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stringlengths 12
494
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listlengths 384
384
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|---|---|
and\n\t\nAppendix\t11\n).\tIn\tAN,\tfour\tcategories\tof\tBMI\tseverity\nratings,\tbased\ton\tthe\tWorld\tHealth\tOrganization\tcategories\tfor\tthinness\tin\tadults,\thave\tbeen\nincorporated\tinto\tthe\tDSM-5\t(\nAPA,\t2013\n).\nDelayed\tgrowth\tand\tstunting\tcan\toccur\tin\tadolescents\twith\tAN.\tHeight\tand\tweight\tdata\tshould\tbe
|
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] |
obtained\tfrom\tthe\tprimary\tmedical\trecord\tand\treplotted\ton\tthe\tNational\tCenter\tHealth\tStatistics\n(NCHS)\tweight-for-age\n\tand\theight-for-age\tpercentiles\tgrowth\tchart\tand\tthe\tBMI-for-age\tpercentiles\ngrowth\tchart\tto\tdetermine\twhether\tlinear\tgrowth\thas\tdeviated\tfrom\tpremorbid\ttrajectories.\tAge\tat
|
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pubertal\tonset\tand\tcurrent\tpubertal\tstage\tprovide\tinformation\tabout\tactual\tversus\texpected\ndevelopment.\tAssessment\tof\ta\tdeficit\tin\tlinear\tgrowth\tand\tpotential\tfor\tcatch-up\tshould\tbe\ndetermined\tby\ta\tpediatrician\tor\tadolescent\n\tmedicine\tspecialist.\tIn\tthe\tolder\tpatient,\ta\theight\tdeficit
|
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medicine\tspecialist.\tIn\tthe\tolder\tpatient,\ta\theight\tdeficit\nis\tlikely\tpermanent.\tIn\tall\tage\tgroups,\theight\tshould\tbe\tcarefully\tmeasured\tusing\ta\tstadiometer\nrather\tthan\ta\tscale-anchored\tmeasuring\trod\t(see\t\nAppendix\t5\n).\nBMI\tshould\tbe\tcalculated\tand\tplotted\ton\tthe\tNCHS\tBMI-for-age\tpercentiles\tgrowth\tchart.\tThe\tBMI
|
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percentile\tdoes\tnot,\thowever,\tdescribe\thow\tfar\tan\tadolescent’s\tBMI\tdeviates\tfrom\tthe\n\tnorm.\tThe\nBMI\tz-score\tis\ttherefore\trecommended\tto\tassess\tthe\tdegree\tof\tdeviation\tfrom\tthe\tmedian,\tas\twell\tas\nto\tcategorize\tthe\tdegree\tof\tmalnutrition\t(\nSAHM,\t2015\n).\tMedian\tBMI,\tdefined\tas\tthe\t50th\tpercentile
|
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] |
SAHM,\t2015\n).\tMedian\tBMI,\tdefined\tas\tthe\t50th\tpercentile\nBMI\tfor\tage\tand\tsex,\tcan\talso\tbe\tused\tto\tcompare\tthe\tadolescent\tto\tthe\treference\tpopulation.\nPercent\tmedian\tBMI\t(current\tBMI/50th\tpercentile,\tBMI\tfor\tage\tand\tsex\tx\t100)\tis\talso\tused\tto\ncategorize\n\tmild,\tmoderate,\tand\tsevere\tdegrees\tof\tmalnutrition\t(\nSAHM,\t2015\n).\tFor\tadolescents,
|
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] |
SAHM,\t2015\n).\tFor\tadolescents,\nweight\trecovery\tis\ttypically\tdefined\tas\t95%\tof\tthe\tmedian\tBMI\t(\nGarber\tet\tal,\t2016\n).\tBMI-for-age\tdata\ntables\tproviding\tthe\t50th\tpercentile\tBMI\tvalue\t(median\tBMI)\tare\tavailable\tat\tthe\tCenters\tfor\tDisease\nControl\tand\tPrevention\t(CDC)\twebsite\tusing\tthe\tsearch\tterm\t“growth\tcharts.”
|
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Rate\tof\tweight\tgain\tin\tAN\tmay\tbe\taffected\n\tby\thydration\tstatus,\tglycogen\tstores,\tmetabolic\tfactors,\nand\tchanges\tin\tbody\tcomposition\t(\nBox\t21.6\n).\tRehydration\tand\treplenished\tglycogen\tstores\ncontribute\tto\tweight\tgain\tduring\tthe\tfirst\tfew\tdays\tof\trefeeding.\tThereafter,\tweight\tgain\tresults\tfrom
|
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increased\tlean\tand\tfat\tstores.\tA\tgeneral\tassumption\tis\tthat\tsomeone\thas\tto\tincrease\tor\tdecrease\ncaloric\tintake\tby\t3500\tkcal\tto\tcause\ta\t1-lb\tchange\tin\n\tbody\tweight,\tbut\tthe\ttrue\tenergy\tcost\tdepends\non\tthe\ttype\tof\ttissue\tgained.\tMore\tenergy\tis\trequired\tto\tgain\tfat\tversus\tlean\ttissue,\tbut\tweight\tgain
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may\tbe\ta\tmix\tof\tfat\tand\tlean\ttissues.\tIn\tadult\twomen\twith\tAN,\tshort-term\tweight\trestoration\thas\nbeen\tassociated\twith\ta\tsignificant\tincrease\tin\ttruncal\tfat\tand\tcentral\tadiposity;\tthis\tdistribution,\nhowever,\tappears\tto\tnormalize\twithin\t1\tyear\tof\tweight\n\tmaintenance\t(\nMayer\tet\tal,\t2009\n).\tShort-term
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] |
maintenance\t(\nMayer\tet\tal,\t2009\n).\tShort-term\nweight\trestoration\tin\tadolescent\tfemales\thas\tbeen\tassociated\twith\tand\twithout\tcentral\tadiposity\t(\nde\nAlvaro\tet\tal,\t2007\n;\t\nFranzoni\tet\tal,\t2013\n).\nBOX\t21.6\nFactors\tAffecting\tRate\tof\tWeight\tGain\tin\tAnorexia\tNervosa\n1.\t\nFluid\tbalance\nA.\n\tPolyuria\tseen\tin\tsemistarvation\nB.\n\tEdema\n(1)\n\tStarvation\n(2)
|
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] |
A.\n\tPolyuria\tseen\tin\tsemistarvation\nB.\n\tEdema\n(1)\n\tStarvation\n(2)\n\tRefeeding\nC.\n\tHydration\tratios\tin\ttissues\n(1)\n\tGlycogen:\t3-4:1\n(2)\n\tProtein\tstores:\t2-3:1\n2.\t\nMetabolic\trate\nA.\n\tResting\tenergy\texpenditure\t(REE):\tLow\tweight:\tREE\t30%\tto\t40%\tbelow\tpredicted\nvalue\tfor\theight,\tweight,\tage,\tgender\nRefeeding:\tprogressive\tincreases\tin\tREE
|
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Refeeding:\tprogressive\tincreases\tin\tREE\nWeight\trestoration:\tREE\tnormalizes\nB.\n\tPostprandial\tenergy\texpenditure\t(PPEE)\nUnder\tnormal\tmetabolic\tconditions:\tPPEE\tapprox.\t10%\tgreater\tthan\tREE\nIn\tAN:\tPPEE\n\tmay\tbe\t30%\tto\t40%\tgreater\tthan\tREE\nDuration\tof\texaggerated\tresponse\tvaries\tamong\tindividuals\nC.\n\tRespiratory\tquotient\n3.
