Factors associated with the increase in resting energy expenditure during refeeding in malnourished anorexia nervosa patients.
BACKGROUND
In malnourished anorexia nervosa (AN) patients, body-weight gain during refeeding is slowed by an increase in resting energy expenditure (REE).


OBJECTIVE
The objective of the study was to identify factors associated with the increase in REE during refeeding.


METHODS
Before and 8, 30, and 45 d after the beginning of refeeding, REE was studied by indirect calorimetry in 87 female AN patients [x +/- SD age: 23.4 +/- 7.9 y; body mass index (in kg/m2) 13.2 +/- 1.3]. Energy intake, body composition (by bioelectrical impedance analysis), physical activity, smoking behavior, abdominal pain, anxiety, depressive mood, serum thyrotropin and thyroid hormone, and urinary catecholamines were measured. REE was also evaluated in 18 patients after 1 y of recovery.


RESULTS
By day 8, REE increased from 3.84 +/- 0.6 to 4.36 +/- 0.59 MJ/d (P < 0.01). This increase (13.4%) was significantly (P <0.01) greater than that expected on the basis of the increase in fat-free mass (FFM; 1.6%). Thereafter, the ratio of REE to FFM remained high and, in multivariate analysis, was significantly related to 4 factors: energy intake (P <0.01), anxiety (P <0.01), abdominal pain (P <0.05), and depressive mood (P <0.05). The ratio also increased significantly with physical activity (P <0.01) and cigarette smoking (P <0.02). This rise in REE leveled off after recovery from AN.


CONCLUSIONS
In AN patients, the rise in REE observed during refeeding was independently linked to anxiety level, abdominal pain, physical activity, and cigarette smoking, and it contributed to resistance to weight gain.
Van Wymelbeke
Virginie
V
Centre Européen des Sciences du Goût, Medical Research Unit-National Center of Scientific Research 5170, Dijon, France.
Brondel
Laurent
L
Marcel Brun
Jean
J
Rigaud
Daniel
D
D015746:Abdominal Pain / Q000378:metabolism; D000328:Adult; D000704:Analysis of Variance; D000856:Anorexia Nervosa / Q000378:metabolism* / Q000523:psychology*; D001007:Anxiety / Q000378:metabolism; D001481:Basal Metabolism / Q000502:physiology*; D001823:Body Composition / Q000502:physiology*; D002153:Calorimetry, Indirect; D016022:Case-Control Studies; D003863:Depression / Q000378:metabolism; D002149:Energy Intake / Q000502:physiology*; D004734:Energy Metabolism / Q000502:physiology; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D012907:Smoking; D013963:Thyroid Hormones / Q000097:blood; D015430:Weight Gain / Q000502:physiology*
D013963:Thyroid Hormones