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Rigaud D.,Service dEndocrinologie et Nutrition
Nutrition Clinique et Metabolisme | Year: 2013

Weight restoration is crucial for successful treatment of anorexia nervosa (AN). Without it, patients may face serious or even fatal complications of severe starvation. Renutrition should take into account clinical characteristics unique to these patients, such as gastroparesis and fear of gaining body weight. The efficacy of tube feeding and home-tube feeding (Home-TF) has been suggested in AN and proven in bulimia nervosa (BN). TF and home-TF allow a better body weight gain (mainly fat-free mass) in AN patients and a strong decrease in the frequency and the intensity of binge-eating/purging episodes at relatively short-term (1. year) in BN patients. In AN, home-TF does not increase anxiety, depression, or worsen the eating behavior. In BN patients, home-TF decreases anxiety and depressive state and improves the quality of life. The goal of home-TF is not to cure the patients, but only to avoid serious malnutrition and its complications and to insure a better investment of the patients for their psychotherapy. Home-TF must be associated with psychotherapy, namely cognitive behavioural therapy and family therapy in adolescents. If the fear of gaining body weight is too high, the risk of failure of home-TF, because of poor compliance, is increasing. In any case, the aims and the goals of home-TF should be extensively explained. © 2013.

Gut hormones and neuropeptides have a regulatory role in the exocrine secretions and the motor activity of the gastrointestinal (Gl) tract. They also act as modulators of food intake and eating behavior. Adipose tissue (AT) also secretes hormonal peptides, which modulate hunger feeling, food intake and energy expenditure (leptin, adiponectin, resistin). Many studies were published on the role of Gl and AT regulatory peptides in eating disorders (anorexia and bulimia nervosa). They could exert their action as regional actors or by joining the hypothalamus. The increase in ghrelin and NPY secretions and the decrease in leptin secretion in anorexia (AN) and bulimia nervosa could to promote hunger, thus increasing fear of eating and risk of binge eating. These hormonal changes could also promote physical hyperactivity, which is observed in 65 to 80% of AN and 20-40% of bulimia nervosa patients (orexin could also play a role). High endorphin levels may explain the relative insensitivity to pain in AN patients. The increased Gl secretion of serotonin and dopamine, associated with a high plasma ghrelin level, could contribute to increasing anxiety. Low resistin and high adiponectin plasma levels could explain the hypersensitivity to insulin that is observed in many AN patients, during the malnutrition state. The role of other Gl hormones and neuropeptides remains to be clarified.

Rigaud D.,Service dEndocrinologie et Nutrition | Pennacchio H.,Association Autrement | Bussens P.,Jouvence Nutrition | Chancenotte J.-M.,Jouvence Nutrition
Cahiers de Nutrition et de Dietetique | Year: 2011

Clinical features of 238 eating disorder (ED) adult patients were compared, according to the subtype (restricting subtype of anorexia nervosa (RAN, binge eating/purging subtype (BPAN) and bulimia nervosa, BN). There were 75 RAN, 91 BPAN and 76 BN needing for hospitalization. BPAN and BN patients had had, before ED, higher BMI, higher frequency of obesity and binge eating and had been more often on slimming diet than RAN patients (p < 0.05). One third of BPAN and BN had begun with RAN. In 75% of the cases, a slimming diet preceded the ED. One quarter of BPAN and BN had had sexual trauma, vs 6% of the RAN (p < 0.01). In the family, there were more obesity, more ED, more anxiety, more depressive states than in population. The father or the mother had more often a thought of ideal thinness and of importance of sport. Meals were very often suppressed, food excluded (NS between groups). Binge/purging episodes occurred 16 ± 6 times a week and lasted 2,6 ± 1,1 h/day. Excessive exercise occurred in 60% of B and 70% of RAN and BPAN (NS) and lasted 2,7 ± 0,7 h/day. Obsessive compulsive disorders occurred in 50% of the cases (NS between groups) and lasted more in AN than in BN patients (BN: 1.9 ± 0.6 h, AN: 2,7 ± 0,8 h). Self-injury occurred in 32% of the cases (BN: 44%, AN: 23%). Smoking abuse was more frequent in BPAN and BN (40%) than in RAN (18%, p < 0.01). Among 18% of the patients received a disability pension from government health insurance. Chronic treated depression was observed in 27% (more in BPAN and BN than RAN, p < 0.05) and chronic treated anxiety in 52% of the patients. Quality of life was strongly impaired in all three eating disorders, and no more in AN than in BN, nor more in RAN than in BPAN: the QUAVIAM total score was similar in the three groups and in each very higher than that of 56 healthy subjects (405 ± 54 vs 88.6 ± 49; p < 0.0001) and than the QUAVIAM global score obtained in 49 recovered ED patients (157 ± 81; p < 0.0001). Each of the six sub-scores was higher (more deteriorated) than those of the healthy controls (p < 0.0001): physical, psychological, ED-related, hedonic, socioprofessional and emotional scores. Only two of the six subscores differed between AN and BN: the psychical and the ED-related subscores were less deteriorated in RAN than in BPAN and BN patients (p < 0.03). © 2010 Société française de nutrition. Published by Elsevier Masson SAS. All rights reserved.

Rigaud D.,Service dEndocrinologie et Nutrition | Pennacchio H.,Service dEndocrinologie et Nutrition | Bizeul C.,Service dEndocrinologie et Nutrition | Reveillard V.,Service dEndocrinologie et Nutrition | Verges B.,Service dEndocrinologie et Nutrition
Diabetes and Metabolism | Year: 2011

Background: To study the long-term prognosis of anorexia nervosa (AN), 484 adult AN patients were followed on a mean duration of 13 years. Results: The mortality rate was 1.2%. Eight factors were linked to the lack of recovery at 2 years: low BMI at discharge, low energy and fat intakes, high drive for excessive exercising, high score for perfectionism, for interpersonal distrust and for anxiety, use of tube-feeding and adhesion to treatment (P<0.02). Four factors explained the risk of the binge/purging form at 2 years: having had binge-eating disorder and overweight before AN, having had purging episodes within the first 2 years of AN; having had very high energy intakes through meals and being not treated by tube-feeding. During the 13-year follow-up, very few binge/purging patients turned out to have the restrictive form. Two main factors explained 67% of the variance of menses recovery: having a BMI>18.5kg/m 2; and having no physical hyperactivity. The recovery rate increased with the elapsing of relapse-free time (P=0.02). After a 13.5-year follow-up, 292 out of the 484 patients were recovered (60.3%), 25.8% had a relatively good outcome, 6.4% a bad outcome and 6.4% a severe outcome. Very few factors were identified as predictors of a good outcome (binge-eating/purging subtype, personality disorder). © 2011 Elsevier Masson SAS.

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