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Management of the Malnourished Patient

Edited by: Michael Kohn, FRACP, FACPM and Neville H. Golden, MD

Early publications on eating disorders were on the medical and nutritional care for young women with anorexia nervosa in the nineteenth century.  Since that time there have been major advances in the science of starvation and physical health restoration but practice can vary and consensus can be elusive. We have also learned that individuals with eating disorders (both men and women) can demonstrate the physical and psychological effects of malnutrition even at a normal or above normal weight. There is not a shared understanding of the physiological changes in starvation nor optimal strategy to best manage malnutrition for patients with anorexia nervosa.  Whilst there are Centres with established refeeding practices lead by clinicians of considerable experience, research is needed  to address questions such as how best to provide nutrition, including  nutrients (calories and micronutrients/supplements) as well as refeeding strategies and the management of early medical complications. In this special issue in Journal of Eating Disorders, we include papers that address management of the malnourished patient with an eating disorder across the weight and age spectrum. 

  1. Although hematological abnormalities in patients with anorexia nervosa have been documented, the mechanisms involved have not been fully clarified, especially during the refeeding period when hematological val...

    Authors: Michitaka Funayama, Akihiro Koreki, Yu Mimura, Taketo Takata, Satoyuki Ogino, Shin Kurose, Yusuke Shimizu and Shun Kudo
    Citation: Journal of Eating Disorders 2022 10:64
  2. Nutritional rehabilitation for patients with anorexia nervosa involves balancing the need for weight gain whilst mitigating the risk of refeeding syndrome. Graded caloric increases and restriction of calories ...

    Authors: Kellie Draffin, Jessica Hamilton, Shea Godsil, Suba Rudolph, Tim Crowe and Richard Newton
    Citation: Journal of Eating Disorders 2022 10:50
  3. The nutritional rehabilitation of malnourished patients hospitalised with anorexia nervosa is essential. The provision of adequate nutrition must occur, while simultaneously, minimising the risk of refeeding c...

    Authors: Elizabeth Kumiko Parker, Victoria Flood, Mark Halaki, Christine Wearne, Gail Anderson, Linette Gomes, Simon Clarke, Frances Wilson, Janice Russell, Elizabeth Frig and Michael Kohn
    Citation: Journal of Eating Disorders 2021 9:160
  4. Restrictive eating disorders (EDs) are often comorbid with anxiety and depression symptoms, placing patients at risk for more severe disease, worse treatment outcomes, and higher rates of mortality. To identif...

    Authors: Jessica A. Lin, Grace Jhe, Julia A. Vitagliano, Carly E. Milliren, Rebecca Spigel, Elizabeth R. Woods, Sara F. Forman and Tracy K. Richmond
    Citation: Journal of Eating Disorders 2021 9:60
  5. Persistent structural changes of the lungs in anorexia nervosa (AN) patients are rarely described in contemporary medical literature. The objective of our paper is to report a rare case of severe bronchiectasi...

    Authors: Anna Saran, Firszt Oliver, Tomasz Łosień, Monika Kulig-Kulesza, Jolanta Myga-Porosiło, Ewa Kluczewska and Dariusz Ziora
    Citation: Journal of Eating Disorders 2020 8:72
  6. Anorexia Nervosa (AN) is a complex psychiatric disorder that can lead to specific somatic complications. Heart abnormalities are frequently reported, while their frequency and associated factors in severely ma...

    Authors: Mouna Hanachi, Annabel Pleple, Caroline Barry, Marika Dicembre, Emilie Latour, Maeva Duquesnoy, Jean-Claude Melchior and Abdallah Fayssoil
    Citation: Journal of Eating Disorders 2020 8:66
  7. Routine supplementation of thiamine in patients with restrictive eating disorders prior to initiation of nutritional rehabilitation, is an example of a clinical guideline based on expert opinion rather than ev...

    Authors: Elizabeth Parker, Terri Maister, Anita Stefoska-Needham, Christine Wearne, Gail Anderson, Linette Gomes, Simon Clarke and Michael Kohn
    Citation: Journal of Eating Disorders 2020 8:41
  8. Extreme anorexia nervosa (AN) is defined as a BMI < 15 kg/m2 in those meeting DSM-V diagnostic criteria for AN. This study seeks to define the frequency of medical complications in this group of patients in order...

    Authors: Dennis Gibson, Ashlie Watters, Jeana Cost, Margherita Mascolo and Philip S. Mehler
    Citation: Journal of Eating Disorders 2020 8:25