Prise en charge nutritionnelle des troubles du comportement alimentaire chez l'adolescent

This review underlines the importance of a structured nutritional treatment in eating disorders particularly in anorexia nervosa, its physiopathological bases and influence on short and long term prognosis of the disease. Somatic and neuropsychological effects of undernutrition, their consequences in terms of morbidity, mortality and sequelae are underlined. The modalities of refeeding at home and during hospitalisation, the necessity of renutrition to a right target weight, and, after that, the importance to work for maintaining a good nutritional state are indicated. The frequency of relapses (around 50%) is underlined, as well as the importance of "therapeutic alliance" between physicians and families (and, as soon as possible, with anorectic adolescent) and the advantage of a good collaboration between psychiatric and pediatric teams. They discuss more briefly about nutritional aspects of bulimia management. Finally the authors state on their own results about 161 patients followed for more than 4 years of which 144 participate in an evaluation (68% of good, 23.3% of intermediary and 8.7% of bad results) attesting of progress versus an anterior evaluation and best results than 2 other studies, published in 1991 and 2001, with the same tests for evaluation.