1. The document discusses clinical and organizational aspects of eating disorders (DCA). It analyzes epidemiology from the perspective of citizenship and the rights of individuals and populations. 2. It questions whether individuals are considered citizens based on meeting diagnostic codes for reimbursement, or when experiencing marginalization and hardship. 3. Results from a study on patients with anorexia nervosa admitted to a residential facility are presented. Key findings include: mean BMI and phase angle at admission indicated severe malnutrition; higher phase angle at discharge was associated with BMI between 15-17 rather than normal weight.

1. ASPETTI CLINICO ORGANIZZATIVI IN AMBITO DEI DCA
Dr. Leonardo Mendolicchio
Psichiatra Psicoanalista
Direttore Sanitario Villa Miralago
Membro Ordinario Associazione Mondiale di Psicoanalisi e
Scuola Lacaniana di Psicoanalisi

3. Epidemiologia di cittadinanza
epidemiologia disciplina del dettaglio o del generale che si mette
al servizio della cittadinanza
epidemiologia di cittadinanza ha il compito di rendere visibili le
persone e le popolazioni nei loro corpi, esistenze, così come essi
esistono e si differenziano nei diversi sottosistemi
amministrativi-istituzionali da cui vengono ‘trattati’, nei contesti
sociogeografici da essi abitati.
La capacità descrittiva-rivelatrice propria dell’epidemiologia è
così ricondotta, nel linguaggio e nelle indicazioni operative, a
categorie di diritto, con una rilettura dei risultati in termini di
violazioni, evitabilità, identificazione di persone, popolazioni,
bisogni ben localizzabili, al fine di costruire progettualità capaci e
coerenti di cambiamento.

4. Cittadinanza:
Si è soggetti normalmente o emergenzialmente
portatori di diritti?
Si è cittadini se si rientra in un codice
diagnostico rimborsabile, o quando si è portatori
di marginalità, disagio, per cui vale l’etica ma
non il diritto esigibile della solidarietà?

