Review article

MEDICAL NUTRITION THERAPY IN MANAGEMENT OF EATING

DISORDERS

Maja Nikolic, Milos Pavlovic and Milica M. Vojinovic

The treatment of eating disorders demands a comprehensive medical approach, where a

dietitian has an important role, primarily due to numerous instances of malnutrition. The
objective of this paper was to recapitulate the research findings and clinical evidence which
show the importance of medical nutrition therapy in the treatment of eating disorders;
furthermore, they present significant guidelines for clinical practice. The research methods
have entailed a thorough exploration of literature available at research data bases. The results
of the research studies published so far have unambiguously pointed out that, when eating
disorders are concerned, there is an urgent need for a diet therapy in order for the patient to
restore the appropriate body weight as well as normal eating habits. On the one hand, certain
authors suggest returning to normal nutritional habits immediately, whereas, on the other
hand, certain others advocate a diet therapy program, that is, a gradual process of recovery.
Patients incapable of oral food intake receive enteral nutrition. Parenteral nutrition is applied for
recovering the lost electrolytes and fluids, but it should be applied rarely, primarily in states of
urgency. For patients suffering from eating disorders the increase in weight indicates good
chances of recovery; therefore, the patient’s nutritional status should be carefully and
continuously noted. Finally, it is important that our country, too, should adopt a carefully
prescribed and conducted diet therapy as an obligatory step in the treatment of patients with
eating disorders. Acta Medica Medianae 2009;48(1):50-55.

Key words: eating disorders, nutrition, medical nutrition therapy, malnutrition

Faculty of Medicine in Nis increasingly prevalent even in less developed and

developing countries. This is considered to be a
Contact: Maja Nikolic
Public Health Institute in Nis
consequence of globalisation - the acquisition of
50 Dr Zoran Djindjic Blvd. the so-called global cultural standards, ways of
18000 Nis, Srbija life as well as nutritional habits (3, 4).
Tel.: 018-226-384, ex. 140 In a multidisciplinary approach of the above
E-mail: mani@junis.ni.ac.yu
mentioned illnesses, which are primarily psychiatric,
depending on the clinical symptoms and a degree
of malnutrition, a diet therapy could be of
Introduction
paramount importance for the patient’s recovery,
and sometimes, even, for the prevention of fatal
The most common eating disorders are:
consequences.
anorexia nervosa (F50), i.e., a neurotic loss of
appetite, and bulimia nervosa (F50), i.e., neurotic Aims
overeating. According to The International
Classification of Diseases and Related Health The aim of this paper was to recapitulate
Problems 10th Revision (1), there are also other clinical evidence which shows the importance of
types of eating disorders diagnosed as: food medical nutrition therapy in the treatment of
avoidance emotional disorder-FAED, selective eating disorders.
eating, restrictive eating, functional dysphagia,
pervasive refusal, and loss of appetite caused by Material and methods
depression. Furthermore, there is another group
of eating disorders which are not characterised The research methods have entailed a thorough
by malnutrition: binge-eating disorder, compulsive exploration of literature available at research
overeating, hyperphagia, excessive eating caused data bases (Medline, Scopus, etc). The key words
by an organic desease. used in the research of data bases are: eating
On the whole, the prevalence rate of disorders, diet, medical nutrition therapy, malnutri-
eating disorders is relatively low (<1%). However, tion. The facts presented in this paper have been
from the 70s onward, there is a constant increase selected by the following criteria: importance for
in numbers (2). Eating disorders, although typical clinical practice, relevance to contemporary life,
of highly developed countries, are now becoming practical use.
50 www.medfak.ni.ac.rs/amm
Acta Medica Medianae 2009,Vol.48 Medical nutrition therapy in management of eating disorders