|
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] |
C.\n\tRespiratory\tquotient\n3.\t\nEnergy\tcost\tof\ttissue\tgained\nA.\n\tFat-free\tmass\nB.\n\tAdipose\ttissue\n4.\t\nPrevious\tobesity\tassociated\twith\tdecreased\tmetabolic\tresistance\tto\tweight\tgain\n5.\t\nPhysical\tactivity:\ttime\tstanding,\tvolitional\tactivity,\tfidgeting\tbehavior\nMedical\tnutrition\ttherapy\tand\n\tcounseling
|
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] |
Medical\tnutrition\ttherapy\tand\n\tcounseling\nTreatment\tof\tan\tED\tmay\tbegin\tat\tone\tof\tfive\tlevels\tof\tcare:\toutpatient,\tintensive\toutpatient,\tpartial\nor\tday\ttreatment,\tinpatient,\tor\tresidential.\tThe\tRDN\tis\tan\tessential\tpart\tof\tthe\ttreatment\tteam\tat\tall\nlevels\tof\tcare;\troles\tand\tresponsibilities\tof\tcaring\tfor\tindividuals\twith\tEDs\tare\tsummarized\tin\t\nTable
|
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] |
Table\n21.2\n.\nTABLE\t21.2
|
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0.08760079741477966,
0.0846099853515625,
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] |
Roles\tand\tResponsibilities\tof\tRegistered\tDietitian\tNutritionists\n\tCaring\tfor\tindividuals\twith\tEating\tDisorders\nNutrition\tAssessment:\nIdentify\tnutrition\tproblems\tthat\n\trelate\tto\tmedical\tand\nphysical\tcondition,\tincluding\teating\tdisorder\tsymptoms\nand\tbehaviors.\nSpecific\tActivities:\nEating\tpatterns\nCore\teating\tattitudes
|
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] |
Specific\tActivities:\nEating\tpatterns\nCore\teating\tattitudes\nCore\tattitudes\tregarding\tbody\tweight\nand\tshape\nAssess\tbehavioral-environmental\nsymptoms:\nFood\trestriction\nBinge\teating\nPreoccupation\nRituals\nSecretive\teating\nAffect\tand\timpulse\tcontrol\nVomiting\tor\tother\tpurging\nbehaviors\nExcessive\texercise\nAnthropometric\tassessment:
|
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behaviors\nExcessive\texercise\nAnthropometric\tassessment:\nMeasure\theight,\tweight,\tcalculate\nBMI\nObtain\theight\tand\tweight\thistory\nAdolescents\tand\tyoung\tadults\tup\tto\nage\t20:\nPlot\ton\tNCHS\tgrowth\tcharts\nAssess\tgrowth\tpatterns\nCalculate\tBMI\tz-score,\tpercent\tof\nmedian\tBMI\nAssess\tdegree\tof\tmalnutrition:\nAdults:\tBMI\nAdolescents:\tBMI\tz-scores\tand
|
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] |
Adults:\tBMI\nAdolescents:\tBMI\tz-scores\tand\npercent\tof\tmedian\tBMI\nInterpret\tbiochemical\tdata\tand\nassess\trisk\tof\trefeeding\n\tsyndrome\nApply\tdiagnosis,\tplan\tintervention,\ncoordinate\twith\ttreatment\tteam\nNutrition\tIntervention:\nCalculate\tand\tmonitor\tenergy\tand\tmacronutrient\tintake\tto\nestablish\texpected\trates\tof\tweight\tchange,\tand\tbody
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establish\texpected\trates\tof\tweight\tchange,\tand\tbody\ncomposition\tand\thealth\tgoals.\tGuide\tgoal\tsetting\tto\nnormalize\teating\tpatterns\tfor\tnutrition\trehabilitation\tand\nweight\trestoration\tor\tmaintenance\tas\tappropriate.\nEnsure\tdiet\tquality,\n\tregular\teating\npattern,\tincreased\tamount\tand\nvariety\tof\tfoods,\tnormal\tperceptions\nof\thunger\tand\tsatiety,\tprovide
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0.06691315025091171,
0.06585586071014404,
0.049530766904354095,
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] |
variety\tof\tfoods,\tnormal\tperceptions\nof\thunger\tand\tsatiety,\tprovide\nsuggestions\tabout\tsupplement\tuse\nProvide\ta\tstructured\tmeal\tplan\nProvide\tpsychological\tsupport\tand\npositive\treinforcement\nCounsel\tpatients\tand\tcaregivers\ton\nfood\tselection\twith\tconsideration\ngiven\tto\tindividual\tpreferences,\nhealth\thistory,\tphysical\tfactors,
|
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0.00543737830594182
] |
given\tto\tindividual\tpreferences,\nhealth\thistory,\tphysical\tfactors,\npsychological\tfactors,\tand\nresources\nNutrition\tMonitoring\tand\tEvaluation:\nMonitor\tnutrient\tintake\tand\tadjust\tas\tneeded.\nMonitor\trate\tof\tweight\tgain\nUpon\tweight\trestoration,\tadjust\tfood\nplan\tfor\tweight\tmaintenance\nCommunicate\tprogress\twith\tthe\ntreatment\tteam
|
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Communicate\tprogress\twith\tthe\ntreatment\tteam\nAdjust\ttreatment\tplan\tas\tneeded\nCare\tCoordination:\nProvide\tcounsel\tto\tteam\tabout\tprotocols\tto\tmaximize\ntolerance\tof\tfeeding\tregimen\tor\tnutrition\nrecommendations,\n\tguidance\tabout\tsupplements\tto\tensure\nmaximum\tabsorption,\tminimize\tdrug\tnutrient\tinteractions,
|
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-0.0011480773100629449,
0.004277429543435574,
0.01935758627951145,
0.013691176660358906,
0.13064801692962646,
0.03547325357794762,
-0.031635724008083344
] |
maximum\tabsorption,\tminimize\tdrug\tnutrient\tinteractions,\nand\treferral\tfor\tcontinuation\tof\tcare\tas\tneeded.\nWork\tcollaboratively\twith\tthe\ttreatment\nteam,\tdelineate\troles\tand\ttasks,\ncommunicate\tnutrition\tneeds\tacross\ntreatment\tsettings\t(i.e.,\tinpatient,\tday\npatient,\toutpatient)\nFunction\tas\ta\tresource\tand\teducator\nfor\tother\thealth\tcare
|
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0.026687201112508774,
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0.0013824020279571414,
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0.04193788766860962,
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0.021171754226088524,
0.10696808993816376,
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0.07419275492429733,
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0.06036214902997017,
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0.0035759848542511463,
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0.03862055018544197,
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0.016392771154642105,
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0.047235794365406036,
0.09346934407949448,
0.06165170297026634,
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] |
Function\tas\ta\tresource\tand\teducator\nfor\tother\thealth\tcare\nprofessionals\tand\tfamily\n\tmembers\nAdvocate\tfor\tevidence-based\ntreatment\tand\taccess\tto\tcare\nAdvanced\tTraining:\nSeek\tspecialized\ttraining\tin\tother\tcounseling\ttechniques,\nsuch\tas\tcognitive\tbehavioral\ttherapy,\tdialectical\nbehavioral\ttherapy,\tand\tmotivational\tinterviewing.
