CPG for Eating Disorders

9.2. Nutritional Counselling (NC)9.2.1. Anorexia nervosa9.2.1.1. What is the efficacy of NC in patients with AN?The answer is based on the NICE CPG (2004) 30 . Two high-quality (1++) SRSE, one elaboratedby the AHRQ of the US (2006) 31 and a more recent one conducted by Bulik, et al. (2007) 202 . Nonew evidence has been identified in the updated search.Scientific EvidenceIn a further RCT (Pike, 2003; USA) 210 , CBT (N=18) was compared to NC (N=15) inwomen (18-45 years) with AN who had been under inpatient treatment for 12months. After weight restoration, a lower percentage of failures, a higher percentageof positive results and a longer time period until recurrence were reported in thegroup that received CBT. However, one of the limitations found in this study was thefact that many patients had received concomitant antidepressant treatment.RCT1+Summary of the EvidenceCPG 30SRSE 311++There is limited evidence to indicate that in inpatients with AN after weightrestoration, CBT is superior to NC in the proportion of recoveries and relapses.(1 RCT; N=33; Pike, 2003) 210 .There is little evidence that CBT is superior to NC in the proportion of patientswho recover and in weight gain.Recommendations(See recommendations 9.GM.1. to 9.GM.5.)9.2.1.2. What is the safety of NC in patients with AN?The answer is based on the evidence described for NC efficacy (question 9.2.1.1.).Scientific EvidenceAN RCT (Pike, 2003) 210 reported an overall dropout rate of 9% (CBT: 0% vs. NC:20%). There was one case of depression and suicidal ideation. The design of thisRCT is limited by the fact that many studied patients were also takingantidepressants, rendering its results questionable.RCT1+91CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS