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Romero-Márquez JM, Novo-Rodríguez M, Novo-Rodríguez C, Siles-Guerrero V, Herrera-Montes I, Navarro-Pelayo FG, López-de-la-Torre-Casares M, Muñoz-Garach A. Bioelectrical Impedance Vector Analysis, Nutritional Ultrasound ®, and Handgrip Strength as Innovative Methods for Monitoring Critical Anorexia Nervosa Physical Recovery: A Pilot Study. Nutrients 2024; 16:1539. [PMID: 38794777 PMCID: PMC11123858 DOI: 10.3390/nu16101539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Eating disorders (EDs) manifest as persistent disruptions in eating habits or related behaviors, significantly impacting physical health and psychosocial well-being. Nutritional assessment in ED patients is crucial for monitoring treatment efficacy. While dual-energy X-ray absorptiometry (DEXA) remains standard, interest in alternative methods such as bioelectrical impedance vector analysis (BIVA) and Nutritional Ultrasound® (NU) has risen due to their affordability and portability. Additionally, hand dynamometry offers a user-friendly approach to assessing grip strength (HGS), indicative of nutritional status. A prospective study was carried out to evaluate the utility of BIVA, NU®, and HGS in 43 female AN patients. Measurements were taken at baseline and hospital discharge. A total of 41 patients completed the study. After the intervention, numerous BIVA-related parameters such as fat (3.5 ± 2 kg vs. 5.3 ± 2.7 kg, p < 0.001) and free fat mass (33.9 ± 3.8 kg vs. 37.5 ± 4.1 kg, p < 0.001) were partially restored. Similarly, Nutritional Ultrasound® showed promising results in assessing body composition changes such as total abdominal fat tissue (0.5 ± 0.3 cm vs. 0.9 ± 0.3 cm, p < 0.05). In the same way, rectus femoris cross-sectional area values correlated with clinical outcomes such as free fat mass (0.883, p < 0.05) and appendicular muscle mass (0.965, p < 0.001). HGS reached the normality percentile after the intervention (21.6 ± 9.1 kg vs. 25.9 ± 12.3 kg, p < 0.05), demonstrating a significant association between grip strength and body composition parameters such as free fat mass (0.658, p < 0.001) and appendicular muscle mass (0.482, p < 0.001). Incorporating BIVA-, NU®-, and HGS-enhanced nutritional assessment into the treatment of AN patients offers cost-effective, portable, and non-invasive alternatives to DEXA. These techniques offer valuable insights into changes in body composition and nutritional status, which, in turn, facilitate treatment monitoring and contribute to improved patient outcomes.
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Affiliation(s)
- Jose M. Romero-Márquez
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Foundation for Biosanitary Research of Eastern Andalusia—Alejandro Otero (FIBAO), 18012 Granada, Spain
| | - María Novo-Rodríguez
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Foundation for Biosanitary Research of Eastern Andalusia—Alejandro Otero (FIBAO), 18012 Granada, Spain
| | - Cristina Novo-Rodríguez
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Granada Biosanitary Research Institute (Ibs. Granada), 18014 Granada, Spain
| | - Víctor Siles-Guerrero
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
| | - Isabel Herrera-Montes
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
| | | | - Martín López-de-la-Torre-Casares
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Granada Biosanitary Research Institute (Ibs. Granada), 18014 Granada, Spain
| | - Araceli Muñoz-Garach
- Department of Endocrinology and Nutrition, Virgen de las Nieves University Hospital, 18014 Granada, Spain; (M.N.-R.); (C.N.-R.); (V.S.-G.); (I.H.-M.); (M.L.-d.-l.-T.-C.)
