Schebendach J E, Golden N H, Jacobson M S, Hertz S, Shenker I R
Eating Disorders Center, Schneider Children's Hospital, Long Island Jewish Medical Center, New Hyde Park, New York 11042, USA.
Ann N Y Acad Sci. 1997 May 28;817:110-9. doi: 10.1111/j.1749-6632.1997.tb48200.x.
Adaptive changes in metabolism result in decreased energy requirements in AN. A retrospective study of 21 hospitalized female AN patients demonstrated that indirect calorimetry (IC) measurement of resting energy expenditure (REE) was significantly lower than REE calculated by the Harris-Benedict equation (HBE). The HBE was adjusted by multiple-regression analysis to reflect the hypometabolic state of AN, and the adjusted equation was prospectively validated in 37 hospitalized female AN patients. Refeeding requires an understanding of both baseline requirements and metabolic changes that occur during nutritional rehabilitation. In our present study, we prospectively evaluated changes in fasting and postprandial REE in 50 hospitalized female patients meeting DSM-IV criteria for AN. Baseline IC measurements of fasting and postprandial REE were obtained within three days of admission, and every two weeks thereafter. Mean fasting REE increased significantly from 72 (+/-11.7) to 83.2 (+/-12.6) percent of predicted (p < 0.001) during the first two weeks of hospitalization. Likewise, postprandial REE also increased significantly from 17.5 (+/-18.2) to 27.9 (+/-15.9) percent above fasting REE during the same time period (p < 0.01). Significant increases in both REE and postprandial REE persisted in patients requiring longer hospitalizations. Despite the fact that prescribed energy intake and triiodothyronine (T3-RIA) levels increased during refeeding, there was no significant relationship between postprandial REE and energy intake or T3 levels after baseline. We conclude that energy metabolism in AN adapts to semistarvation by a reduction in fasting REE. With refeeding there is a reversal of this adaptive function, demonstrated by an increase in both fasting and postprandial energy expenditure. The increase in postprandial REE is not related to energy intake or thyroid function.
新陈代谢的适应性变化导致神经性厌食症患者的能量需求降低。一项对21名住院女性神经性厌食症患者的回顾性研究表明，静息能量消耗（REE）的间接测热法（IC）测量值显著低于通过哈里斯-本尼迪克特方程（HBE）计算得出的REE。通过多元回归分析对HBE进行调整，以反映神经性厌食症的低代谢状态，并且在37名住院女性神经性厌食症患者中对调整后的方程进行了前瞻性验证。重新进食需要了解基线需求以及营养康复期间发生的代谢变化。在我们目前的研究中，我们前瞻性地评估了50名符合DSM-IV神经性厌食症标准的住院女性患者空腹和餐后REE的变化。在入院三天内以及此后每两周获取空腹和餐后REE的基线IC测量值。在住院的前两周内，平均空腹REE从预测值的72（±11.7）%显著增加至83.2（±12.6）%（p<0.001）。同样，在同一时期，餐后REE也从比空腹REE高17.5（±18.2）%显著增加至27.9（±15.9）%（p<0.01）。在需要更长住院时间的患者中，REE和餐后REE均持续显著增加。尽管在重新进食期间规定的能量摄入量和三碘甲状腺原氨酸（T3-RIA）水平有所增加，但基线后餐后REE与能量摄入量或T3水平之间没有显著关系。我们得出结论，神经性厌食症患者的能量代谢通过降低空腹REE来适应半饥饿状态。随着重新进食，这种适应性功能发生逆转，表现为空腹和餐后能量消耗均增加。餐后REE的增加与能量摄入量或甲状腺功能无关。