|
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] |
behavioral\ttherapy,\tand\tmotivational\tinterviewing.\nUse\tadvanced\tknowledge\tand\tskills\nrelating\tto\tnutrition\nSeek\tsupervision\tand\tcase\nconsultation\tfrom\ta\tlicensed\nhealth\tprofessional\tto\tgain\tand\nmaintain\n\tproficiency\tin\teating\ndisorders\ttreatment\nBMI\n,\tBody\tmass\tindex;\t\nNCHS\n,\tNational\tCenter\tfor\tHealth\tStatistics.
|
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BMI\n,\tBody\tmass\tindex;\t\nNCHS\n,\tNational\tCenter\tfor\tHealth\tStatistics.\nAdapted\tfrom:\tOzier\tAD,\tHenry\tBW:\tPosition\tof\tthe\tAmerican\tDietetic\tAssociation:\tNutrition\tintervention\tin\tthe\ttreatment\tof\teating\tdisorders.\t\nJ\tAcad\nNutr\tDiet\n,\t111:1236,\t2011.
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of\tcare\tas\tweight\trestoration\tprogresses.\tIn\tother\tinstances,\ttreatment\tbegins\ton\tan\toutpatient\nbasis;\thowever,\tif\tprogress\tis\tabsent\tor\tconsidered\tinadequate,\tcare\tis\tstepped\tup\tto\ta\tmore\nintensive\n\tlevel.\nIn\tBN,\ttreatment\ttypically\tbegins\tand\tcontinues\ton\tan\toutpatient\tbasis.\tOn\toccasion\ta\tpatient\twith
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] |
BN\tmay\tbe\tdirectly\tadmitted\tto\tan\tintensive\toutpatient\tor\tday\ttreatment\tprogram.\tHowever,\ninpatient\thospitalization\tis\trelatively\tuncommon\tand\tgenerally\tis\tof\tshort\tduration\tand\tfor\tthe\nspecific\tpurpose\tof\tfluid\tand\telectrolyte\tstabilization.\nAnorexia\tnervosa\nGuidelines\tfor\tMNT\tfor\tAN\n\tare\tsummarized\tin\t\nBox\t21.7
|
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] |
Guidelines\tfor\tMNT\tfor\tAN\n\tare\tsummarized\tin\t\nBox\t21.7\n.\tGoals\tfor\tnutrition\trehabilitation\tinclude\nrestoration\tof\tbody\tweight\tand\tnormalization\tof\teating\tpatterns\tand\tbehaviors.\tAlthough\tMNT\tis\tan\nessential\tcomponent\tof\ttreatment,\tguidelines\tare\tbased\tlargely\ton\tclinical\texperience\trather\tthan\nscientific\tevidence\t(\nRocks\tet\tal,\t2014\n).\nBOX\t21.7
|
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] |
scientific\tevidence\t(\nRocks\tet\tal,\t2014\n).\nBOX\t21.7\nGuidelines\tfor\tMedical\tNutrition\tTherapy\tfor\tAnorexia\tNervosa\n1.\t\nCaloric\n\tprescription\nA.\n\tInitial\tprescription\nAPA\t(2006):\t30\tto\t40\tkcal/kg/day\t(approx.\t1000\tto\t1600\tkcal/day)\nHigher\tkcal\tprescriptions\trequire\tmonitoring\tfor\trefeeding\tsyndrome\t(RFS)
|
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Types\tof\tfeedings:\tmeal\tbased,\tliquid\tsupplements,\ttube\tfeedings;\ttotal\tparenteral\nnutrition\t(TPN)\t(rare)\nB.\n\tWeight\tgain\tphase:\nAssess\tfor\tindividualized\tversus\tstandardized\tapproach\nProgressive\tincreases\tin\n\tkcal\tprescription\tto\tpromote\tdesired\trate\tof\tweight\tgain\nLate\ttreatment:\t70\tto\t100\tkcal/kg/day\t(APA,\t2006);\tapprox.\t3000\tto\t4000\tkcal/day
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for\tfemales\tand\t4000\tto\t4500\tkcal/day\tfor\tmales\nC.\n\tWeight\tmaintenance\tphase:\nAdults:\t40\tto\t60\tkcal/kg/day\nChildren/adolescents:\tkcal\tintake\tsufficient\tfor\tnormal\tgrowth\tand\tdevelopment\n2.\t\nMacronutrient\tintake\nA.\n\tProtein\n15%\tto\t20%\tkcal\nMinimum\n\tintake\t=\tRecommended\tdietary\tallowance\t(RDA)\tin\tg/kg\tideal\tbody\nweight
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weight\nPromote\thigh\tbiologic\tvalue\tsources;\tavoid\tvegetarian\tdiets\nB.\n\tCarbohydrate\n50%\tto\t60%\tkcal\nDecrease\tcarbohydrate\tto\t40%\tkcal\tif\tblood\tglucose\tis\televated\tor\tpatient\thas\nRFS\nProvide\tinsoluble\tfiber\tfor\ttreatment\tof\tconstipation.\nC.\n\tFat\nHospitalized/day\ttreatment\tpatients:\t30%\tkcal\nOutpatients:\tprogressively
|
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] |
Outpatients:\tprogressively\n\tincrease\tdietary\tfat\tuntil\ta\t30%\tfat\tkcal\tdiet\tis\nattained.\nInclude\tsources\tof\tessential\tfatty\tacids\n3.\t\nMicronutrient\tintake:\nA.\n\t100%\tRDA\tmultivitamin/mineral\tsupplement.\nB.\n\tAvoid\tsupplemental\tiron\tduring\tinitial\tphase\tof\trefeeding\tand\tif\tpatient\tis\nconstipated.\nC.\n\tAssess\tneed\tfor\tadditional\tthiamin\tsupplement.\nD.
