A. Malnutrition related to under consumption of food

B. Malnutrition related to over-nutrition (excessive consumption of food)

C. Response to hormones and/or neurotransmitters

Malnutrition due to underconsumption of energy-producing macronutrients (carbohydrates, proteins, fats) and/or micronutrients relative to individual need is a concern with anorexia nervosa, bulimia nervosa, and avoidant restrictive food intake disorder. Brain research underscores the importance of the multidisciplinary team in the multifactorial origin of eating disorders, with altered brain function as a result of malnutrition (either over-nutrition or under-nutrition) playing important roles.

Anxiety and depressive states related to fear of eating affect release of adrenocorticotropic hormone, cortisol, dopamine, and catecholamines, especially in the early stages of feeding the semi-starved anorexia nervosa patient when the thermic effect of food may increase.

 The severity of underweight in anorexia nervosa and the level of over-concern with body shape to corticotropin-releasing hormone and subsequently to cortisol levels are also associated.

Cortisol, an anorexigenic catabolic marker that leads to mobilization of glucose, free fatty acids, and amino acids from endogenous stores during stress, subsequently decreases lean body mass, with increased energy expenditure. Thus, cortisol may be at least partially responsible for loss of desire to eat and difficulty of weight restoration.

Understanding Nutritional Needs of Patients With Eating Disorders

, by Christina Scribner, MS, RDN, CEDRD, CSSD, on which this quiz is based.

1. Rigaud D, Verges B, Colas-Linhart N, et al. Hormonal and psychological factors linked to the increased thermic effect of food in malnourished fasting anorexia nervosa. J Clin Endocrinol Metab. 2007;92:1623-1639.

2. Castellini G, Castellani W, Lelli L, et al. Association between resting energy expenditure, psychopathology and HPA-axis in eating disorders. World J Clin Cases. 2014;2:257-264.

Eating Disorders

Neuropsychiatry

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