Results and Discussion A special diet program is meant to reinforce

the psychiatric treatment of eating disorders.
Due to the fact that eating disorders are When anorexia nervosa is concerned, the patient
caused by various biological and psychological receives a diet therapy in order to restore the
factors, it is essential that a multidisciplinary normal nutritional habits and thus reach and
team should be involved in the treatment. Except maintain healthy body weight. When bulimia
psychiatrists, this team should include other nervosa is concerned, a diet therapy is applied in
medical specialists such as nutrition experts order to terminate the process of binge-eating.
(dietitians or dietologists), physiotherapists, other The purpose is, firstly, to cleanse the body
medical workers as well as the patient’s parents through acquiring a normal eating behavior;
(Chart 1, Draft 1). secondly, it is necessary in order to change the
patient attitude to food, nutrition in general, and
Table 1. Basic steps in the treatment of patients with their own body
eating disorders For the successful treatment of eating diso-
rders, it is highly important to make a connection
Creating a therapeutic bond between the patient and based on a “thin but healthy” principle, first with
the therapist parents, then with patients themselves. Younger
Informing and counseling the family; encouraging the patients are not often prone to cooperate,
family to accept responsibility
especially because they feel fear and aversion.
Evaluating the need for hospitalization On the other hand, patients suffering from
Assessment of the nutritional status bulimia nervosa and selective eating concede to a
Restoring the healthy patterns of nutritional behavior therapeutic bond more easily (6).
Providing relevant information on the
Cognitive behavioral therapy nature of the illness is of vital importance for the
Psychodynamic therapy final success of the treatment. The close family
Group therapy
members of the patient must be well informed
about the nature of the illness, its course,
Physical therapy complications and the recommended therapy
Medication program. After the patient is examined and the
illness diagnosed, the doctor talks both to the
Eating disorders often result in malnutrition. patient and his parents and gives details about
Malnutrition leads to deterioration in the general the nature of the illness, potential risks. Then, he
state of the patient’s health, and, in some cases, points out the need for teamwork. Also, it is
it can be fatal (5,6,7). desirable to supply the parents with printed
material.
The fact is that the patient himself cannot
take care of his own health and nutrition;
therefore, his parents are to take responsibility
for and control over his diet. However, this does
not relate to other aspects of the patient’s life,
his choice of hobbies, clothes, friends. As the
treatment progresses, the patient gradually
regains control over his own nutrition. Through
this “try-and-fail” process the patient takes full
responsibility for his eating behavior.
The patient suffering from anorexia nervosa
becomes angry and infuriated even at the
slightest interference into his diet. Therefore, it is
important to have his consent as to the course of
the treatment in advance. Also, there is clear
evidence of a family-oriented therapy having
beneficial effects (8).
Before the appropriate diet program is
prescribed, it is important to make an
assessment of the patient’s nutritional status. In
this case, there is no point in determining the
desirable body weight since the patient’s ideals
are always below the standard.
The assessment of the patient’s nutritional
status determines whether the patient should be
hospitalized or not. In this case, the following
factors are taken into account: the mental state
of the patient, anxiety of the parents, whether
Draft 1. An algorithm for basic treatment decisions outpatient treatment allows for certain therapy
regarding patients with anorexia nervosa or bulimia programs (Chart 2).
nervosa (according to the American Psychiatric On the one hand, patients suffering from
Association) anorexia nervosa are most often in need of hospital
51
Medical nutrition therapy in management of eating disorders Maja Nikolić et al.

