Relationship of clinical factors to caloric requirements in subtypes of eating disorders

Newman, Michael M.; Halmi, Katherine A.; Marchi, Peggy

doi:10.1016/0006-3223(87)90033-3

Cited by 26 publications

(10 citation statements)

References 19 publications

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“…Initial reduction in fasting REE is a consistent finding in malnourished AN patients 3–12 . In a retrospective study of 21 hospitalized female AN patients, we demonstrated that IC measurement of REE was significantly lower than REE predicted by the Harris–Benedict equation (HBE) 8 .…”

Section: Introductionmentioning

confidence: 65%

The Metabolic Responses to Starvation and Refeeding in Adolescents with Anorexia Nervosa

Schebendach

Golden

Jacobson

et al. 1997

Annals of the New York Academy of Sciences

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Adaptive changes in metabolism result in decreased energy requirements in AN. A retrospective study of 21 hospitalized female AN patients demonstrated that indirect calorimetry (IC) measurement of resting energy expenditure (REE) was significantly lower than REE calculated by the Harris-Benedict equation (HBE). The HBE was adjusted by multiple-regression analysis to reflect the hypometabolic state of AN, and the adjusted equation was prospectively validated in 37 hospitalized female AN patients. Refeeding requires an understanding of both baseline requirements and metabolic changes that occur during nutritional rehabilitation. In our present study, we prospectively evaluated changes in fasting and postprandial REE in 50 hospitalized female patients meeting DSM-IV criteria for AN. Baseline IC measurements of fasting and postprandial REE were obtained within three days of admission, and every two weeks thereafter. Mean fasting REE increased significantly from 72 (+/-11.7) to 83.2 (+/-12.6) percent of predicted (p < 0.001) during the first two weeks of hospitalization. Likewise, postprandial REE also increased significantly from 17.5 (+/-18.2) to 27.9 (+/-15.9) percent above fasting REE during the same time period (p < 0.01). Significant increases in both REE and postprandial REE persisted in patients requiring longer hospitalizations. Despite the fact that prescribed energy intake and triiodothyronine (T3-RIA) levels increased during refeeding, there was no significant relationship between postprandial REE and energy intake or T3 levels after baseline. We conclude that energy metabolism in AN adapts to semistarvation by a reduction in fasting REE. With refeeding there is a reversal of this adaptive function, demonstrated by an increase in both fasting and postprandial energy expenditure. The increase in postprandial REE is not related to energy intake or thyroid function.

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Section: Introductionmentioning

confidence: 65%

The Metabolic Responses to Starvation and Refeeding in Adolescents with Anorexia Nervosa

Schebendach

Golden

Jacobson

et al. 1997

Annals of the New York Academy of Sciences

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“…These authors attributed the difference in the results between their studies and the Kaye et al (1986) study to age differences between the subjects. However, Newman et al (1987) also found that bulimic patients without and bulimic patients with a history of anorexia nervosa required less calories to maintain weight than did the anorexic restrictors and anorexic binge purgers.…”

Section: Weight Gain In Anorexic Individualsmentioning

confidence: 99%

Refeeding, metabolic rate, and weight gain in anorexia nervosa: A review

Salisbury

Levine

Crow

et al. 1995

Int. J. Eat. Disord.

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Patients with anorexia nervosa require refeeding to restore normal body weight. A variety of studies have examined the role of metabolic rate in the refeeding of anorectic patients. Several measurement techniques have been used to divide metabolic rate into its components: basal metabolic rate, resting energy expenditure, activity‐induced thermogenesis, and dietary‐induced thermogenesis. In anorexia nervosa patients several consistent findings are present. First, the number of kilocalories required for weight gain or weight maintenance increases as weight increases. Second, over 50% of the body mass gained in anorectic individuals represents fat tissue. Finally, both a history of bulimic symptoms and a higher premorbid body weight may lead to lower calorie requirements. These findings suggest the need for gradual increase in calories provided throughout treatment; resting energy expenditures may aid the determination of caloric requirements. © 1995 by John Wiley & Sons, Inc.

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“…This finding is consistent with clinical experience that most patients treated successfully do not report significant weight gain. However, this does not rule out the possibility that TEE may be lowered in patients with BN who are not actively symptomatic, as suggested by some studies of RMR (Altemus et al, 1991) and total food intake (Newman et al, 1987;Gwirtsman et al, 1989). According to this line of reasoning, patients with BN may have an underlying abnormality of energy regulation, which is compensated for by bulimic behaviors; in other words, binge eating and/or vomiting may serve to elevate the low baseline TEE of patients to normal levels.…”

Section: Discussionmentioning

confidence: 85%

“…Evidence that this may indeed be the case in BN derives from clinical observations that a majority of patients with BN begin their binge eating and purging during a period of dieting, (Mitchell, Hatsukami, Pyle, & Eckert, 1986) and a disproportionate number of women with BN have a pre-morbid history of obesity and are therefore at a reduced weight compared to their previous body weight (Fairburn, Welch, Doll, Davies, & O'Connor, 1997). In fact, several studies have reported that normal weight BN patients have reduced caloric requirements for weight maintenance (Newman, Halmi, & Marchi, 1987;Gwirtsman et al, 1989).…”

Section: Introductionmentioning

confidence: 97%

Total energy expenditure as measured by doubly‐labeled water in outpatients with bulimia nervosa

Kotler

Devlin

Matthews

et al. 2001

Intl J Eating Disorders

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Relationship of clinical factors to caloric requirements in subtypes of eating disorders

Cited by 26 publications

References 19 publications

The Metabolic Responses to Starvation and Refeeding in Adolescents with Anorexia Nervosa

The Metabolic Responses to Starvation and Refeeding in Adolescents with Anorexia Nervosa

Refeeding, metabolic rate, and weight gain in anorexia nervosa: A review

Total energy expenditure as measured by doubly‐labeled water in outpatients with bulimia nervosa

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