|
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] |
constipated.\nC.\n\tAssess\tneed\tfor\tadditional\tthiamin\tsupplement.\nD.\n\tAssess\tneed\tfor\tadditional\tcalcium\tsupplementation.\n4.\t\nEnergy\tdensity\nA.\n\tPromote\tintake\tof\tenergy\tdense\tfoods\tand\tbeverages\nIf\tnutrient\tintake\tis\tassessed\tby\tcomputer\tanalysis,\tcalculate\ta\tDietary\tEnergy\nDensity\tScore\t(DEDS):\tDEDS\t=\tkcal\tintake\tdivided\tby\tweight\t(g)\tof\tfood\tand
|
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] |
beverage\nB.\n\tGoal\tfor\tDEDS:\t≥1.0\n5.\t\nDiet\tvariety\nA.\n\tPromote\tintake\tof\ta\twide\tvariety\tof\tfoods\tand\tbeverages\twithin\tall\tfood\tgroups.\nB.\n\tPay\tparticular\tattention\tto\tthe\tvariety\n\tof\tcomplex\tcarbohydrates,\tcaloric\tbeverages,\nand\tadded\tfats.\nRefeeding\tmay\toccur\tin\ta\tvariety\tof\tsettings\tincluding\tinpatient\tmedical\tunits,\tinpatient\tpsychiatric
|
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units,\tresidential\tprograms,\tday\ttreatment/partial\thospitalization,\tand\toutpatient\tsettings.\tFor\nadolescents\tengaged\tin\tFBT,\tthe\tfamily\thome\tis\tthe\tprimary\tsetting\tfor\trefeeding.\tRefeeding\tmay\ninclude\tcombinations\tof\tmeal-based\n\tfeedings,\tliquid\tcalorie\tsupplements,\ttube\tfeedings\t(continuous
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or\tbolus);\tparenteral\tnutrition\t(PN)\tis\trarely\tused\tand\tnot\trecommended\tunless\tno\tother\tform\tof\nrefeeding\tis\tpossible\t(\nGarber\tet\tal,\t2016\n).\nWeight\trestoration\tfor\tmedically\tunstable,\tseverely\tmalnourished\t(BMI\t<15\tkg/m\n2\n\tin\tadult\tand\n<70%\tmedian\tBMI\tin\tadolescents),\tor\tgrowth-impaired\tadolescents\tmay\trequire\tsupervised\tweight\ngain
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gain\n\tin\ta\tspecialized\tinpatient\tunit\tor\tresidential\ttreatment\tprogram.\tA\tfew\tprograms\tincorporate\nweight\tstabilization,\tweight\tgain,\tand\tweight\tmaintenance\tphases\tinto\ttheir\ttreatment\tprograms,\tbut\nmost\tinitiate\tweight\tshortly\tafter\tadmission.\tTreatment\tincludes\ta\ttargeted\trate\tof\texpected\tweight
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] |
gain.\tThe\tAPA\t(2006)\trecommends\ta\ttargeted\tweight\tgain\tof\t2\tto\t3\tlbs.\tper\tweek,\tothers,\tincluding\nthe\tSAHM,\n\tconsider\tthis\trate\tof\tweight\tgain\ttoo\tconservative\t(\nSAHM,\t2015\n;\t\nGarber\tet\tal,\t2012\n;\nGolden\tet\tal,\t2013\n;\t\nKatzman,\t2012\n;\t\nKohn\tet\tal,\t2011\n).
|
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] |
;\nGolden\tet\tal,\t2013\n;\t\nKatzman,\t2012\n;\t\nKohn\tet\tal,\t2011\n).\nInitial\tcalorie\tprescriptions,\tand\tsubsequent\tcaloric\tadjustments,\tare\talso\tnot\twidely\tagreed\tupon.\nThe\tcurrent\tstandard\tof\tcare\tfor\trefeeding\tis\tto\t“start\tlow”\t(approximately\t1200\tkcal/day)\tand\n“advance\tslow”\t(200\tkcal\tincreases\tevery\tother\tday),\tthe\tpurpose
|
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] |
hospitalizations\thas\tprompted\tsome\ttreatment\tprograms\tto\tuse\tmore\taggressive\t“standardized”\napproaches\tto\trefeeding,\twhich\tincludes\ta\thigher\tinitial\tcalorie\tprescription\tand\tmore\trapid\nadvancement\n\tduring\tthe\trefeeding\tprocess.\tAn\texample\tof\ta\tstandardized\tapproach\tdescribed\tby\nHaynos\tet\tal\t(2016)\tis\tprovided\tin\t\nTable\t21.3
|
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0.014518975280225277
] |
Haynos\tet\tal\t(2016)\tis\tprovided\tin\t\nTable\t21.3\n.\tThis\ttype\tof\tprotocol\tmay\tbe\tsafe\tand\teffective\tin\nclinical\tsettings\tthat\tinclude\ta\thighly\tskilled\teating\tdisorder\ttreatment\tteam.\tIn\ta\tclinical\tsetting\tthat\nis\tless\tspecialized,\tit\tmay\tbe\tsafer\tto\tprescribe\tan\tinitial\tdiet\tin\taccordance\twith\tthe\tAPA\tpractice\nguideline
|
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guideline\n\t(2006)\trecommendation\tof\t30\tto\t40\tkcal/kg\tof\tbody\tweight\tper\tday\t(approximately\t1000\tto\n1600\tkcal/day)\tfollowed\tby\tprogressive\tcalorie\tincreases\t(e.g.,\t200\tkcal)\tat\ta\tfrequency\tthat\twill\npromote\ta\tconsistent\trate\tof\tweight\tgain.\tA\tsystematic\treview\tof\tfeeding\tapproaches\tin\tAN