- Granada Biosanitary Research Institute (Ibs. Granada), 18014 Granada, Spain
- Network Biomedical Research Center Physiopathology of Obesity and Nutrition (CiberOBN), Carlos III Health Institute, 28029 Madrid, Spain
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Campos Del Portillo R, Palma Milla S, Matía Martín P, Loria-Kohen V, Martínez Olmos MÁ, Mories Álvarez MT, Castro Alija MJ, Martín Palmero MÁ, Carrillo Lozano E, Valero-Pérez M, Campos Del Portillo MI, Sirvent Segovia AE, Plaza Blázquez P, de la Cruz López DM, Pita F. [Consenso del grupo de trabajo de los trastornos de la conducta alimentaria de SENPE (GTTCA-SENPE). Evaluación y tratamiento médico-nutricional en la anorexia nerviosa. Actualización 2023]. NUTR HOSP 2024. [PMID: 38466575 DOI: 10.20960/nh.05175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
Anorexia nervosa (AN) is a multifactorial disorder. A possible role of the social network and the gut microbiota in pathogenesis has been added. Exogenous shocks such as the COVID19 pandemic have had a negative impact on patients with AN. The potential medical and nutritional impact of malnutrition and/or compensatory behaviors gives rise to a complex disease with a wide range of severity, the management of which requires a multidisciplinary team with a high level of subject matter expertise. Coordination between levels of care is necessary as well as understanding how to transition the patient from pediatric to adult care is essential. A proper clinical evaluation can detect possible complications, as well as establish the organic risk of the patient. This allows caregivers to tailor the medical-nutritional treatment for each patient. Reestablishing adequate nutritional behaviors is a fundamental pillar of treatment in AN. The design of a personalized nutritional treatment and education program is necessary for this purpose. Depending on the clinical severity, artificial nutrition may be necessary. Although the decision regarding the level of care necessary at diagnosis or during follow-up depends on a number of factors (awareness of the disease, medical stability, complications, suicidal risk, outpatient treatment failure, psychosocial context, etc.), outpatient treatment is the most frequent and most preferred choice. However, more intensive care (total or partial hospitalization) may be necessary in certain cases. In severely malnourished patients, the appearance of refeeding syndrome should be prevented during renourishment. The presence of AN in certain situations (pregnancy, vegetarianism, type 1 diabetes mellitus) requires specific care. Physical activity in these patients must also be addressed correctly.
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Affiliation(s)
| | - Samara Palma Milla
- Servicio de Endocrinología y Nutrición. Unidad de Nutrición Clínica y Dietética. Hospital Universitario La Paz
| | - Pilar Matía Martín
- Servicio de Endocrinología y Nutrición. Hospital Clínico San Carlos. Instituto de Investigación Sanitaria San Carlos (IdISSC). Universidad Complutense. Madrid
| | - Viviana Loria-Kohen
- Departamento de Nutrición y Ciencia de los Alimentos. Facultad de Farmacia. Universidad Complutense de Madrid. Grupo de Investigación VALORNUT-UCM (920030)
| | | | | | | | | | | | - Marlhyn Valero-Pérez
- Servicio de Endocrinología y Nutrición. Unidad de Nutrición Clínica y Dietética. Hospital Universitario La Paz
| | | | | | - Pilar Plaza Blázquez
- Servicio de Endocrinología y Nutrición. Hospital Universitario Puerta de Hierro Majadahonda
| | | | - Francisco Pita
- Servicio de Endocrinología y Nutrición. Complexo Hospitalario Universitario de A Coruña
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Rosa-Caldwell ME, Eddy KT, Rutkove SB, Breithaupt L. Anorexia nervosa and muscle health: A systematic review of our current understanding and future recommendations for study. Int J Eat Disord 2023; 56:483-500. [PMID: 36529682 DOI: 10.1002/eat.23878] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Conduct a systematic review on muscle size and strength in individuals with anorexia nervosa (AN). METHOD In accordance with PRISMA guidelines, we searched Pubmed for articles published between 1995 and 2022 using a combination of search terms related to AN and muscle size, strength, or metabolism. After two authors screened articles and extracted data, 30 articles met inclusion criteria. Data were coded, and a risk bias was conducted for each study. RESULTS The majority of studies focused on muscle size/lean mass (60%, n = 18) and energy expenditure (33%, n = 9), with few studies (17%, n = 5) investigating muscle function or possible mechanisms underlying muscle size (20%, n = 6). Studies supported that individuals with AN have smaller muscle size and reduced energy expenditure relative to controls. In some studies (33%, n = 10) recovery from AN was not sufficient to restore muscle mass or function. Mechanisms underlying short and long-term musculoskeletal alterations have not been thoroughly explored. DISCUSSION Muscle mass and strength loss may be an unexplored component of physiological deterioration during and after AN. More research is necessary to understand intramuscular alterations during AN and interventions to facilitate muscle mass and functional gain following weight restoration in AN. PUBLIC SIGNIFICANCE Muscle health is important for optimal health and is reduced in individuals with AN. However, we do not understand how muscle is altered at the cellular level throughout the course of AN. Here we review what is currently known regarding muscle health during AN and with weight restoration.