treatment, while, on the other, patients suffering program. It would be wrong to make an agreement
from selective eating are rarely hospitalized. only with the patient, especially if he is a youth,
because he can show a great manipulative
Table 2. Criteria for hospitalization of patients with potential. Therefore, it is important to stress that
eating disorders the parents take ultimate responsibility for the
choice of a diet.
Body mass index below 15 kg/m2 or relative body Nutritional rehabilitation includes: the asse-
weight below 75% or below the 3rd percentile in ssment of nutritional habits and nutritional status,
children under 18
diet therapy, and nutritional counseling.
Dehydration Nutritional assessment implies taking the diet
Circulatory collapse, manifested in low blood history and the assessment of the biochemical,
pressure, slow or irregular pulse, bad peripheral metabolic and anthropometric indicators of his
circulation nutritional status.
Electrolyte deficiency
The diet history should include the asse-
Recurrent vomiting and blood in the vomit
ssment of the energy intake, the intake of macro
Depression, suicidal ideas or intensions, or other
more serious psychiatric disorders and micronutrients, the patient’s attitude to
eating behavior and eating in general. Anorexia
Unsuccessful outpatient treatment
nervosa is characterized by lower energy intake -
below 1000kcal per day. Bulimia is, in turn, very
Recovering the lost fluid and electrolyte difficult to follow in terms of energy intake
balance, if recommended, demands inpatient because of the ‘purging’ phases, that is, self-
hospital care. Stationary health centers hold a induced vomiting (11). Namely, when they are
supreme position because of the fact that they not in the binge phase, patients suffering from
detect and treat complications rapidly; also, they bulimia often avoid food with carbohydrates and
provide better conditions for enteral nutrition. For fats. Therefore, inadequate energy intake and
younger patients, as well as their parents, limited choice of food cause malnutrition. When
admission into children’s ward is less stressful the medical history of nutrition is recorded, a
than admission into psychiatric ward. The doctor should pay attention as to how much
compromise can be made between inpatient fluids have been taken usually. On the one hand,
hospital care and outpatient services. Besides, some patients drink fluids rarely because they
outpatient clinics turn out to be very efficient in feel bloated afterwards; on the other hand, some
the treatment of adult patients. others drink large quantities of fluids to ward off
In the treatment of eating disorders, a diet the feeling of hunger.
therapy is applied with an aim to restore a Patients with eating disorders have typical
healthy diet, that is, good nutritional habits. The attitudes and types of nutritional behavior.
return to a normal diet can be either rapid or They avoid red meat, pastry, sweets, meat
gradual. The former program (rapid) should be and roasted food. They often classify certain
applied to patients without considerable reduction types of food as ‘absolutely good’ or ‘absolutely
in weight, those taken ill recently, and the ones bad’. They perform rituals at the table. They have
treated as outpatients. On the other hand, patents their own ways of eating, of combining different
with considerable and continuous decrease in food or/and they use spices excessively. Not only
weight are rehabilitated through a gradual should these rituals be noted but also the
nutrition therapy (9). duration of the meal itself. The patient suffering
Adequate nutrition can be provided in three from bulimia devour food rapidly, with an
ways: oral, enteral and sometimes parenteral insatiable appetite, whereas, patients suffering
nutrition (10). If the patient’s state of health from anorexia eat slowly and spend much more
requires the level of essential nutrients be increased time. A bulimic will often avoid certain types of
immediately, enteral nutrition is applied. A food because he believes they could trigger off
dietitian, together with hospital medical stuff, the binge episodes (12).
applies enteral nutrition through a nasogastric In anorexia nervosa the level of serum
tube. On the other hand, parenteral nutrition is albumin is usually normal. Despite the fact that
used in order for the patient to recover the lost patients avoid food with fat and cholesterol, the
fluid and electrolyte balance. This is an level of cholesterol in the serum is elevated. Also,
alternative method used when it is impossible to there is an imbalance between lipoproteins
apply either oral or enteral nutrition. primarily because of liver dysfunction (13,14).
A dietitian has an essential role in the Bulimics also have abnormal levels of lipids in
medical team for the treatment of eating their blood, and the low level of glucose in the
disorders. He is a consultant adviser to parents serum especially because of the deficient
and other team members on the following issues: precursors in gluconeogenesis (15). Hyperca-
• Making a nutrition plan according to the rotenemia is often found in anorexics. Vitamin
individual’s nutrition needs. deficiency is often found in patients suffering
• Monitoring the gradual increase in food intake. from malnutrition. On the other hand, eating
• Replacing certain food stuffs. disorders rarely cause anemia. It can occur only
• Specifying the essential nutrients. as a result of bleeding from the ruptures in the
• Making recommendations for dietary supplements. digestive tract. In anorexia the organic need for
The patient, his parents and dietitian should iron is lower because of amenorrhea on the one
all reach an agreement on the recommended diet hand and the catabolic state on the other. Also,
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Acta Medica Medianae 2009,Vol.48 Medical nutrition therapy in management of eating disorders

