Define Micronutrients Requirements for Anorexia Nervosa?
It is advisable to include one 100% RDA multivitamin tablet with minerals. The use of prophylactic thiamine supplements in oral form is recommended for in-patients and that undergoing rapid weight gain. In the absence of data on the appropriate dose of thiamine, it is recommend giving 25 mg per day; in cases of confirmed deficiency, higher dosages may be required. Riboflavin deficiency may cause angular stomatitis and iron deficiency causes anaemia. Vitamin C deficiency can cause bleeding gums. These problems may need specific nutritional supplementation. Vitamin D requirements are higher than average in anorexia nervosa, owing to the risk of osteoporosis, and there is an argument for giving vitamin D supplements its part of refeeding. Calcium rich foods should also be included because of risk of osteoporosis and osteopaenia.
As discussed above, the patient must be encouraged to increase food intake gradually and decrease energy output to achieve a positive balance. A nasogastric tube may be needed but is not the preferred method and majority of patients can be fed orally. To ensure intake of sufficient calories, the feedings should start early in the day. Initially, the intake is generally low and patient can tolerate three meals per day, may be without abdominal distention and discomfort. But as the calorie prescription increases (>3000 Kcals may be required) the number of feedings must be increased. This may result in guilt feedings in patients because they feel that they are snacking between meals. It is wise to introduce calorie dense, may be commercial liquid supplements between meals which are easier to discontinue when the desired weight is reached, During treatment daily food record and caloric intake should be recorded along with eating behaviour, time of the meal and the meal consumed, food/drink eaten and their amounts etc. In addition, all the foods eaten at a binge and the time and method of purging also needs to be noted down whenever they occur to further plan the treatment and monitor the course of the disorder. In addition to the food diary, record of exercise undertaken should also be maintained to evaluate energy balance. Body weight must be checked daily when patient is hospitalized and later once every one or two weeks after discharge.