Level of ghrelin with Anorexia Nervosa (AN) patients. Subgroup AN: with and without tubefeeding.

Research Background: PICOWO (Psychological Institute for Consultation,
Education and Scientific Research), in coöperation with the University of
Amsterdam (Prof. Dr. J. Treur, Artificial Intelligence), has developed a
simulationmodel for eating disorders (Bosse, Delfos, Jonker & Treur, 2003).
An ongoing doctoral dissertation study is dedicated to enhancing this model
with the implications of ghrelin (Msc. F. Both, promotor Prof. J.
Treur/co-promotor Dr. M.Delfos).
In line with the current study, clinical data will be collected concerning
the implications of ghrelin with AN-patients for the purpose of model
improvement.


Hypothesis:
1. The level of ghrelin in AN patients is higher than the level in healthy
volunteers.
2. The level of ghrelin in AN patients with tube feeding will not or hardly
rise in comparison to AN patients without tube feeding, with comparable BMI.
3. AN patients recognize the appetite that is attented by fear which develops
at the beginning of feeding.
4. When ghrelin indeed appers to be lower in tube feeding and the appetite is
low, psychologic education could be helpfull to accept the tube feeding as a
fase of treatment.
5.When ghrelin is correlated with BMI we can expect that the levels will by
higher in patients with a lower BMI: there is a negative correlation.
6. An important hypothesis is that the level of ghrelin will not or hardly rise
in tube feeding, which will cause a decrease of fear for binge eating -like
feeding and play a significant role in the treatment of AN.

Research Goals: During the pre-study several clues indicated that hunger is
not increased when tubefeeding is administered. This could
point to a lower ghrelin production during tubefeeding,
indicating that tubefeeding is the next step in the
psychological battle against the hunger that overwhelmes AN-patients and
causes fear, since the exact same hunger is minimalized at first due to
tubefeeding. Studying the implication of ghrelin-levels with
patients suffering from AN is expected to be highly valuable, especially
when monitoring the difference in effect for tubefeeding and non-tubefeeding
patients. Several hypotheses have been developed for this
purpose.

Research Methodology: A qualitative study on ghrelin-levels in case of
eating-disorders. Procedures: No adaptation in the existing
treatment method of any individual patient. Patients will be studied on one
day, during the morning. The following procedures will be executed:
1 Single-time drip administering, unless the patient prefers multiple
punctures. 6ml blood will be taken between 10 times, each half hour.
2 Hunger-survey's (duration:few minutes)
Regular measurements: weight, fatpercentage, standard bloodparameters:
regular measurements on hospital charts

Description and estimation concerning risk and pressure/load/burden:
The burden on the patient entails two interventions on top of
regular treatment
-Blood to be taken 10 x 6 ml after drip administering. Above average
bloodtaking, however not an intervention outside the regular diagnostic, no
increased risk in patient-side.
-Hunger-survey: no above average risk. Complexity not above high-school
level.
Measurements: weight, fatpercentage, regular (blood)measurements as
determined by hospital