• Jacob Frølich, Camilla Viola Buskbjerg Palm, and Rene K Støving.
• Centre for Eating Disorders, Department of Endocrinology, Odense University Hospital, Odense, Denmark. Electronic address: Jacob.froelich@rsyd.dk.
• Nutrition. 2016 Jan 1; 32 (1): 146-8.

AbstractExtreme 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.Copyright © 2016 Elsevier Inc. All rights reserved.

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