|
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] |
conducted\tby\tGarber\tet\tal\t(2016)\tresulted\tin\tthe\tfollowing\tevidence-based\tconclusions:\t(1)\tlower\ncalorie\trefeeding\tis\ttoo\n\tconservative\tin\tmildly\t(80%\tto\t89%\tmedian\tBMI)\tand\tmoderately\t(70%\tto\n79%\tmedian\tBMI)\tmalnourished\tadolescents;\t(2)\tthere\tis\tinsufficient\tevidence\tto\tsupport\tchanging
|
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] |
the\tcurrent\tstandard\tof\tcare\tfor\trefeeding\t(i.e.,\tstart\tlow,\tgo\tslow)\tin\tseverely\tmalnourished\nadolescents\t(<70%\tmedian\tBMI)\tand\tadults\t(BMI\t<15\tkg/m\n2\n).\nTABLE\t21.3\nExample\tof\ta\tStandardized\tRefeeding\tProtocol\tfor\tHospitalized\n\tPatients\twith\tAnorexia\tNervosa\nDays\tSince\nAdmission\nMeal\tPrescription\n(kcal)\nLiquid\tSupplement\t(Ensure\tPlus)
|
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] |
Admission\nMeal\tPrescription\n(kcal)\nLiquid\tSupplement\t(Ensure\tPlus)\nPrescription\t(kcal)\nTotal\tPrescription\n(kcal)\n0\n1800\n0\n1800\n7\n2200\n0\n2200\n9\n2220\n350\n2550\n12\n2600\n350\n2950\n15\n2600\n700\n3300\n17\n3000\n700\n3700\nHaynos\tA,\tSnipes\tC,\tet\tal.\t\nInt\tJ\tEat\tDisord\n\t49:50,\t2016.\nRisk\tof\thypophosphatemia\tand\tcomplications\tassociated\twith\tthe
|
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] |
Risk\tof\thypophosphatemia\tand\tcomplications\tassociated\twith\tthe\t\nrefeeding\tsyndrome\t(RFS)\n\tmay\npresent\tduring\tthe\tfirst\tfew\tweeks\n\tof\tnutritional\trehabilitation.\tManifestations\tof\tRFS\tinclude\tfluid\nand\telectrolyte\timbalance;\tcardiac,\tneurologic,\tand\thematologic\tcomplications;\tand\tsudden\tdeath.
|
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Risk\tfor\tthe\tdevelopment\tof\tRFS\tmay\tdepend\tmore\ton\tthe\tdegree\tof\tmalnutrition\trather\tthan\tcaloric\nintake\tand\trate\tof\tweight\tgain\t(\nAgostino\tet\tal,\t2013\n;\t\nGarber\tet\tal,\t2012\n;\t\nGolden\tet\tal,\t2013\n;\t\nKohn\tet\nal,\t2011\n).\tAt-risk\tindividuals\tmust\n\tbe\tmonitored\tcarefully\twith\tdaily\tmeasurements\tof\tserum
|
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] |
be\tmonitored\tcarefully\twith\tdaily\tmeasurements\tof\tserum\nphosphorus,\tpotassium,\tand\tmagnesium\tfor\tthe\tfirst\t5\tto\t7\tdays\tof\trefeeding,\tand\tevery\tother\tday\tfor\nseveral\tweeks\tthereafter.\tSupplemental\tphosphorus,\tmagnesium,\tand\tpotassium\tmay\tbe\tgiven\torally\nor\tintravenously.\tIn\tsome\tinstances,\tprophylactic\tsupplementation\tis\tprovided\tto\thigh-risk
|
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] |
individuals;\tin\tother\tcases,\tsupplementation\tis\tbased\n\ton\tserum\tlevels.\tThiamin\t(B1)\tsupplementation\nmay\tbe\trequired\tat\tthe\tonset\tand\tthroughout\tthe\tcourse\tof\tnutritional\trehabilitation.\tPlasma\tglucose\nlevels\tmust\tbe\tclosely\tmonitored\tfor\thypo-\tand\thyperglycemia\t(\nBoateng\tet\tal,\t2010\n).\tA\tsystematic
|
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0.10610954463481903,
0.03554992377758026,
0.06907624751329422,
-0.003114476567134261
] |
and\tClinical\tExcellence\t(NICE)\t(\nNICE,\t2009\n).\nLater\tin\tthe\tcourse\tof\tweight\trestoration,\tcaloric\tprescriptions\tin\tthe\trange\tof\t70\tto\t100\tkcal/kg\tof\nbody\tweight\tper\tday\t(approximately\t3000\tto\t4000\tkcal/day)\tmay\tbe\tneeded,\tand\tmale\tpatients\tmay\nrequire\tas\tmuch\n\tas\t4000\tto\t4500\tkcal/day\t(\nAPA,\t2006\n).\tChanges\tin\tREE,\tDIT,\tand\tthe\ttype\tof\ttissue
|
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] |
APA,\t2006\n).\tChanges\tin\tREE,\tDIT,\tand\tthe\ttype\tof\ttissue\ngained\tcontribute\tto\thigh\tenergy\trequirements.\tPatients\twho\trequire\textraordinarily\thigh\tenergy\nintakes\tshould\tbe\tquestioned\tor\tobserved\tfor\tdiscarding\tof\tfood,\tvomiting,\texercising,\tand\texcessive\nphysical\tactivity,\tincluding\tfidgeting.
