Clinical efficacy and safety of parenteral nutrition in adolescent girls with anorexia nervosa.
OBJECTIVE
Anorexia nervosa (AN) is a common chronic disorder characterized by severe malnutrition and psychological disturbances. Parenteral nutrition (PN) is not usually used in nutritional rehabilitation of AN. The aim of our study was to retrospectively evaluate the indications, clinical efficacy, and safety of PN as assessed by short- and long-term outcomes in AN inpatient girls.


METHODS
During the last 10 years a total of 198 inpatients were included in our study: 104 (53%) received oral and parenteral refeeding (group A) and 94 (47%) oral refeeding alone (group B). For each nutritional treatment, clinical efficacy was evaluated by short- and long-term outcomes, and safety was assessed by complication rate.


RESULTS
Short-term outcome assessment indicated weekly weight gain and maximum caloric intake to be higher in PN-treated patients. Long-term outcome evaluation showed rehospitalization and recovery rate to be similar in the two groups, but failure of first nutritional rehabilitation requiring PN significantly greater in group B (17.5%) than in group A (3%) (p = .01). The number of complications was significantly higher in group A than in group B (p = .004), although all complications resolved.


CONCLUSIONS
Among all nutritional rehabilitation strategies, PN offers an alternative and safe way to successfully treat AN patients. Presence of clinical complications and reduced compliance with individual, group, and family therapy seem to be the main indications for PN, as it promptly improves nutritional status. At pediatric and adolescent ages, psychological disturbances can also contraindicate the use of enteral nutrition, and therefore represent an additional indication for PN.
Diamanti
A
A
Gastroenterology and Nutrition Unit, Children's Hospital Bambino Gesù, Rome, Italy. diamanti@opbg.net
Basso
M S
MS
Castro
M
M
Bianco
G
G
Ciacco
E
E
Calce
A
A
Caramadre
A M
AM
Noto
C
C
Gambarara
M
M
D000293:Adolescent; D000856:Anorexia Nervosa / Q000523:psychology / Q000628:therapy*; D000886:Anthropometry; D001835:Body Weight; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D009751:Nutritional Requirements; D010043:Outcome and Process Assessment, Health Care; D010288:Parenteral Nutrition / Q000009:adverse effects / Q000379:methods*; D011336:Probability; D018570:Risk Assessment; D012720:Severity of Illness Index; D016896:Treatment Outcome; D015430:Weight Gain