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Affiliation(s)
- Megan E Rosa-Caldwell
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Kamryn T Eddy
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Seward B Rutkove
- Department of Neurology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Dauty M, Menu P, Jolly B, Lambert S, Rocher B, Le Bras M, Jirka A, Guillot P, Pretagut S, Fouasson-Chailloux A. Inpatient Rehabilitation during Intensive Refeeding in Severe Anorexia Nervosa. Nutrients 2022; 14:nu14142951. [PMID: 35889908 PMCID: PMC9322979 DOI: 10.3390/nu14142951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 02/01/2023] Open
Abstract
Severe forms of anorexia nervosa are responsible for weight loss and life-threatening consequences. Refeeding represents a real psychiatric and somatic challenge. Physical activities are usually not recommended during intensive refeeding in order to avoid energy expenditure. This study assessed the interest in an early return to controlled physical activities, during a hospitalization in a Physical Medicine and Rehabilitation (PMR) department, including continuous nasogastric refeeding and psychiatric care. A total of 37 subjects aged 32 ± 11 years old performed inpatient physical activities during nasogastric refeeding initiated after intensive care. The physical activity program was adapted according to the hyperactivity of the patients. Evaluation parameters were weight, body mass index (BMI), body composition (fat, lean, and bone masses), and function (strength, balance, walking, ventilation). Patient satisfaction, re-hospitalizations, and physical activities continuation were assessed at 12 months of follow-up. Weight, BMI, and body fat increased significantly (+2.7 ± 1.7 kg; +1.0 ± 0.6 kg/m2; +1.7 ± 2.5 kg, respectively). Muscle strength increased even if the lean mass did not. Walking distance, balance, and respiratory function were significantly improved. Weight and fat mass gains did not differ according to the presence or absence of hyperactivity. At 12 months, 46% of the patients continued to be physically active, but 21% of the patients had been re-hospitalized. The early return to controlled physical activities in PMR hospitalization does not compromise the efficiency of intensive refeeding in severe anorexia nervosa patients.
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Affiliation(s)
- Marc Dauty
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France; (M.D.); (P.M.); (B.J.)
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France;
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm UMR 1229, Regenerative Medicine and Skeleton, RMeS, Nantes Université, ONIRIS, 44042 Nantes, France
| | - Pierre Menu
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France; (M.D.); (P.M.); (B.J.)
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France;
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm UMR 1229, Regenerative Medicine and Skeleton, RMeS, Nantes Université, ONIRIS, 44042 Nantes, France
| | - Baptiste Jolly
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France; (M.D.); (P.M.); (B.J.)
| | - Sylvain Lambert
- Psychiatrie et Santé Mentale, UIC 18, CHU Nantes, Nantes Université, 44000 Nantes, France; (S.L.); (B.R.)
| | - Bruno Rocher
- Psychiatrie et Santé Mentale, UIC 18, CHU Nantes, Nantes Université, 44000 Nantes, France; (S.L.); (B.R.)
| | - Maëlle Le Bras
- Service d’Endocrinologie, Diabétologie et Nutrition, Institut du Thorax, CHU Nantes, Nantes Université, 44000 Nantes, France;
| | - Adam Jirka
- Equipe Transversale D’assistance Nutritionnelle, CHU Nantes, Nantes Université, 44000 Nantes, France;
| | - Pascale Guillot
- Service de Rhumatologie, CHU Nantes, Nantes Université, 44000 Nantes, France;
| | - Stéphane Pretagut
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France;
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France; (M.D.); (P.M.); (B.J.)
