Features of Refeeding Therapy in Patients with Anorexia Nervosa

Background: anorexia nervosa (AN) is the actual issue of medicine due to continued increase of the prevalence and extension of onset age of disease. The efficiency of treatment of this category of patients remains low. One of the main somatic manifestations of AN is severe, life-dangerous malnutrition. The most important component of treatment and rehabilitation is nutritional metabolic intervention to restore the nutritional status of patients.

The aim was to study energy expenditures and daily nitrogen loss in patients with AN to develop recommendations for optimizing their substrate supply during the period of rehabilitative nutrition with a high risk of developing refeeding syndrome and consider the role of psychological correctional measures.

Patients and methods: energy expenditures (indirect calorimetry on the Cosmed Quark RMR apparatus) and daily nitrogen loss were studied in 81 patients with AN, aged from 18 to 55 years, who were treated in the somatopsychiatric department of the Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine.

Results: the target optimal energy intake is 58.5–73 kcal/kg per day of actual body weight, and protein intake is 1.95–2.39 g/kg per day. An acceptable positive result is achieved a gradual gain in body weight (500–1000 g per week).

Conclusion: nutritional and metabolic therapy of patients with AN should be carried out in the mode of personalized differentiated hyperalimention, considering the initial nutritional status and adequate metabolic tolerance of the gradually increasing substrate load.

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