Weltzin T E, Fernstrom M H, Hansen D, McConaha C, Kaye W H
Department of Psychiatry, University of Pittsburgh School of Medicine, PA.
Am J Psychiatry. 1991 Dec;148(12):1675-82. doi: 10.1176/ajp.148.12.1675.
This study tested previous findings that patients with eating disorders who attain normal weight have abnormal caloric requirements for maintaining weight.
Fifty-three female patients meeting the DSM-III-R criteria for anorexia nervosa and/or bulimia nervosa were divided into four subgroups, and their daily caloric intake was measured over a weight-stable period. Patients with anorexia nervosa (restricting and bulimic subtypes) were studied 4 weeks after refeeding and weight gain, when they had attained 95% of average body weight. Patients with normal-weight bulimia (previously anorexic or never previously anorexic) were studied 1-4 weeks after admission to an inpatient unit.
After weight restoration, restricting anorexic patients required significantly more calories per day to maintain weight than did bulimic anorexic patients, as measured with corrections for weight, body surface area, and fat-free mass. Previously anorexic normal-weight bulimic patients required significantly more calories per day to maintain weight than never-anorexic normal-weight bulimic patients, as measured with correction for weight but not with the other factors used to correct caloric intake.
To maintain stable weight after weight restoration, restricting anorexic patients require a significantly higher caloric intake than do bulimic anorexic patients. Differences in caloric needs between normal-weight bulimic patients with and without histories of anorexia may depend on the methods used to correct caloric requirements. Body surface area may be the most precise correction factor across different subgroups of eating disorder patients. Elevated caloric requirements, when coupled with reduced food intake, may particularly contribute to relapse in anorexic patients.
本研究验证了先前的研究结果，即体重恢复正常的饮食失调患者在维持体重方面有异常的热量需求。
53名符合DSM-III-R神经性厌食症和/或神经性贪食症标准的女性患者被分为四个亚组，并在体重稳定期测量她们的每日热量摄入量。神经性厌食症患者（限制型和暴食型亚型）在重新进食和体重增加4周后进行研究，此时她们的体重达到平均体重的95%。体重正常的贪食症患者（以前是厌食症患者或从未患过厌食症）在入院1至4周后进行研究。
体重恢复后，经体重、体表面积和去脂体重校正后测量，限制型厌食症患者维持体重所需的每日热量明显高于暴食型厌食症患者。经体重校正但未用其他校正热量摄入的因素测量，以前是厌食症患者的体重正常的贪食症患者维持体重所需的每日热量明显高于从未患过厌食症的体重正常的贪食症患者。
体重恢复后，为维持体重稳定，限制型厌食症患者所需的热量摄入量明显高于暴食型厌食症患者。有厌食症病史和无厌食症病史的体重正常的贪食症患者在热量需求上的差异可能取决于校正热量需求的方法。体表面积可能是饮食失调患者不同亚组中最精确的校正因素。热量需求增加，再加上食物摄入量减少，可能特别会导致厌食症患者复发。