deficiency in zinc, calcium, magnesium and vitamin the calorie intake decreases, and supplemented
D is possible. Vomiting and laxatives can cause a drinks could be replaced with usual drinks.
serious imbalance between fluids and electrolytes. However, a potential problem could arise. The
Dehydration, hypokalemia, hypochloremia are likely patient might continue to use supplemented
to happen; hyponatremia happens less frequently. drinks more often than solid food. So, he might
The anthropometric assessment of the follow the diet regime intended for weight
nutritional status implies determining the body reduction, even after his recovery.
fat percentage, that is, lean body mass. In the Bitter plants have always been used for
clinical practice the body fat percentage is appetite stimulation in case the patient is aware
calculated by measuring the average thickness of of his problem; if he wants to change his eating
four skin folds (biceps, triceps, subscapular and behavior, he needs to regain the feeling of
suprailiac). In practice, lean body mass could be hunger and appetite. The plants which are often
calculated by measuring the circumference of the used are: Acorus calamus-Sweet Flag, Cnicus
upper arm muscle, that is, by measuring the benedictus-Blessed Thistle, Taraxacum offinale-
circumference of biceps and the skin fold of Dandelion, Hypericum perforatum-St. John’s
triceps, and by comparing these measurements wort. Yet, the effect of these stimulators is
with the standard values for the particular age questionable.
and sex. The anthropometric measures should be Careful clinical observation is necessary
done at the beginning and during the nutritional during the diet therapy. It is important to detect
rehabilitation of the patient with an eating disorder. vital indicators which show cardiopulmonary
A patient with anorexia nervosa is under constant function and to detect peripheral edemas. The
surveillance so that a desired result - the refeeding syndrome appears in 6% of the
increase in body weight - could be noted. In the hospitalized patients (19). It causes minor
treatment of bulimia, however, the short–term abnormalities (a short lasting edema in the feet)
goal is to maintain body weight (16). or serious complications which require utmost
In cases of malnutrition, it is essential that urgency (prolonged QT interval, hypophosphatemia
a patient suffering from an eating disorder should followed by exhaustion, confusion and progressive
gradually increase the overall calorie intake. The neuromuscular dysfunction). This syndrome appears
initial diet implies only 1000 kcal per day. A few most often in patients who have less than 70 %
days later, the calorie intake could imply 200 kcal of the ideal body weight, and in those receiving
more per week. It is possible to start with 1200- enteral and parenteral nutrition. Also, it can
1500 kcal per day and take in 500 kcal more appear in patients who devour food rapidly.
every fourth day. Thus, the increase in body weight Slower nutrition means a lower risk of complications.
is about 0.5-1 kg per week. The maximum increase The level of electrolytes in the serum (especially
should reach 3500 kcal for women and 4000 kcal phosphorus and magnesium), and kidney
for men (17). function should be carefully noted. The clinical
Slight malnutrition demands small but changes and laboratory results which demand
frequent meals, as well as the use of spices which utmost urgency are: changed perception, tachy-
stimulate the appetite. It is recommended to take cardia, congestive heart insufficiency, atypical
in substances with high energetic density such as abdominal pain, prolonged QT interval, QT
juices, dried and stone fruit, as well as highly dispersion (indicator of abnormal ventricular
energetic drinks. The meals should have eye repolarization followed by the risk of arrhythmias,
appeal to stimulate the appetite and the potassium below 3 mmol/l in the serum and
appropriate nutritional behavior. After the meal, phosphorus below 0,8 mmol/l.
the patient is required to be lying in bed in a The evidence shows that many patients
warm room for a half an hour. with eating disorders have deficiency in oligoe-
Severe cases of malnutrition demand lements and minerals. However, except for zinc
digestible, light, small and frequent meals (8-10), (20), there are only a few detailed studies of that
skimmed milk (100 ml) with an addition of 10- field so far. The used supplements are: zinc,
15g of skimmed powdered milk. Thus, the patient calcium, magnesium, iron, vitamins and minerals.
takes in about 1 liter of milk. If the patient is too Use of fortified foods is recommended (21).
weak, milk is dissolved. The treatment of complications depends on
In further stages, sugar, starch, yoghurt, clinical experience. Peripheral edemas are treated
mashed food, soups and boiled meat are added. by elevating the legs and restricting the salt
The patient gradually returns to a diet which is intake (22).
diverse in ingredients, and high in calories. It It might be very beneficial to include the
should be emphasized that the patient is less parents in the treatment (23). Careful planning
tolerant when it comes to fatty food (18). and cooperation between people who arrange
It is recommended that anorexics and meals, parents and the patient is very important.
bulimics should include legumes in their diet. (Who brings the meals? Who is supposed to be
These patients often have problems with glucose present during the meal? How is the time
levels because they consume simple sugars most structured during the meal?)
frequently. Therefore, these patients often suffer The ultimate goal of every meal is to have
from cyclothymia, that is, a mood disorder. an individual diet program. The dietitian should
Highly energetic drinks are very useful as be consulted as to the energy value of the meal.
dietary supplements since they provide the Since these patients are made furious quite
necessary calories. As the therapy progresses, easily, it is important to have a balanced attitude
53
Medical nutrition therapy in management of eating disorders Maja Nikolić et al.

