[Evaluation of the utility of a Nutrition Education Program with Eating Disorders].
BACKGROUND
As eating disorders include both psychological and physiological components, appropriate management of these disorders requires input from a number of disciplines working together in a coordinated manner, following an integrated Programme. The Eating Disorders-Nutrition Education Programme has as its purpose achieving healthier habits and modifying eating behaviour. The Programme should take place as one part of Eating Disorders treatment.


OBJECTIVE
To determine the efficacy of a Nutrition Education Programme about nutritional state and eating patterns in a group of patients diagnosed with Eating Disorders who follow the usual check-up protocol in the clinic for nutrition and mental health.


METHODS
89 patients were included, including 5% men. They received individual nutritional education with weekly/fortnightly appointments during a period of 4-6 months. Educational counseling was carried out by a dietician. The mean age of the sample was 24 +/- 8 years and the diagnoses were: Anorexia Nervosa Restrictive (ANR) 32.5% Anorexia Nervosa Purgative (ANP) 26.5%, Bulimia Nervosa (BN) 18%, Eating Disorder Not Otherwise Specified (EDNOS) 21% and Binge Eating Disorder (BED) 2%. The average evolution time since the diagnosis was 4.8 +/- 5 years. An anthropometric assessment, assessment of daily oral intake, 24-hour dietary recall, and Eating Attitudes Test (EAT26) questionnaires were completed at the first appointment and again at the end of the programme.


RESULTS
The mean score of the EAT26 questionnaire was 32 +/- 15 initially, and after 4-6 months the score was 23.7 +/- 14 (p < 0.001). This change represents a significant improvement in the patients' symptoms after the Programme. Furthermore there were significant differences in the evaluation of the questionnaire by scales and by diagnosis. After 4-6 months, there was a meaningful reduction in episodes of vomiting per week (from 7.5 +/- 10 to 1 +/- 1.8 p < 0.001) in ANP and BN binge-purging (8 +/- 9.7 vs 2.2 +/- 3.2 p < 0,01). In addition, a favourable trend in the number of binges per week was observed for both diagnoses. The percentage of subjects that ate less than 4 meals per day decreased from 70% to 19% after the Education Programme (p < 0.001). Some 67% of the patients dedicated a specific time for eating and a 54% started to have complete meals. These results that show a very favourable tendency with respect to the normalization of eating patterns. There was improvement in the intake of dairy products, vegetables, fruits, cereals and oil (p < 0.05). At the beginning, 34% consumed at least 3 of the 6 food groups within the recommended range, but at the end 70% did (p < 0.001). After the nutritional education programme, an important increase in energy ingestion and carbonhydrate consumption took place (p < 0.001), as much with ANR as with ANP. With respect to micronutrients, the ingestion of vitamin B2 significantly increased, as well as folic acid and calcium (p < 0.001) in ANP, and magnesium and calcium (p < 0.001) in ANR. In ANR, we found a significant improvement in nutritional status (p < 0.001). Variables including weight, BMI, muscular circumference of the arm and tricipetal fold were at the limit of significance. Regarding ANP and EDNOS, the initial evaluation demonstrated that they were within normal limits, and they were maintained after nutritional education. In BN, progress towards normalization of BMI took place, increasing from 26.4 +/- 6.6 to 25.5 +/- 5.7 (-2.3 kg).


CONCLUSIONS
The Nutritional Education Programme carried out by qualified professionals should be a part of Eating Disorders treatment, along with medical and psychological monitoring and as part of an interdisciplinary, multiprofessional team effort.
Loria Kohen
V
V
Unidad de Nutrición Clínica y Dietética, Hospital Universitario La Paz, Madrid, España.
Gómez Candela
C
C
Lourenço Nogueira
T
T
Pérez Torres
A
A
Castillo Rabaneda
R
R
Villarino Marin
M
M
Bermejo López
L
L
Zurita
L
L
D001068:Feeding and Eating Disorders / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D009752:Nutritional Status; D010353:Patient Education as Topic; D015397:Program Evaluation; D055815:Young Adult