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Open Access Highly Accessed Review

Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment

Enrica Marzola1, Jennifer A Nasser2, Sami A Hashim3, Pei-an Betty Shih4 and Walter H Kaye4*

Author Affiliations

1 Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy

2 Department of Nutrition Sciences, Drexel University, 19102 Philadelphia, PA, USA

3 Department of Medicine, St. Luke's/Roosevelt Hospital Center, 10025 New York, NY, USA

4 UCSD Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C – 207 La Jolla, 92037 San Diego, CA, USA

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BMC Psychiatry 2013, 13:290  doi:10.1186/1471-244X-13-290

Published: 7 November 2013


Restoration of weight and nutritional status are key elements in the treatment of anorexia nervosa (AN). This review aims to describe issues related to the caloric requirements needed to gain and maintain weight for short and long-term recovery for AN inpatients and outpatients.

We reviewed the literature in PubMed pertaining to nutritional restoration in AN between 1960–2012. Based on this search, several themes emerged: 1. AN eating behavior; 2. Weight restoration in AN; 3. Role of exercise and metabolism in resistance to weight gain; 3. Medical consequences of weight restoration; 4. Rate of weight gain; 5. Weight maintenance; and 6. Nutrient intake.

A fair amount is known about overall caloric requirements for weight restoration and maintenance for AN. For example, starting at 30–40 kilocalories per kilogram per day (kcal/kg/day) with increases up to 70–100 kcal/kg/day can achieve a weight gain of 1–1.5 kg/week for inpatients. However, little is known about the effects of nutritional deficits on weight gain, or how to meet nutrient requirements for restoration of nutritional status.

This review seeks to draw attention to the need for the development of a foundation of basic nutritional knowledge about AN so that future treatment can be evidenced-based.

Anorexia nervosa; Treatment resistance; Nutritional rehabilitation; Refeeding; Weight restoration; Weight maintenance; Caloric requirements; Refeeding syndrome