during the meal: firmness and consistence, on and 5.30 p.m. and it is of the same size as lunch.
one hand, and empathy and flexibility on the Every meal is finished by taking a supplement for
other. During the meal, the patient is often enteral nutrition (nutridrink, for example), which
nervous and annoyed, and he often leaves the is removed before the end of the treatment.
table. Although it is necessary to be committed to Simple meals are added between the regular
the course of the treatment, some compromises ones. Four months later, the patients are allowed
are possible to make. For example, it is possible to eat together, they can eat in restaurants in the
to change a dining room, to replace one type of company of a medical worker or a familiar
food with another, to change the objective of the person. After every meal, the patients have a
meal. This kind of approach shows concern for rest in a room with the maximal temperature of
the patient. The objectives are agreed on in 40 ‘C (26).
advance. The patient can be asked only to touch Patients who receive enteral nutrition
the food with his lips or he can be asked to take should sit together with the rest of the patients in
in ¾ of the meal. The patient should be observed order to witness the proceedings at the table and
during and immediately after the meal in case he to start eating independently when they are
hides and removes the food. The food can be ready. A bolus of supplemented milk is given
hidden under his clothes, under the table or after the meal as an encouragement for dining at
simply spread on the table to appear partly the table. It has an advantage over the constant
consumed. intake because it simulates the normal eating
The patient needs to be encouraged in a habits and the reappearance of normal appetite
specific way. This rule applies to every patient and hunger. The use of nasogastric tube is reconsi-
who suffers from an eating disorder. One part of dered every day; as oral nutrition becomes more
the patient’s character wants to have a strict frequent, enteral nutrition is applied rarely (24).
control over his nutrition, while the other part The meals must be adapted to every
wants the healthy eating behavior and normal life patient independently. Since there is not a single,
back. The patient should be encouraged to resist unique approach in the treatment of eating
that part which manifests itself in eating disorders, the meals have to be under constant
disorders. Some patients need direct verbal surveillance. A multidisciplinary team should
encouragement, other subjects for discussion, or discuss the applied approach continuously (27).
the presence of other people, especially pears.
Parents and medical workers should cooperate Conclusion
and they should solve any problem related to the
patient’s nutrition and his attitude to meals at the The nature of eating disorders and frequent
table. Lack of cooperation makes a negative instances of malnutrition demand that a diet therapy
impact on the patient’s recovery (24,25). should be a necessary step in the treatment.
The premature feeling of satiated appetite, The purpose of a diet therapy is for the
slight abdominal bloating, or nausea occur patient to accomplish normal body weight and to
frequently. They occur because the food exits the recover the healthy patterns of eating behavior.
stomach later than usual. So, it is required to There are two possible ways: to return to normal
have small, frequent and moderate meals. Such diet immediately or, in severe cases of malnu-
meals are intended to reduce anxiety as well, trition, to recover gradually through a specific
since anorexics often perceive portions to be therapy program.
larger than they actually are. The patient should If oral nutrition is impossible or the patient
participate in making a nutrition plan and, to refuses to take food orally, enteral nutrition is
some degree, in the selection of food. It is not applied. To stimulate the normal eating patterns
recommended to talk about calories but only a bolus of food is given during the meal in the
about healthy nutrition in general. A diet list, daytime or at night. Parenteral nutrition is
which specifies the size of the portion, could be applied rarely, in states of urgency, to recover
handed to the patient, but not the number of the electrolyte and fluid balance.
calories. Meals are arranged by doctors, nurses,
Breakfast should be served between 7 and dietitians, and the family members so as to have
8 a.m.; it includes 1.5 dl of yoghurt, sandwich, a the patient under constant surveillance. The
glass of orange juice, a cup of coffee/tea. A objective is set for every meal.
month later, the patient is encouraged to add one Recovering the normal body weight is a
sandwich to the list; but, he is allowed to eat two good prognostic factor for patients suffering from
sandwiches at the most. Lunch is served between eating disorders.
11.30 and 12.30. Dinner is served between 4.30

