American Journal of Clinical Nutrition, Vol 66, 133-140, Copyright © 1997 by The American Society for Clinical Nutrition, Inc

ORIGINAL RESEARCH COMMUNICATIONS

Increase in diet-induced thermogenesis at the start of refeeding in severely malnourished anorexia nervosa patients

M Moukaddem, A Boulier, M Apfelbaum and D Rigaud
INSERM U 286 Faculte Xavier Bichat, Paris, France.

Many reports describe the difficulty for anorexia nervosa patients to gain weight during refeeding. To assess whether an increase in diet- induced thermogenesis (DIT) participates to this resistance, we studied DIT by indirect calorimetry in 11 severely malnourished anorexia nervosa patients [body mass index (BMI; in kg/m2) = 13] to accomplish two purposes: 1) to compare DIT in a strict semistarvation state with that obtained after 1 wk refeeding, when metabolism is shifted to a dynamic trend toward regaining weight, without significant change in body composition; 2) to study the effect on DIT of two energetic loads representing each one-third of the energy intake during semistarvation and refeeding, respectively: 1.25 and 2.92 MJ. To avoid bias, the two liquid loads were infused intragastrically in a random double-blind fashion. A significant increase in DIT during refeeding was observed for the two loads (204 +/- 23 kJ for the 1.25-MJ liquid meal and 482 +/- 78 kJ for the 2.92-MJ one, P < 0.02). The higher the load, the larger the increase with refeeding (P < 0.001). This increment in DIT exceeded the increase in active lean body mass and was poorly correlated with lean body mass. These results provide clear evidence of a strong cellular "waste" mechanism in anorexia nervosa patients during the early phase of refeeding, which enhances the adaptative resistance to overfeeding that we have already shown for resting energy expenditure.

This article has been cited by other articles:

				D. Rigaud, B. Verges, N. Colas-Linhart, A. Petiet, M. Moukkaddem, V. Van Wymelbeke, and L. Brondel Hormonal and Psychological Factors Linked to the Increased Thermic Effect of Food in Malnourished Fasting Anorexia Nervosa J. Clin. Endocrinol. Metab., May 1, 2007; 92(5): 1623 - 1629. [Abstract] [Full Text] [PDF]

				V. Van Wymelbeke, L. Brondel, J. Marcel Brun, and D. Rigaud Factors associated with the increase in resting energy expenditure during refeeding in malnourished anorexia nervosa patients Am. J. Clinical Nutrition, December 1, 2004; 80(6): 1469 - 1477. [Abstract] [Full Text] [PDF]

				M. S. Sherman, A. Pillai, A. Jackson, and T. Heiman-Patterson Standard Equations Are Not Accurate in Assessing Resting Energy Expenditure in Patients With Amyotrophic Lateral Sclerosis JPEN J Parenter Enteral Nutr, November 1, 2004; 28(6): 442 - 446. [Abstract] [Full Text] [PDF]

				C. Mika, B. Herpertz-Dahlmann, M. Heer, and K. Holtkamp Improvement of Nutritional Status as Assessed by Multifrequency BIA During 15 Weeks of Refeeding in Adolescent Girls with Anorexia Nervosa J. Nutr., November 1, 2004; 134(11): 3026 - 3030. [Abstract] [Full Text] [PDF]

				D. Rigaud, J. Hassid, A. Meulemans, A. T. Poupard, and A. Boulier A paradoxical increase in resting energy expenditure in malnourished patients near death: the king penguin syndrome Am. J. Clinical Nutrition, August 1, 2000; 72(2): 355 - 360. [Abstract] [Full Text] [PDF]

				G. Mingrone, E. Capristo, A. V Greco, G. Benedetti, A. De Gaetano, P. A Tataranni, and G. Gasbarrini Elevated diet-induced thermogenesis and lipid oxidation rate in Crohn disease Am. J. Clinical Nutrition, February 1, 1999; 69(2): 325 - 330. [Abstract] [Full Text] [PDF]