5. Etica Vs Diritto

6. Graph. I – PA of the subjects stratified per BMI.
As already explained, some exams did not give reliable results
because of the serious conditions of the patients. Therefore, in
this population, 31.8% of the exams (N=42) were not consid-
ered in the further analysis we made.
Table 5 shows the results obtained from the analysis of the
water distribution in all patients. As expected, most patients
showed a level of TBW and ECW exceeding normal levels, due
to their status of severe malnutrition.
Table 5. Number of patients and percentage among patients
with reliable results:
N Percentage%
TBW at normal levels 7 7.8
TBW exceeding normal levels 79 87.8
TBW under normal levels 4 4.4
ECW at normal levels 20 22.2
ECW exceeding normal levels 57 63.3
ECW under normal levels 13 14.4
Minors 35 14.8 ± 1.6
Table 3 shows the mean PA of the subjects in the whole group
and divided per sex and age. Mean PA of whole group was 4.91
± 1.16. There were no significant differences in PA between
males and females and between adults and Minors.
Table 3. Mean PA ± Standard Deviation Score of the subjects divided
per sex and age.
N Mean ± Std.
Dev.
All patients 132 4.91 ± 1.16
Males 8 4.95 ± 0.95
Females 124 4.91 ± 1.17
Adults 97 4.91 ± 1.27
Minors 35 4.96 ± 0.79
It was decided to stratify the patients depending on BMI. We
individuated seven categories of patients:
BMI kg/m2
N Percentage%
> 13 27 20.5
Between 13.1 and 14 22 16.7
Between 14.1 and 15 32 24.2
Between 15.1 and 16 24 18.2
Between 16.1 and 17 15 11.4
Cite this article: Claudia M. Comparison between Body Mass Index and Phase Angle in Predicting Nutritional Status in Patients with Anorexia Nervosa. J J FoodNutri. 2015, 2(3): 016.
this population, 31.8% of the exams (N=42) were not co
ered in the further analysis we made.
Table 5 shows the results obtained from the analysis o
water distribution in all patients. As expected, most pa
showed a level of TBW and ECW exceeding normal levels
to their status of severe malnutrition.
Table 5. Number of patients and percentage among pa
with reliable results:
N Percentage
TBW at normal levels 7 7.8
TBW exceeding normal levels 79 87.8
TBW under normal levels 4 4.4
ECW at normal levels 20 22.2
ECW exceeding normal levels 57 63.3
ECW under normal levels 13 14.4
Males 8 4.95 ± 0.95
Females 124 4.91 ± 1.17
Adults 97 4.91 ± 1.27
Minors 35 4.96 ± 0.79
It was decided to stratify the patients depending on BMI. We
individuated seven categories of patients:
BMI kg/m2
N Percentage%
> 13 27 20.5
Between 13.1 and 14 22 16.7
Between 14.1 and 15 32 24.2
Between 15.1 and 16 24 18.2
Between 16.1 and 17 15 11.4
Cite this article: Claudia M. Comparison between Body Mass Index and Phase Angle in Predicting Nutritional Status in Patients with Anorexia Nervosa. J J FoodNutri. 2015, 2(3
Between 17.1 and 18 8 6.1
< 18 4 3.0
Then we compared the PA among the different categories of
BMI; the results are presented in graphic I. As the graphic
shows, there is a statistically significant difference in PA among
the categories of BMI: patients having a BMI between 15.1 and
17 have a better PA than those with major and minor BMI. The
analysis of variance confirmed the result (p < 0.02).
Graph. I – PA of the subjects stratified per BMI.
As already explained, some exams did not give reliable results
because of the serious conditions of the patients. Therefore, in
this population, 31.8% of the exams (N=42) were not consid-
ered in the further analysis we made.
mong
hole
dif-
and
vided
.
roup
4.91
ween
vided
6
5
3
JacobsJournal of Food and Nutrition
Comparison between Body Mass Index and Phase Angle in Predicting Nutritional
Status in Patients with Anorexia Nervosa
Maffo
n
i Cl audi a 1*
, Apicella1
, Dozio1
, Antonelli1
, Mendolicchio1
1
Villa Miralago, Cuasso al Monte, Italy
*Corresponding author: Dr. Maffoni Claudia, Villa Miralgo, Via Casamora, 1921050 Cuasso al Monte (Va, Italy),
Tel: +39349/4746334; Email: claudia.maffoni@gmail.com
Received: 08-06-2015
Accepted: 09-07-2015
Published:
Copyright: © 2015 Maffoni
Research Article
Abstract
Background: Phase angle (PA) is an important parameter for the diagnosis of malnutrition in many diseases, but there are
only a few studies that demonstrate its importance and efficacy in patients affected by Anorexia Nervosa (AN). Moreover,
BMI is only a partial predictor of nutritional status of patients with AN, as there is a great variety of other factors that can
affect its utility and that can be detected through bioimpedance.
Methods: Phase angle values stratified by BMI were measured in a population of patients with AN at admission in a resi-
dential care setting.
Results: Our population has a mean BMI of 14,7 ± 1.7 kg/m2
and a mean PA of 4.91 ± 1.16, both indicating a status of severe
malnutrition. The comparison between PA and BMI showed that, in this population, a higher PA is not associated to a higher
BMI, but to a BMI between 15 and 17 kg/m2
.
Conclusions: The results suggest the utility of PA as a better parameter for the diagnosis of malnutrition in patients with AN
and that, in clinical practice, we could aim to a BMI between 15 and 17 kg/m2
than to a BMI corresponding to normal weight,
less sustainable for this kind of patients and easily leading to a major risk of relapse.
Keywords: Phase angle; Anorexia Nervosa; Malnutrition; Biompedance; Body Mass Index
atus in Patients with Anorexia Nervosa. J J FoodNutri. 2015, 2(3):
A better outcome is, therefore, correlated to
ndition at admission and a minor duration of