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Acta Medica Medianae 2009,Vol.48 Medical nutrition therapy in management of eating disorders

References

1. International Statistical Classification of Dieseases 15. Sullivan PF, Gendall KA, Bulik CM, Carter FA, Joyce
and Related Health Problems, Tenth Revision. Vol. PR. Elevated total cholesterol in bulimia nervosa. Int
1, WHO, 1992, Geneva. J Eat Disord 1998; 23(4):425-32.
2. Hoek HW, van Hoeken D. Review of the prevalence 16. Mladenović I, Nikolić M. Difference in anthropometric
and incidence of eating disorders. Int J Eat Disord characteristics and functional abilities active and
2003;34:383-96. non active women. Sport Mont 2006;10-11:665-74.
3. Pokrajac-Bulian A, Zivcić-Becirević I, Calugi S, Dalle 17. Mehler PS. Diagnosis and care of patients with
Grave R. School prevention program for eating anorexia nervosa in primary care settings. Ann
disorders in Croatia: a controlled study with six months Intern Med 2001; 134:1048-59.
of follow-up. Eat Weight Disord 2006;11(4):171-8. 18. Nikolić M, Mitrović V, Nikić D. Medical nutrition
4. Vander Wal JS, Gibbons LJ, del Pilar Grazioso M. The therapy in management of food allergy, Acta Fac
sociocultural model of eating disorder development: Med Naiss 2007; 24 (1):45-50.
Application to a Guatemalan sample. Eating Behaviors 19. Stanga Z, Bruner A, Leuenberger M, Grimble RF,
2008; 9(3):277-84. Shenkin A, Allison SP, Lobo DN. Nutrition in clinical
5. Norman K, Pichard C, Lochs H, Pirlich M. Prognostic practice-the refeeding syndrome: illustrative cases
impact of disease-related malnutrition. Clinical and guidelines for prevention and treatment. Eur J
Nutrition 2008; 27(1):5-15. Clin Nutr 2008; 62(6):687-94.
6. Sardesai VM. Introduction to Clinical Nutrition. New 20. Lask B, Fosson A, Rolfe U, Thomas S. Zink deficiency
York : Marcel Dekker, 2003. and childhood onset anorexia nervosa. J Clin
7. Nikolić M. Dijetetika. WUS Austria, Niš: Medicinski Psychiatry 1993; 54: 63-6.
fakultet u Nišu, 2008. 21. Lazarević K, Nikolić M, Mitrović V. Primena i značaj
8. Eisler I, Russell DC, Szmukler G., le Grange D, fortifikacije u prevenciji bolesti izazvanih nedostatkom
Dodge E. Family and individual therapy in anorexia mikronutrijenata. Srp Arh Celok Lek 2006; (Suppl
nervosa-a five-year follow-up. Arch Gen Psychiatry 2):139-144.
1997; 54: 1025-30. 22. Gentile MG, Manna GM, Ciceri R, Rodeschini E. Efficacy
9. Gowers GS. Treatment of anorexia nervosa in childhood of inpatient treatment in severely malnourished
and adolescence. Psychiatry 2005; 4(4):14-7.
anorexia nervosa patients. Eat Weight Disord
10. American Dietetic Association. Position of the
2008;13(4):191-7.
American Dietetic Association: Nutrition intervention
23. Arthuis M, Duché DJ. Diagnosis and treatment of
in the treatment of anorexia nervosa, bulimia
disturbances in eating behavior among adolescents:
nervosa, and other eating disorders. J Am Diet
Assoc 2006; 106(12):2073-82. anorexia nervosa and bulimia nervosa. [Article in
11. Practice guidelines for the treatment of patients with French] Bull Acad Natl Med 2002;186(3):699-707.
eating disorders (revision). American Psychiatric 24. Pavlović M. Higijensko dijetetski aspekti poremećaja
Association Work Group on Eating Disorders, Am J ponašanja u ishrani. Diplomski rad. Niš: Medicinski
Psychiatry 2000; 157(Suppl 1): 1-39. fakultet u Nišu, 2008.
12. Sedlet KJ. Energy expenditure and the abnormal 25. Fernstorm MH, Weltzin TE, Neuberger S, Sriniva-
eating pattern of bulimic: a case report, J Am Diet saqam N, Kaye WH. Twenty-four hour intake in
Assoc 1989; 89(1):74-7. patients with anorexia nervosa and in healthy
13. Matzkin V, Slobodianik N, Pallaro A, Bello M, control subjects. Biol Psychiatry 1994;36:696-702.
Geissler C. Risk factors for cardiovascular disease in 26. Bergh C, Brodin U, Greger L, Södersten P..
patients with anorexia nervosa. Int J Psychiatr Nurs
Randomized controlled trial of a treatment for
Res 2007; 13(1):1531-45.
14. Krízová J, Dolinková M, Lacinová Z, Sulek S, anorexia and bulimia nervosa. PNAS 2002;
Dolezalová R, Housová J. et al. Adiponectin and 99(14):9486-91.
resistin gene polymorphisms in patients with anorexia 27. Nikolić M, Gajić I, Stanković N. Uticaj stanja
nervosa and obesity and its influence on metabolic ishranjenosti na kvalitet života, Scr Med 2003;
phenotype. Physiol Res 2008; 57(4):539-46. 34(2):81-5.

