None listed
Conditions
Brief summary
We propose a comprehensive investigation of the effects of a standardised, intensive refeeding regime on GI function in adolescent patients with restrictive AN, which will form the fundamental basis for subsequent acute investigative and longer-term intervention studies. The study aims to examine whether gastrointestinal (GI) hormone and appetite responses to, and gastric emptying of, a mixed-nutrient oral test meal in anorexia nervosa (AN) patients are modified in response to changes in nutrient exposure and energy expenditure occurring during the refeeding period. Thirty adolescent participants with AN (age 12-19 years) will be recruited during their inpatient admission at the Children’s Hospital at Westmead and Westmead Hospital. They will be studied on 3 separate occasions during their nutritional rehabilitation, and their results compared to thirty age-matched healthy-weight adolescent control participants assessed on one occasion. On each study day, participants in both the AN and control groups will undergo indirect calorimetry to assess energy expenditure. After this, they will receive an oral test meal, following which, GI hormones and appetite perceptions will be measured. Gastric emptying will also be measured on all study days. Specific hypotheses: (1) In comparison with healthy, age-matched controls, adolescents with AN will have exaggerated ‘anorexigenic’ gut hormone secretion and delayed gastric emptying in response to an intragastric mixed-nutrient test meal. (2) With increased GI nutrient exposure during refeeding over 2 weeks, gut hormone concentrations, blood glucose and gastric emptying will return towards healthy levels. Outcome measures: Gut hormone concentrations, gastric emptying, appetite perceptions, blood glucose, GI symptoms. Study implications: GI hormone, blood glucose and gastric emptying disturbances in AN will be comprehensively characterised before, during and after treatment, identifying possible GI mechanisms underlying the starvation condition and potential treatment interventions.
Interventions
Adolescent participants with anorexia nervosa (AN) (age 12-19 years) will be recruited during their inpatient admission at the Children’s Hospital at Westmead and Westmead Hospital. They will be studied on 3 separate occasions during their nutritional rehabilitation, at baseline (within 5 days of admission), and one and two weeks post-baseline. Their results will be compared to age-matched healthy-weight adolescent control participants assessed on one occasion. On each study day, participants in
Adolescent participants with anorexia nervosa (AN) (age 12-19 years) will be recruited during their inpatient admission at the Children’s Hospital at Westmead and Westmead Hospital. They will be studied on 3 separate occasions during their nutritional rehabilitation, at baseline (within 5 days of admission), and one and two weeks post-baseline. Their results will be compared to age-matched healthy-weight adolescent control participants assessed on one occasion. On each study day, participants in both the AN and control groups will undergo indirect calorimetry to assess energy expenditure. After this, they will receive an oral test meal of 2 Weetbix with 150mL full cream milk, an apple and a 250 mL full cream milk drink (2002kJ, 65.16g CHO, 19.12g protein, 14.92g fat) , following which, GI hormones and appetite perceptions will be measured. Gastric emptying will also be measured on all study days.
Sponsors
University of Adelaide
Eligibility
Sex/Gender
All
Age
12 Years to 19 Years
Healthy volunteers
Yes
Inclusion criteria
Participants will include 30 adolescent females with AN (restricting sub-type) (age: 12-19 years) admitted to the Departments of Adolescent Medicine at the CHW and Westmead Hospital, as well as 30 healthy-weight (BMI between 25th and 75th percentiles), aged-matched adolescent female controls. Potential AN participants will meet the diagnosis of anorexia nervosa as per the Diagnostic and Statistical Manual of Mental Health Disorders (4th edition) criteria, and will only be studied once medically stable (i.e. Heart rate >50bpm overnight). Adolescent females must have also reached Tanner stage 3 of development.
Exclusion criteria
1) significant GI disease or previous surgery 2) current medical instability 3) current use of any medications which may affect GI function, weight or appetite 4) diabetes mellitus 5) epilepsy 6) pre-existing cardiovascular/respiratory disease 7) any other significant illness as assessed by the investigator 8) pregnancy or lactation 9) current use of contraceptive medication (e.g. Depo-Provera, Norplant, hormone releasing IUD’s) 11) intake of > 20 g alcohol per day 12) smokers (cigarettes, cigars, marijuana) 13) donation of blood in the 12 weeks prior to enrolment in the study, and participants will also be instructed to abstain from donating blood for 12 weeks after study completion. 14) high performance athletes 15) unable to comprehend study protocol 16) participation in any other research project within the last 3 months 18) abnormal liver function tests 19) have iron or haemoglobin levels below the normal range, as assessed with a screening blood test on admission, and in the week prior to each study day, conducted as part of routine clinical care.
Outcome results
None listed