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Application Criteria of Enteral Nutrition in Patients With Anorexia Nervosa: Correlation Between Clinical and Psychological Data in a "Lifesaving" Treatment

Agostino Paccagnella, MD, Alessandra Mauri, PhD^*, Carla Baruffi, MD, Rita Berto, PhD^*, Raffaella Zago, MD, Maria Lisa Marcon, RD, Daniela Pizzolato, RD, Francesca Fontana, MD, Lenio Rizzo, MD, Mario Bisetto, Silvana Agostini, MD and Giancarlo Foscolo, MD^||

From the ^* Faculty of Psychology, University of Padua, Italy; and the Dietetics and Clinical Nutrition Unit, Department of Psychiatry, Department of Pediatry, Child Neuropsychiatry Unit, and the ^|| Department of Medicine, Socio-Sanitary Administration No 9, Veneto Region, Treviso, Italy

Correspondence: Agostino Paccagnella, MD, Via Stangade 41, Teviso 31100, Italy. Electronic mail may be sent to apaccagnella{at}ulss.tv.it.

Background: Data and research increasingly point to multiple factors in the genesis of eating-behavior disorders, but the lack of a clear etiological definition prevents a unique therapeutic or prognostic approach from being defined. Therapeutic approaches, as well as scientific research, have separately analyzed the psychological aspects and the clinical-nutrition aspects without integrating the variables or correlating clinical and psychological data. This work has several goals because it aims at considering the problem from the 2 different perspectives. Psychological and clinical variables are analyzed both separately and together in order to assess (a) the minimal criteria to define a cure as "lifesaving" and submit a patient to artificial nutrition; (b) the kind of implementation artificial nutrition should follow; (c) which indicators of the efficacy of artificial nutrition must be taken into account; (d) the results in nutrition terms that may be obtained during the follow-up; (e) if artificial nutrition may be used as a therapeutic tool; (f) if there are any psychological effects after artificial nutrition; (g) if there are any effects due to the patients' age; and (h) the correlation between the psychological profile of a patient and the acceptance of the nutrition treatment. Methods: Several psychological and pharmacologic variables, together with clinical and anthropometric data and blood chemical values, were all considered. Conclusions: Besides defining minimal criteria for a "lifesaving" cure and proposing 2 ad hoc scales for the assessment of patients' subjective willingness toward feeding and for the objective measurement of feeding itself, clinical data and correlations with psychological data evidenced the importance of artificial nutrition and specifically of enteral nutrition as a therapeutic tool, allowing us to define the modalities of implementation of enteral nutrition. Results show that, because enteral nutrition did not deteriorate the psychological state of the patients, and was found to be accepted more positively than feeding orally in the most critical initial phase, it should be included in the therapy.

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