Reed Kylie K, Silverman Ava E, Abbaspour Afrouz, Burger Kyle S, Bulik Cynthia M, Carroll Ian M
Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
J Eat Disord. 2024 May 21;12(1):63. doi: 10.1186/s40337-024-01019-7.
Weight gain and nutritional rehabilitation are essential first steps to achieve medical stabilization in anorexia nervosa, and frequent resistance to weight gain requires patients to consume high kilocalorie loads. Adaptive hypometabolism is common when patients begin treatment, and rebound hypermetabolism is suspected to be a significant barrier to weight gain. The aim of this review was to summarize existing data describing metabolic changes in anorexia nervosa during weight restoration. The reported findings challenge current hypotheses of weight gain resistance and highlight key areas for future research.
Using scoping review guidelines, three databases were searched for studies investigating metabolic changes in anorexia nervosa before and after renourishment. Two reviewers systematically screened the titles and abstracts of 447 articles, and full-text versions of 106 studies were assessed for eligibility. A total of 36 studies were included for review. Data regarding the study description, sample population (including age, weight, BMI, duration of treatment, and caloric intake), and metabolic variable descriptions were extracted.
Female patients with anorexia nervosa from studies across 13 countries were included. Across the studies, average BMI increased from 13.7 kg/m at admission to 17.57 kg/m. Patients presented to treatment with clinically reduced energy expenditure levels. After varying levels of nutritional rehabilitation and weight restoration, measured energy expenditure increased significantly in 76% of the studies. Energy expenditure values at the second timepoint increased to the standard range for normal weight female teenagers and adults. Despite these increases, the studies do not indicate the presence of a hypermetabolic state during renourishment. Additionally, all studies including both measured and predicted energy expenditure reported that predicted energy expenditure overestimated measured values.
This study provides a detailed evaluation of the literature investigating energy expenditure and metabolic rate in patients with anorexia nervosa before and following a period of renourishment. The findings from this review identify important gaps in the current beliefs of energy expenditure in anorexia nervosa and highlight a need for further exploration of metabolic alterations during weight restoration.
体重增加和营养康复是实现神经性厌食症病情稳定的关键首要步骤，而患者对体重增加的频繁抗拒要求其摄入高热量食物。患者开始治疗时，适应性低代谢很常见，而反弹高代谢被认为是体重增加的一个重大障碍。本综述的目的是总结现有数据，描述体重恢复过程中神经性厌食症患者的代谢变化。所报告的研究结果对当前关于体重增加抵抗的假说提出了挑战，并突出了未来研究的关键领域。
按照范围综述指南，检索了三个数据库，以查找调查神经性厌食症患者营养补充前后代谢变化的研究。两名审阅者系统筛选了447篇文章的标题和摘要，并对106项研究的全文版本进行了资格评估。总共纳入36项研究进行综述。提取了有关研究描述、样本人群（包括年龄、体重、体重指数、治疗持续时间和热量摄入）以及代谢变量描述的数据。
纳入了来自13个国家的研究中的神经性厌食症女性患者。在这些研究中，平均体重指数从入院时的13.7kg/m²增加到了17.57kg/m²。患者接受治疗时临床能量消耗水平降低。经过不同程度的营养康复和体重恢复后，76%的研究中测量的能量消耗显著增加。第二个时间点的能量消耗值增加到了正常体重女性青少年和成年人的标准范围。尽管有这些增加，但研究并未表明营养补充期间存在高代谢状态。此外，所有包括测量和预测能量消耗的研究均报告，预测能量消耗高估了测量值。
本研究对有关神经性厌食症患者营养补充前后能量消耗和代谢率的文献进行了详细评估。本综述的研究结果揭示了当前对神经性厌食症患者能量消耗认知中的重要差距，并强调需要进一步探索体重恢复期间的代谢改变。