MEDICINSKA NUTRITIVNA TERAPIJA KOD POREMEĆAJA PONAŠANJA

U ISHRANI
Maja Nikolić, Miloš Pavlović i Milica M. Vojinović

Poremećaji ponašanja u ishrani zahtevaju multidisciplinaran pristup tokom lečenja,

gde svoje mesto nalazi stručnjak za ishranu, pre svega zbog rešavanja često prisutnih
malnutricija. Cilj rada bio je da sumira istraživanja i kliničke dokaze o značaju medicinske
nutritivne terapije u kontroli poremećaja ponašanja u ishrani, kako bi se dale smernice od
značaja za kliničku praksu. Metodologija rada obuhvatila je revijski pregled literature
dostupne na istraživačkim bazama podataka. Rezultati do sada publikovanih radova su
nedvosmisleno ukazali da je kod poremećaja ponašanja u ishrani dijetoterapija neophodna
za postizanje odgovarajuće telesne mase bolesnika i vraćanje normalnih obrazaca ishrane.
Neki autori sugerišu prelazak na normalnu ishranu odmah, dok se drugi zalažu za tzv.
postepeni program dijetoterapije. Ukoliko je onemogućeno unošenje hrane na usta,
primenjuje se enteralna ishrana. Parenteralna ishrana je rezervisana za nadoknadu
elektrolita i tečnosti u urgentnim stanjima i treba je ređe primenjivati. Dodavanje telesne
mase predstavlja povoljan prognostički faktor za bolesnike sa poremećajima ponašanja u
ishrani, te stanje ishranjenosti treba savesno i redovno pratiti. Pravilno propisana i vođena
dijetoterapija treba da uđe u obavezan protokol lečenja bolesnika sa poremećajima
ponašanja u ishrani i u našoj sredini. Acta Medica Medianae 2009;48(1):50-55.

Ključne reči: poremećaji ponašanja, ishrana, medicinska nutritivna terapija,

malnutricija
55