Abstract
Background
Refeeding inpatients with anorexia nervosa (AN) is costly, stressful, and can precipitate the refeeding syndrome. Caloric intake is usually increased gradually from a low starting point until a steady weight gain is achieved. There is no reliable equation that predicts the number of calories required for a weight gain. It was our clinical suspicion that anxiety, exercise, and cigarette smoking might increase the caloric need for refeeding.
Method
We conducted an observational cohort study of 17 females with AN admitted to an inpatient eating disorder unit for refeeding. We estimated the energy intake by observation, the caloric expenditure due to exercise with a triaxial accelerometer, the number of cigarettes smoked by history, and the anxiety by the Beck Anxiety Inventory (BAI).
Results
Neither anxiety, exercise, or cigarette smoking predicted the caloric requirement for refeeding, individually or in combination. Discussion: Our data suggest that the caloric requirement for weight gain during refeeding is not predicted by the patient's anxiety, exercise or smoking habits. The standard methods of estimating caloric requirements for refeeding remain indirect calorimetry and previous history.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Rodriguez G., Moreno L.A., Sarria A., Fleta J., Bueno M.: Resting energy expenditure in children and adolescents: agreement between calorimetry and prediction equations. Clin Nutr., 21, 255–260, 2002.
Marra M., Polito A., De Filippo E., Cuzzolaro M., Ciarapica D., Contaldo F., Scalfi L.: Are the general equations to predict BMR applicable to patients with anorexia nervosa? Eat. Weight Disord., 7, 53–59, 2002.
Wahrlich V., Anjos L.A.: Validation of predictive equations of basal metabolic rate of women living in Southern Brazil. Rev. Saude Publica, 35, 39–45, 2001.
Pauly R.P., Lear S.A., Hastings F.C., Birmingham C.L.: Resting energy expenditure and plasma leptin levels in anorexia nervosa during acute refeeding. Int. J. Eat. Disord., 28, 231–234, 2000.
Fehling P.C., Smith D.L., Warner S.E., Dalsky G.P.: Comparison of accelerometers with oxygen consumption in older adults during exercise. Med. Sci. Sports Exerc., 31, 171–175, 1999.
Fulton J.E., Masse L.C., Tortolero S.R., Watson K.B., Heesch K.C., Kohl H.W., Blair S.N., Caspersen C.J.: Field evaluation of energy expenditure from continuous and intermittent walking in women. Med. Sci. Sports Exerc., 33, 163–170, 2001.
Leenders N., Sherman W.M., Nagaraja H.N.: Comparisons of four methods of estimating physical activity in adult women. Med. Sci. Sports Exerc., 32, 1320–1326, 2000.
MacDonald A., Hildebrandt L.: Comparison of formulaic equations to determine energy expenditure in the critically ill patient. Nutrition, 19, 233–239, 2003.
Hofstetter A., Schutz Y., Jequier E., Wahren J.: Increased 24-hour energy expenditure in cigarette smokers. N. Engl. J. Med., 314, 79–82, 1986.
Brkljacic B., Korsic M., Delic D.: The effect of smoking on the metabolic rate and heart rate. Lijec Vjesn., 110, 252–254, 1988.
Kaye W.H., Gwirtsman H.E., Obarzanek E., George D.T.: Relative importance of calorie intake needed to gain weight and level of physical activity in anorexia nervosa. Am. J. Clin. Nutr., 47, 989–994, 1988.
Blaza S.E., Garrow J.S.: The effect of anxiety on metabolic rate. Proc. Nutr. Soc., 39, 13A, 1980.
Schmidt W.D., O'Connor P.J., Cochrane J.B., Cantwell M.: Resting metabolic rate is influenced by anxiety in college men. J. Appl. Physiol., 80, 638–642, 1996.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Birmingham, C.L., Hlynsky, J., Whiteside, L. et al. Caloric requirement for refeeding inpatients with anorexia nervosa: The contribution of anxiety exercise, and cigarette smoking. Eat Weight Disord 10, e6–e9 (2005). https://doi.org/10.1007/BF03354660
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03354660