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France;
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm UMR 1229, Regenerative Medicine and Skeleton, RMeS, Nantes Université, ONIRIS, 44042 Nantes, France
- Correspondence:
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Lavín-Pérez AM, Martín-Sánchez C, Martínez-Núñez B, Lobato-Rincón LL, Villafaina S, González-García I, Mata-Cantero A, Graell M, Merellano-Navarro E, Collado-Mateo D. Effects of Dog-Assisted Therapy in Adolescents with Eating Disorders: A Study Protocol for a Pilot Controlled Trial. Animals (Basel) 2021; 11:2784. [PMID: 34679805 PMCID: PMC8532616 DOI: 10.3390/ani11102784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Eating disorders are characterized by a persistent disturbance that alters food intake and it is often accompanied by anxiety, depression, low self-esteem, or reduced functional capacity and quality of life. Animal-assisted therapies (AAT) have shown benefits in these variables in children and adult populations. Thus, the present pilot study will aim to evaluate the effects of a dog-assisted therapy on the eating disorders symptoms, mental, psychosocial, and physical health, quality of life, and handgrip strength of adolescents suffering from eating disorders. METHODS The current pilot study will involve 32 patients, who will be assigned to a control or an experimental group. Intervention will be conducted once a week for seven weeks. Neither the experimental nor the control group will discontinue their usual care. The main outcome measures will be the eating disorder symptoms and the health-related quality of life measured with standardized questionnaires, while the secondary variables will be anxiety, depression, character, behavior, strength, and body mass. CONCLUSIONS This pilot-controlled trial will be the first to evaluate the effects of dog-assisted therapy on the physical and mental health of adolescents with eating disorders. Significant improvements, in the primary and secondary outcomes, may be expected based on the known benefits of AAT on self-esteem, stress, and self-control in different populations. Finally, although the program is focused on the improvement of adolescents' health, animal welfare will be a priority in this study.
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Affiliation(s)
- Ana Myriam Lavín-Pérez
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (A.M.L.-P.); (D.C.-M.)
| | - Cristina Martín-Sánchez
- Animal-Assisted Intervention Office, Rey Juan Carlos University, Móstoles, 28933 Madrid, Spain; (C.M.-S.); (L.L.L.-R.); (I.G.-G.)
| | - Beatriz Martínez-Núñez
- Psychiatry and Clinical Psychology Department, Hospital Infantil Universitario Niño Jesús, 28943 Madrid, Spain; (B.M.-N.); (M.G.)
| | - Luis Lucio Lobato-Rincón
- Animal-Assisted Intervention Office, Rey Juan Carlos University, Móstoles, 28933 Madrid, Spain; (C.M.-S.); (L.L.L.-R.); (I.G.-G.)
- Department of Psychology, King Juan Carlos University, Alcorcón, 28943 Madrid, Spain
| | - Santos Villafaina
- Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Sciences, University of Extremadura, 10003 Caceres, Spain
| | - Israel González-García
- Animal-Assisted Intervention Office, Rey Juan Carlos University, Móstoles, 28933 Madrid, Spain; (C.M.-S.); (L.L.L.-R.); (I.G.-G.)
| | - Ana Mata-Cantero
- Perroterapia-Animal-Assisted Interventions, Rivas Vaciamadrid, 28943 Madrid, Spain;
| | - Montserrat Graell
- Psychiatry and Clinical Psychology Department, Hospital Infantil Universitario Niño Jesús, 28943 Madrid, Spain; (B.M.-N.); (M.G.)
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), 28943 Madrid, Spain
| | | | - Daniel Collado-Mateo
- Centre for Sport Studies, Rey Juan Carlos University, Fuenlabrada, 28943 Madrid, Spain; (A.M.L.-P.); (D.C.-M.)
- Animal-Assisted Intervention Office, Rey Juan Carlos University, Móstoles, 28933 Madrid, Spain; (C.M.-S.); (L.L.L.-R.); (I.G.-G.)
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