Krahn D D, Rock C, Dechert R E, Nairn K K, Hasse S A
Department of Psychiatry's Eating Disorders Program, University of Michigan, Ann Arbor 48109-2029.
J Am Diet Assoc. 1993 Apr;93(4):434-8. doi: 10.1016/0002-8223(93)92291-5.
Accurate prediction of the energy level necessary to promote weight restoration in patients with anorexia nervosa would be clinically useful. Resting energy expenditure (REE), respiratory quotient, and body composition were measured in 10 nonmedicated women with anorexia nervosa during a vigorous refeeding protocol. REE was measured three times per week by open-circuit indirect calorimetry after an overnight fast. Subjects ranged in age from 19 to 38 years and weighed 39.9 +/- 4.3 kg (mean +/- standard deviation) at admission. The refeeding protocol was as follows: phase 1, 1,200 kcal/day for 1 week (baseline); phase 2, an increase of 300 kcal/day for 1 week; phase 3, 3,600 kcal/day until target weight was reached; phase 4, 1,800 to 2,800 kcal/day (stabilization). REE was 30.0 +/- 6.4, 33.5 +/- 6.7, 37.3 +/- 6.6 and 34.5 +/- 4.4 kcal/kg body weight during phases 1, 2, 3, and 4, respectively. The Harris-Benedict equation overestimated phase 1 24-hour REE by a mean of 14% and underestimated REE in phases 2, 3, and 4 by a mean of 8%, 24%, and 23%, respectively. Skinfold measurements revealed percent body fat to be 12 +/- 4% at admission and 19 +/- 5% at discharge, with a mean of 48% of the weight gained during refeeding attributable to increased body fat. These findings indicate that refeeding in anorexia nervosa is associated with increased REE, which cannot be explained by increased body mass, and that caloric requirements for weight restoration in patients with anorexia nervosa are best determined by monitoring individual response.
准确预测神经性厌食症患者恢复体重所需的能量水平具有临床实用价值。在一项积极的重新进食方案中，对10名未接受药物治疗的神经性厌食症女性进行了静息能量消耗（REE）、呼吸商和身体成分的测量。在禁食过夜后，每周通过开路间接测热法测量三次REE。受试者年龄在19至38岁之间，入院时体重为39.9±4.3千克（平均值±标准差）。重新进食方案如下：第1阶段，每天1200千卡，持续1周（基线）；第2阶段，每天增加300千卡，持续1周；第3阶段，每天3600千卡，直至达到目标体重；第4阶段，每天1800至2800千卡（稳定期）。在第1、2、3和4阶段，REE分别为30.0±6.4、33.5±6.7、37.3±6.6和34.5±4.4千卡/千克体重。哈里斯-本尼迪克特方程高估了第1阶段的24小时REE，平均高估14%，而低估了第2、3和4阶段的REE，平均分别低估8%、24%和23%。皮褶测量显示，入院时体脂百分比为12±4%，出院时为19±5%，重新进食期间体重增加的平均48%归因于体脂增加。这些发现表明，神经性厌食症患者重新进食与REE增加有关，这不能用体重增加来解释，并且神经性厌食症患者恢复体重的热量需求最好通过监测个体反应来确定。
