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Diet

Diet is the most essential factor to work on in patients with Anorexia Nervosa, and must be tailored to each patient’s needs. Initial meal plans may be low in calories, about 1200, in order to build comfort in eating, and then food amount can gradually be increased. Food variety is important when establishing meal plans as well as foods that are higher in energy density. Other more specific dietary treatments are listed below.

Zinc:

Patients with anorexia Nervosa have a high likelihood of being zinc deficient, and this probability increases if they are vegetarians. Vegetarianism is adapted by many patients with eating disorders because it is wide acclaimed as healthy and easy to manage calorie intake.

Sufficient Zinc must be available during recovery, and normal zinc levels were seen in the Notre Dame study to increase weight gain at a faster rate. Zinc supplementation can also help reduce reproductive issues for patients with Anorexia Nervosa. Leptin, a hormone regulating hunger and metabolism, levels decrease from zinc deficiency and even more with patients due to the reduction in size of adipose tissue. Reproductive tissues have recently been discovered to contain leptin receptors, thus a decrease in leptin concentration would lead to a lower rate of fertility.

Unfortunately, despite the connection to weight gain and reproduction, Zinc supplementation seems to be largely underappreciated and many do not consider zinc deficiency as an important factor in regard to Anorexia Nervosa.

Prognosis:

Although overall the prognosis may seem favorable, this is not the case for all patients of Anorexia Nervosa. Among psychiatric disorders, Anorexia Nervosa has one of the highest mortality rates because of side effects of the disorder, such as cardiac complications or suicide. In intermediate to long-term studies with juveniles, death rates, on average, have ranged anywhere from 1.8-14.1%. Recovery can be lifelong for some, energy intake and eating habits may never return to normal. Many studies have attempted to study relapse and recovery through longitudinal studies but this is difficult, time consuming, and costly. Recovery is also viewed on a spectrum rather than black and white. According to the Morgan-Russell criteria patients can have a good, intermediate, or poor outcome. Even when a patient is classified as having a “good” outcome, weight only has to be within 15% of average and normal menstruation must be present in females. The good outcome also excludes psychological health. Recovery for patients with Anorexia Nervosa is undeniably positive, but recovery does not mean normal.

Relapse

According to the Eckert study, relapse is greatest in the first year after normal body weight is obtained. This includes right after release from inpatient institutions. Relapse includes a return to food restriction as well as a shift to binge eating habits. As stated above higher energy density in dietary plans is important. Patients with lower dietary energy density in their meals, prior to being discharged, had worse outcomes within the year, therefore a higher likelihood of relapse. This is speculated to be due to fat and fluid consumption. Patients who’s dietary plans included fats and foods containing fats were forced to eat a more realistic and “normal” plan than those with lower energy density. Therefore when released from inpatient treatment, the patients with higher dietary energy density plans had adopted healthier and more balanced eating habits. A greater food variety in inpatient dietary plans may help lower rates of relapse as well.

Research

Ethyl_eicosapentaenoic_acid: The ethyl-eicosapentaenoate supplements were combined with Forceval, a multivitamin and mineral supplement. The results showed rapid improvement in diet, weight, and mood after three months, but this is just the tip of research on N-3 fatty acids such as ethyl-eicosapentaenoate.