Original article
Clinical Efficacy and Safety of Parenteral Nutrition in Adolescent Girls with Anorexia Nervosa

https://doi.org/10.1016/j.jadohealth.2007.09.024Get rights and content

Abstract

Purpose

Anorexia nervosa (AN) is a common chronic disorder characterized by severe malnutrition and psychological disturbances. Parenteral nutrition (PN) is not usually used in nutritional rehabilitation of AN. The aim of our study was to retrospectively evaluate the indications, clinical efficacy, and safety of PN as assessed by short- and long-term outcomes in AN inpatient girls.

Methods

During the last 10 years a total of 198 inpatients were included in our study: 104 (53%) received oral and parenteral refeeding (group A) and 94 (47%) oral refeeding alone (group B). For each nutritional treatment, clinical efficacy was evaluated by short- and long-term outcomes, and safety was assessed by complication rate.

Results

Short-term outcome assessment indicated weekly weight gain and maximum caloric intake to be higher in PN-treated patients. Long-term outcome evaluation showed rehospitalization and recovery rate to be similar in the two groups, but failure of first nutritional rehabilitation requiring PN significantly greater in group B (17.5%) than in group A (3%) (p = .01). The number of complications was significantly higher in group A than in group B (p = .004), although all complications resolved.

Conclusion

Among all nutritional rehabilitation strategies, PN offers an alternative and safe way to successfully treat AN patients. Presence of clinical complications and reduced compliance with individual, group, and family therapy seem to be the main indications for PN, as it promptly improves nutritional status. At pediatric and adolescent ages, psychological disturbances can also contraindicate the use of enteral nutrition, and therefore represent an additional indication for PN.

Section snippets

Methods

All patients were followed at the Neuropsychiatry Unit of our Hospital, that is the major Italian Centre for the management of eating disorders at pediatric and adolescent age.

Treatment of both AN outpatients and inpatients was entrusted to a multidisciplinary team composed by specialized psychiatric nursing staff, dietitians, psychologists, and numerous medical experts, including a psychiatrist, gastroenterologist, cardiologist, endocrinologist and dentist.

Anthropometric measurements

Table 1 shows all data regarding anthropometric measurements at admission and at discharge in both groups in which discharge weight, BMI, and percentage of ideal body weight values were significantly higher than those registered at admission.

Medical history

Rates of psychiatric comorbidity are reported in Table 1. In all, 28 patients in PN-treated group and 13 in orally treated group showed comorbid psychiatric problems. These were represented by severe depression in 15, anxiety disorders in 13,

Discussion

Nutritional rehabilitation in adolescent girls with AN is aimed at promoting metabolic recovery, restoring a healthy body weight, and improving eating habits and psychological behavior. Our experience confirms the clinical efficacy of nutritional treatment for AN patients. Severe malnutrition could require the use of artificial nutrition to rapidly correct dangerous clinical conditions and to reverse medical complications. However, because forced PN or EN refeeding can be accompanied by

Conclusion

In conclusion, nutritional rehabilitation represents an essential part of AN treatment. Although this intervention alone does not guarantee a favorable outcome, the patient’s chances of success have dramatically improved. Among all nutritional rehabilitation strategies, PN offers a useful alternative for successfully treating AN patients when nasogastric feeding (preferred by most physicians) is not possible, either because it is not allowed in a psychiatric unit or because an adult patient or

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