|
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physical\tactivity,\tincluding\tfidgeting.\nAfter\tthe\tgoal\tweight\tis\tattained,\tthe\tcaloric\tprescription\tmay\tbe\tslowly\tdecreased\n\tto\tpromote\nweight\tmaintenance.\tWeight\tmaintenance\trequirements\tare\tgenerally\thigher\tthan\texpected\tand\tare\nusually\tin\tthe\trange\tof\t2200\tto\t3000\tkcal/day.\tCaloric\tprescriptions\tmay\tremain\tat\thigher\tlevels\tin
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adolescents\twith\tthe\tpotential\tfor\tcontinued\tgrowth\tand\tdevelopment.\nAN\tpatients\treceiving\tcare\tin\tless-structured\tenvironments,\tsuch\tas\tan\toutpatient\ttreatment\nprogram\tor\ta\tprivate\tnutrition\n\tpractice,\tmay\tbe\tchallenging\tand\tresistant\tto\tfollowing\tformalized
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practice,\tmay\tbe\tchallenging\tand\tresistant\tto\tfollowing\tformalized\nmeal\tplans.\tA\tpractical\tapproach\tis\tthe\taddition\tof\t200\tto\t300\tcalories\tper\tday\tto\tthe\tpatient’s\ttypical
|
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(baseline)\tenergy\tintake;\thowever,\tthe\tRDN\tmust\tbe\tmindful\tthat\tthese\tpatients\ttend\tto\toverestimate\ntheir\tenergy\tintake\t(\nSchebendach\tet\tal,\t2012\n).\nOnce\tthe\tenergy\tprescription\tis\tcalculated,\ta\treasonable\tdistribution\tof\tmacronutrients\n\tmust\tbe\ndetermined.\tPatients\tmay\texpress\tmultiple\tfood\taversions.\tExtreme\tavoidance\tof\tdietary\tfat\tis
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common,\tbut\tcontinued\tomission\twill\tmake\tit\tdifficult\tto\tprovide\tconcentrated\tsources\tof\tenergy\nneeded\tfor\tweight\trestoration.\tA\tdietary\tfat\tintake\tof\tat\tleast\t30%\tof\tcalories\tis\trecommended.\tThis\ncan\tbe\taccomplished\teasily\twhen\tAN\tpatients\tare\ttreated\ton\tinpatient\tunits\tor\tin\tday\thospital
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programs.\tOn\tan\toutpatient\tbasis,\thowever,\tsmall,\tprogressive\tincreases\tin\tthe\tdietary\tfat\nprescription\tmay\telicit\tmore\tcooperation\tand\tless\tresistance.\tAlthough\tsome\tpatients\twill\taccept\nsmall\tamounts\tof\tadded\tfat\t(such\tas\tsalad\tdressing,\tmayonnaise,\tor\tbutter),\tmany\tdo\tbetter\twhen\tthe
|
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0.0567176528275013,
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] |
fat\tcontent\tis\tless\tobvious\t(as\tin\tcheese,\tpeanut\tbutter,\tgranola,\tand\tsnack\tfoods).\tEncouraging\tthe\ngradual\n\tchange\tfrom\tfat-free\tproducts\t(fat-free\tmilk)\tto\tlow-fat\tproducts\t(1%\tor\t2%\tmilk)\tand\tfinally\nto\tfull-fat\titems\t(whole\tmilk)\tis\talso\tacceptable\tto\tsome\tpatients.
|
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] |
to\tfull-fat\titems\t(whole\tmilk)\tis\talso\tacceptable\tto\tsome\tpatients.\nProtein\tintake\tin\tthe\trange\tof\t15%\tto\t20%\tof\ttotal\tcalories\tis\trecommended.\tTo\tensure\tadequacy\nthe\tminimum\tprotein\tprescription\tshould\tequal\tthe\tRDA\tfor\tage\tand\tsex\tin\tgram\tper\tkilogram\t(g/kg)\nIBW\t(see\tinside\tcover).\tVegetarian\tdiets
|
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] |
IBW\t(see\tinside\tcover).\tVegetarian\tdiets\n\toften\tare\trequested\tbut\tshould\tbe\tdiscouraged\tduring\tthe\nweight\trestoration\tphase\tof\ttreatment.\nCarbohydrate\tintake\tin\tthe\trange\tof\t50%\tto\t60%\tof\tcalories\tare\tgenerally\twell\ttolerated.\tA\tlower\ncarbohydrate\tdiet\t(e.g.,\t40%\tof\tcalories)\tmay\tbe\tindicated\tfor\ta\thyperglycemic\tpatient.\tConstipation
|
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] |
is\ta\tcommon\tproblem\tin\tearly\ttreatment,\tand\tfood\tsources\tof\tinsoluble\tfiber\tmay\tbe\tbeneficial\t(see\nAppendix\t28\n).\nAlthough\tvitamin\tand\tmineral\tsupplements\tare\tnot\tuniversally\tprescribed,\tthe\tpotential\tfor\nincreased\tneeds\tduring\tthe\tlater\tstages\tof\tweight\tgain\tmust\tbe\tconsidered.\tProphylactic\tprescription
|
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of\ta\tvitamin\tand\tmineral\tsupplement\tthat\tprovides\t100%\tof\tthe\tRDA\tmay\tbe\treasonable,\tbut\tiron\nsupplementation\tmay\tbe\tcontraindicated\tearly\tin\ttreatment\t(Royal\tCollege\tof\tPsychiatrists,\t2005).\nOwing\tto\n\tthe\tincreased\trisk\tof\tlow\tBMD,\tcalcium\tand\tvitamin\tD–rich\tfoods\tshould\tbe\tencouraged;
|
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] |
there\tis\tno\tconsensus\ton\tthe\tuse\tof\tcalcium\tand\tvitamin\tD\tsupplements\tin\tthis\tpopulation.\nDelayed\tgastric\temptying\tand\tresultant\tearly\tsatiety\twith\tcomplaints\tof\tabdominal\tdistention\tand\ndiscomfort\tafter\teating\tare\tcommon\tin\tAN.\tIn\tearly\ttreatment\tintake\tis\tgenerally\tlow\tand\tcan\tbe\ntolerated\tin\tthree\tmeals\tper
|
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] |
tolerated\tin\tthree\tmeals\tper\n\tday.\tHowever,\tas\tthe\tcaloric\tprescription\tincreases,\tbetween-meal\nfeedings\tbecome\tessential.\tThe\taddition\tof\tan\tafternoon\tor\tevening\tsnack\tmay\trelieve\tthe\tphysical\ndiscomfort\tassociated\twith\tlarger\tmeals,\tbut\tsome\tpatients\texpress\tfeelings\tof\tguilt\tfor\t“indulging”
|
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between\tmeals.\tCommercially\tavailable,\tdefined-formula\tliquid\tsupplements\tcontaining\t30\tto\t45\ncalories\tper\tfluid\tounce\toften\tare\tprescribed\n\tonce\tor\ttwice\tdaily.\tPatients\tare\tfearful\tthat\tthey\twill\nbecome\taccustomed\tto\tthe\tlarge\tamount\tof\tfood\trequired\tto\tmeet\tincreased\tcaloric\trequirements;
|
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] |
thus\tuse\tof\ta\tliquid\tsupplement\tis\tappealing\tbecause\tit\tcan\teasily\tbe\tdiscontinued\twhen\tthe\tgoal\nweight\tis\tattained.\tThe\tconsumption\tof\tmeals,\tsnacks,\tand\tliquid\tsupplements\tmust\tbe\tsupervised\nduring\tintake\tand\timmediately\tafter\t(1-hour\tperiod)\n\tintake\tto\tprevent\tpurging.
