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Dietary energy density and diet variety as predictors of outcome in anorexia nervosa^1,2,3

¹ From the Eating Disorders Research Unit, New York State Psychiatric Institute, Columbia College of Physicians and Surgeons, Columbia University, New York, NY (JES, LESM, EA, MJD, and BTW), and the Department of Health and Behavior Studies, Program in Nutrition, Teachers College, Columbia University, New York, NY (IRC and RLW)

Background:Anorexia nervosa (AN) is a serious psychiatric illness associated with significant morbidity and mortality. Successful treatment results in weight restoration, but recidivism is common, and the rate of relapse is estimated to be as high as 50%. Maintenance of a healthy diet is central to the recovery process, but the relation between diet and relapse has not been investigated in AN patients.

Objective:The objective of the study was to determine whether diet energy density and diet variety in recently weight-restored women with AN predict outcome.

Design:After gaining weight to a body mass index (BMI; in kg/m²) of 20, 47 hospitalized women completed 4-d food records, from which a mean diet energy density score (DEDS) and a mean diet variety score (DVS) were calculated. Outcome was determined at study end by using modified Morgan-Russell criteria, and it was dichotomized as "treatment success" or "treatment failure." Data were analyzed by using Student's t test. A logistic regression model was constructed to evaluate the effects of DEDS, DVS, and caloric intake on outcome.

Results:Groups did not differ significantly in mean measures of age, admission and weight-restored BMI, or caloric intake. However, DEDS and DVS were significantly higher in the success group than in the failure group. The success and failure groups were followed for a mean of 240 and 170 d, respectively. In the logistic regression model, DEDS (P = 0.016) and DVS (P = 0.048) but not caloric intake (P = 0.585) significantly predicted outcome.

Conclusion:In recently weight-restored women with AN, lower DEDS and DVS but not caloric intake were associated with poor outcome.