricionales), y abuso de otros suplementos, como barras y polvos de proteína, y creatina (esto último en varones activos en el gimnasio) 2,[52][53][54] .…”