To the limit of extreme malnutrition

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Extreme malnutrition with body mass index (BMI) as low as 10 kg/m 2 is not uncommon in anorexia nervosa, with survival enabled through complex metabolic adaptations. In contrast, outcomes from hunger strikes and famines are usually fatal after weight loss to about 40% below expected body weight, corresponding to BMI 12 to 13 kg/m 2 in adults. Thus, many years of adaptation in adolescent-onset anorexia nervosa, supported by supplements of vitamins and treatment of intercurrent diseases, may allow survival at a much lower BMI. However, in the literature only a few cases of survival in patients with BMI <9 kg/m 2 have been described. We report on the case of a 29-y-old woman who was successfully treated in a specialized unit. She had a BMI of 7.8 kg/m 2. To our knowledge, this level of extreme malnutrition has not previously been reported. The present case emphasizes the importance of adherence to guidelines to decrease refeeding complications.

Original languageEnglish
Issue number1
Pages (from-to)146-148
Number of pages3
Publication statusPublished - 1. Jan 2016


  • Anorexia nervosa
  • Eating disorder
  • Refeeding syndrome


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