|
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] |
intake\tto\tprevent\tpurging.\nClaims\tof\tlactose\tintolerance,\tfood\tallergies,\tand\tgluten\tsensitivity\tcomplicate\tthe\trefeeding\nprocess.\tThese\tmay\tbe\tlegitimate\tor\tsimply\ta\tcovert\tmeans\tof\tlimiting\tfood\tchoice.\tTo\tthe\textent\npossible,\tall\tclaims\tshould\tbe\tverified\tby\tprior\tor\tcurrent\tmedical\ttesting.\tLactose\tintolerance
|
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secondary\tto\tmalnutrition\tmay\toccur\tbut\ttypically\tresolves\tduring\tthe\tcourse\tof\n\tweight\trestoration.\tIf\nmedically\twarranted,\tlactose-free\twhole\tmilk\tproducts\tand\tthe\tprescription\tof\tan\toral\tenzyme\nsupplement\tbefore\tmeals\tand\tsnacks\tcan\tbe\teasily\taccommodated.\nFood\tallergies\tand\ta\tgluten-free\tdiet\tare\tfar\tmore\tchallenging.\tMany\tpatients\tclaim\tto\tbe
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influences\tand\treligious\tbeliefs\trelative\tto\tthe\tpatient’s\tvegetarian\tstatus\tmust\tbe\texplored.\nInstitutions\tvary\twith\trespect\tto\ttheir\tmenu-planning\tprotocol.\tIn\tsome\tinstitutions\tthe\tmeal\tplan\nand\tfood\tchoices\tare\tfixed\n\tinitially\twithout\tpatient\tinput;\tas\ttreatment\tprogresses\tand\tweight\tis
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] |
restored,\tthe\tpatient\tgenerally\tassumes\tmore\tresponsibility\tfor\tmenu\tplanning.\tIn\tother\tinpatient\nprograms\tthe\tpatient\tparticipates\tin\tmenu\tplanning\tfrom\tthe\tbeginning\tof\ttreatment.\tSome\ninstitutions\thave\testablished\tguidelines\tthat\tthe\tpatient\tmust\tcomply\twith\tto\tmaintain\tthe\t“privilege”\nof\tmenu\tplanning.\tGuidelines\tmay\trequire
|
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] |
of\tmenu\tplanning.\tGuidelines\tmay\trequire\n\ta\tcertain\ttype\tof\tmilk\t(e.g.,\twhole\tvs.\tlow-fat)\tand\tthe\ninclusion\tof\tspecific\ttypes\tof\tfoods\tsuch\tas\tadded\tfats,\tanimal\tproteins,\tdesserts,\tand\tsnacks.\tA\ncertain\tnumber\tof\tservings\tfrom\tthe\tdifferent\tfood\tgroups\tmay\tbe\tprescribed\tat\tdifferent\tcalorie\nlevels.
|
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levels.\nMeal\tplanning\tmethods\tvary\tamong\ttreatment\tprograms,\tbut\tdata\tto\tsuggest\tthat\tone\tmethod\tis\nsuperior\tto\tanother\tis\tlacking.\tSome\tprograms\n\tuse\tfood\tgroup\texchanges,\tothers\tcustomize\ttheir\napproach.\tRegardless\tof\tthe\tmethod,\tAN\tpatients\tfind\tit\tdifficult\tto\tmake\tfood\tchoices\tand\tplan
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macronutrient\tdistribution.\tUnder\tthese\tcircumstances\tthe\tRDN\tmust\tuse\tcounseling\n\tskills\tto\tbegin\nthe\tprocess\tof\tdeveloping\ta\tplan\tfor\tnutritional\trehabilitation.\tAN\tpatients\tare\ttypically\nprecontemplative\tand,\tat\tbest,\tambivalent\tabout\tmaking\tchanges\tin\teating\tbehavior,\tdiet,\tand\tbody
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referred\tto\tFairburn\t(2008)\tfor\ta\tthorough\treview\tof\tCBT\ttechniques.\nEffective\tnutritional\trehabilitation\tand\tcounseling\tmust\tultimately\tresult\tin\tweight\tgain\tand\nimproved\teating\tattitudes\tand\tbehaviors.\tA\tcomprehensive\treview\tof\tnutrition\tcounseling\ttechniques
|
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] |
can\tbe\tfound\tin\t\nChapter\t13\n\tand\tin\tHerrin\tand\tLarkin\t(2013)\tand\tStellefson\tMyers\tand\tCaperton-\nKilburn\t(2017).\nAvoidant/restrictive\n\tfood\tintake\tdisorder\nPatients\twith\tARFID\trestrict/avoid\ttheir\tfood\tintake\tto\tthe\textent\tthat\tit\tis\tclinically\tsignificant;\nhowever,\tfood\trestriction\tis\tnot\tassociated\twith\tshape\tand\tweight\tconcerns.\tPatients\tmay\thave
|
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] |
sensory\tproblems\trelated\tto\tappearance,\ttaste,\tsmell,\tcolor,\tor\ttexture\tof\tfood.\tOthers\thave\ta\tfear\tof\nswallowing/vomiting\tand\tthey\tmay\thave\tdifficulty\twith\tsolid\tfoods\tor\tfoods\twith\n\ta\tlumpy\ttexture.\nThere\tare\tcurrently\tno\tevidence-based\tguidelines\tspecific\tto\tARFID\t(\nKohn,\t2016\n).\tSince\tARFID\tis
|
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Kohn,\t2016\n).\tSince\tARFID\tis\nassociated\twith\treluctance\tto\tnormalize\teating\tbehaviors,\tbehavioral\tmanagement\tmay\tbe\tthe\tfirst-\nline\ttreatment.\tBehavioral\tmanagement\tshould\tinclude:\t(1)\tan\tindividualized\tassessment\tof\tthe\nrestrictive\tbehaviors\tthat\tincludes\ta\tdetailed\thistory\tof\tsymptoms\tthat\tinterfere\twith\tnormal\n\teating
|
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eating\nand\tfood\tchoice,\t(2)\ta\tplan\tthat\tspecifically\treinforces\tthe\tsuccessful\teating\tof\trestricted\tfoods,\tand\n(3)\ta\tplan\tthat\tspecifically\treinforces\tthe\treversal\tof\tavoidant/restrictive\tbehaviors\t(\nSteinglass\tet\tal,\n2016\n).\tTreatment\tneeds\tto\tinclude\tindividualized\tgoals\tappropriate\tfor\tspecific\tsymptoms.\tFor
|
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example,\tdiscomfort\twith\toral\tsensations\tmay\trequire\tgraded\texposure\tto\tnovel\tfoods,\n\tand\tfear\tof\nchoking\tor\tvomiting\tmay\trequire\tspecific\tswallowing\texercises\ttargeted\tto\tthese\tsymptoms\n(\nSteinglass\tet\tal,\t2016\n),\tand\tcollaboration\twith\toccupational\ttherapists\twho\tspecialize\tin\tfeeding
|
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disorders\tmay\tbe\tnecessary.\tThe\tNine\tItem\tAvoidant/Restrictive\tFood\tIntake\tDisorder\tScreen\t(NIAS)\nmay\tuseful\tin\tthe\tassessment\tof\tARFID-related\teating\tbehaviors\tin\tthis\tpatient\tpopulation\t(\nZickgraf\nand\tEllis,\t2018\n)\nBulimia\tnervosa\nGuidelines\tfor\tMNT\tin\tBN\tare\tsummarized\tin\t\nBox\t21.8\n.\tBN\tis\tdescribed\tas\ta\tstate\tof\tdietary\tchaos
|
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] |
Box\t21.8\n.\tBN\tis\tdescribed\tas\ta\tstate\tof\tdietary\tchaos\ncharacterized\tby\tperiods\tof\tuncontrolled,\tpoorly\tstructured\teating,\tfollowed\tby\tperiods\tof\trestrained\nfood\tintake.\tThe\tRDN’s\trole\tis\tto\thelp\tdevelop\ta\treasonable\tplan\tof\tcontrolled\teating\twhile\tassessing\nthe\tpatient’s\ttolerance\tfor\tstructure.\nBOX\t21.8\nGuidelines\tfor\tMedical
|
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] |
BOX\t21.8\nGuidelines\tfor\tMedical\n\t\nNutrition\tTherapy\tof\tBulimia\tNervosa\n1.\t\nCaloric\tprescription\tfor\tweight\tmaintenance\nA.\n\tIf\tmetabolic\trate\tappears\tnormal,\tprovide\tdietary\treference\tintake\t(DRI)\tfor\tenergy\n(approximately\t2200\tto\t2400\tkcal/day).\nB.\n\tIf\tthere\tis\tstrong\tevidence\tof\ta\thypometabolic\trate:\nStart\tat\t1600\tto\t1800\tkcal/day
|
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] |
Start\tat\t1600\tto\t1800\tkcal/day\nIncrease\tin\t100\tto\t200\tkcal/week\tincrements\tup\tto\t2200\tto\t2400\tkcal/day\nB.\n\tMonitor\n\tbody\tweight\tand\tadjust\tcaloric\tprescription\tfor\tweight\tmaintenance.\nC.\n\tAvoid\tlow-calorie\tdiets\tas\tthese\tmay\texacerbate\tbingeing\tand\tpurging\tbehaviors.\n2.\t\nMacronutrients\nA.\n\tProtein\n(1)\n\t15%\tto\t20%\tkcal\n(2)
|
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] |
2.\t\nMacronutrients\nA.\n\tProtein\n(1)\n\t15%\tto\t20%\tkcal\n(2)\n\tMinimum:\trecommended\tdietary\tallowance\t(RDA)\tin\tg/kg\tof\tideal\tbody\tweight\n(3)\n\tHigh\tbiological\tvalue\tsources\nD.\n\tCarbohydrate\n(4)\n\t50%\tto\t60%\tkcal\n(5)\n\tProvide\tinsoluble\tfiber\tsources\n\tfor\ttreatment\tof\tconstipation\nE.\n\tFat\n(6)\n\t30%\tkcal\n(7)\n\tProvide\tsource\tof\tessential\tfatty\tacids\n3.
|
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Fat\n(6)\n\t30%\tkcal\n(7)\n\tProvide\tsource\tof\tessential\tfatty\tacids\n3.\t\nMicronutrients\nA.\n\t100%\tRDA\tmultivitamin/mineral\tsupplement\nB.\n\tAvoid\tsupplemental\tiron\tif\tpatient\tis\tconstipated\n4.\n\tEnergy\tdensity\nC.\n\tProvide\tfoods\twith\ta\trange\tof\tenergy\tdensities\nD.\n\tProvide\tan\toverall\tdiet\twith\tan\tenergy\tdensity\tof\tapproximately\t1.0\n5.\t\nDiet\tvariety\nE.
|
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5.\t\nDiet\tvariety\nE.\n\tPromote\n\tintake\tof\ta\twide\tvariety\tof\tfoods\tand\tbeverages\twithin\tall\tfood\tgroups\nDuring\tthe\tinitial\tonset\tof\tBN,\tmuch\tof\tthe\tpatient’s\teating\tand\tpurging\tbehavior\tis\taimed\tat\nweight\tloss.\tLater\tin\tthe\tprocess,\tthe\tbehaviors\tmay\tbe\thabitual\tand\tout\tof\tcontrol.\tEven\tif\tthe
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patient\tis\tlegitimately\toverweight,\timmediate\tgoals\tmust\tbe\tinterruption\tof\tthe\tbinge-and-purge\ncycle,\trestoration\tof\tnormal\n\teating\tbehavior,\tand\tstabilization\tof\tbody\tweight.\tAttempts\tat\tdietary\nrestraint\tfor\tthe\tpurpose\tof\tweight\tloss\ttypically\texacerbate\tbinge-purge\tbehavior\tin\tBN\tpatients.
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Patients\twith\tBN\thave\tvarying\tdegrees\tof\tmetabolic\tefficiency,\twhich\tmust\tbe\ttaken\tinto\taccount\nwhen\tprescribing\tthe\tbaseline\tdiet.\tAssessment\tof\tREE\talong\twith\tclinical\tsigns\tof\ta\thypometabolic\nstate,\tsuch\tas\ta\tlow\tT\n3\n\tlevel\n\tand\tcold\tintolerance,\tare\tuseful\tin\tdetermining\tthe\tcaloric\tprescription.
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] |
If\ta\tlow\tmetabolism\tis\tsuspected,\ta\tcaloric\tprescription\tof\t1600\tto\t1800\tcalories\tdaily\tis\ta\treasonable\nplace\tto\tstart;\thowever,\tthis\tprescription\tshould\tbe\ttitrated\tupwards,\tin\t100\tto\t200\tcalorie\tper\tweek\nincrements,\tto\tstimulate\tthe\tmetabolic\trate.\tUltimately,\ta\tweight\tmaintenance\tdiet\tof\t2200\tto\t2400
|
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] |
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