Adolescente

Journal of Adolescent Health 42 (2008) 111–118

Original article

Clinical Efficacy and Safety of Parenteral Nutrition in Adolescent Girls with Anorexia Nervosa
A. Diamantia,*, M.S. Bassoa, M. Castroa, G. Biancob, E. Ciaccoc, A. Calcea, A.M. Caramadreb, C. Notoa, and M. Gambararaa
a

Gastroenterology and Nutrition Unit, Children’s Hospital “Bambino Gesù”, Rome, Italy b NeuropsychiatryUnit, Children’s Hospital “Bambino Gesù”, Rome, Italy c Parenteral Nutrition Pharmacy Unit, Children’s Hospital “Bambino Gesù”, Rome, Italy Manuscript received May 4, 2007; manuscript accepted September 26, 2007

See Editorial p. 109
Abstract Purpose: Anorexia nervosa (AN) is a common chronic disorder characterized by severe malnutrition and psychological disturbances. Parenteral nutrition (PN) isnot 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%) oralrefeeding 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. Conclusion: Among all nutritional rehabilitation strategies, PN offers an alternative and safe way to successfully treat AN patients. Presence ofclinical 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. © 2008 Society for Adolescent Medicine. All rightsreserved.
Parenteral nutrition; Adolescents; Anorexia nervosa

Keywords:

Anorexia nervosa (AN) is a common chronic disorder with a prevalence in Western countries of .5–1% in female adolescents and young women aged 15–19 years [1]. This disease is characterized mainly by both severe malnutrition and psychological disturbances, and it may require a variety

*Address correspondence to:Antonella Diamanti, M.D., Gastroenterology and Nutrition Unit, Children’s Hospital Bambino Gesù–Piazza S. Onofrio, 4, 00165 Rome, Italy. E-mail address: diamanti@opbg.net

of treatments [2– 4]. A multidisciplinary approach, with nutritional rehabilitation, psychosocial interventions, and medications, is required to treat malnutrition as well as psychological, behavioral, and social deficits [2– 4].Severe malnutrition can also hinder efficacious treatment of patients with AN [3,4]. Therefore weight restoration has to be considered mandatory for psychotherapy to be useful. [2– 4]. Although it has always been stressed how important nutritional rehabilitation is in these patients, only a few studies report the use of techniques of artificial nutrition

1054-139X/08/$ – see front matter © 2008Society for Adolescent Medicine. All rights reserved. doi:10.1016/j.jadohealth.2007.09.024

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A. Diamanti et al. / Journal of Adolescent Health 42 (2008) 111–118

delivery in this field. Enteral nutrition (EN) and parenteral nutrition (PN) are both used in nutritional rehabilitation of AN patients [2–7]. EN showed beneficial effects in improving nutritional status of AN patients [6 – 8]....