Introduction:
Nutrition therapy is an integral part of the Eating Disorder (ED) management proven to help patients to normalise eating patterns and psychologically accept body image.
Case Report :
This is a case of an 11-year old Chinese girl admitted to Paediatric ward for Anorexia Nervosa. She also had underlying anxiety problem and refused schooling since September 2016. During admission she weighed 34 kg and her height was 149 cm with BMI of 15.2 kg/m2. Her maximum weight was 53 kg in October 2016. According to mom, she skipped her breakfast and ate only 2 slices of bread for lunch and 1 medium size red apple for dinner. Usually she drinks a lot of water to prevent hunger. Estimated energy intake at home was 210 kcal with protein 4 g/day. She claimed she is a vegetarian where she could only eat fruits and vegetables. Her nutrition diagnosis was Disordered eating patterns related to environmental-related obsessive desire to be thin as evidenced by avoidance of food or energy-containing beverages and anorexia nervosa. The objective of dietary management was to prescribe energy and protein to meet nutritional needs by providing complete, balance and variety of foods. The energy requirement was 1900 kcal (based on RNI) and protein requirement was 36 g (1 g/kg). Multidisciplinary team approach focuses on nutrition education including balanced meal, amount and type of carbohydrate, protein and fat that her body needs. Portion size education and variety of foods also was part of nutrition intervention. Structured meal plan was given daily to the patient. Oral nutrition supplement given during initial stages of management. On the other hand, doctors and psychologist worked on psychotherapy to control her anxiety and inappropriate perception of her body image. Close monitoring done to evaluate intake amount, acceptance of meals served and ability to consume variety of food selection. Day 8 in wards, patient managed to gain 3 kg and include porridge/noodles into her diet. She was allowed to discharge and will continue her follow-up as out-patient in clinic.
Conclusion:
Patient focus multidisciplinary approach is essential to improve eating behaviour, cognitive function and for effective long term solution.