7. 1.11 Inpatient and day patient treatment
1.11.1
Admit people with an eating disorder whose physical health is severely
compromised to a medical inpatient or day patient service for medical
stabilisation and to initiate refeeding, if these cannot be done in an outpatient
setting.
1.11.2
Do not use an absolute weight or BMI threshold when deciding whether to
admit people with an eating disorder to day patient or inpatient care.
1.11.3
When deciding whether day patient or inpatient care is most appropriate, take
the following into account:
The person's BMI or weight, and whether these can be safely managed in a day
patient service or whether the rate of weight loss (for example more than 1 kg
a week) means they need inpatient care.
Whether inpatient care is needed to actively monitor medical risk parameters
such as blood tests, physical observations and ECG (for example bradycardia
below 40 beats per minute or a prolonged QT interval) that have values or
rates of change in the concern or alert ranges: refer to Box 1 in Management
of Really Sick Patients with Anorexia Nervos(MARSIPAN), or Guidance 1 and 2
in junior MARSIPAN.
The person's current physical health and whether this is significantly declining.
Whether the parents or carers of children and young people can support them
and keep them from significant harm as a day patient.
Linee Guida NICE 2017

8. 15
Disorder Inventory. IC=Ineffectiveness. IPC=Interpersonal Problems, APC=Affective Problems.
OC=Overcontrol. GPMC=General Psychological Maladjustment. EDRC=Eating Disorder Risk.
Bolded values are significant (p<0.005).
Admission Discharge T statistic Effect size
(Cohen’s d)
BMI 15.18 17.42 -5.187
p<0.001*
0.71
PhA 4.97 5.61 -3.407
p=0.003*
0.59
MMPI-Hs 65.29 60.42 1.280
p=0.227
0.36
MMPI-D 71.57 61.17 2.256
p=0.045*
0.56
MMPI-Hy 61.74 57.17 0.664
p=0.520
0.19
MMPI-Pd 63.40 62.92 0.376
p=0.714
0.11
MMPI-Mf 47.31 49.17 -1.436
p=0.179
0.39
MMPI-Pa 65.17 62.00 0.321
p= 0.754
0.09
MMPI-Pt 64.83 56.17 1.601
p=0.138
0.43
MMPI-Sc 65.77 61.42 1.301
p=0.220
0.78
MMPI-Ma 54.54 54.92 -0.750
p=0.469
0.22
MMPI-Si 60.86 56.08 1.057
p=0.313
0.30
BUT-GSI 2.55 1.99 4.173
p<0.001*
0.64
EDI 3-EDRC 70.63 57.40 3.304
p=0.003
0.56
EDI 3-IC 79.00 63.08 3.528
p=0.002*
0.58
EDI3-IPC 72.58 55.32 3.354
p=0.003*
0.56
EDI 3-APC 70.61 57.96 3.216
p=0.004*
0.54
15
discharge. BMI=Body Mass Index. PhA=phase angle. MMPI=Multiphasic Personality Inventory.
Hs=hypochondria. D=depression. Hy=hysteria. Pd=psychopathic deviate. Mf=masculine-
feminine interests. Pa=paranoia. Pt=psychasthenia. Sc=schizophrenia. Ma=mania. Si=social
introversion/extroversion. BUT-GSI=Body Uneasiness Test-Global Score Index. EDI-3=Eating
Disorder Inventory. IC=Ineffectiveness. IPC=Interpersonal Problems, APC=Affective Problems.
OC=Overcontrol. GPMC=General Psychological Maladjustment. EDRC=Eating Disorder Risk.
Bolded values are significant (p<0.005).
Admission Discharge T statistic Effect size
(Cohen’s d)
BMI 15.18 17.42 -5.187
p<0.001*
0.71
PhA 4.97 5.61 -3.407
p=0.003*
0.59
MMPI-Hs 65.29 60.42 1.280
p=0.227
0.36
MMPI-D 71.57 61.17 2.256
p=0.045*
0.56
MMPI-Hy 61.74 57.17 0.664
p=0.520
0.19
MMPI-Pd 63.40 62.92 0.376
p=0.714
0.11
MMPI-Mf 47.31 49.17 -1.436
p=0.179
0.39
MMPI-Pa 65.17 62.00 0.321
p= 0.754
0.09
MMPI-Pt 64.83 56.17 1.601
p=0.138
0.43
MMPI-Sc 65.77 61.42 1.301
p=0.220
0.78
MMPI-Ma 54.54 54.92 -0.750
p=0.469
0.22
MMPI-Si 60.86 56.08 1.057
p=0.313
0.30
BUT-GSI 2.55 1.99 4.173
p<0.001*
0.64
EDI 3-EDRC 70.63 57.40 3.304
p=0.003
0.56
EDI 3-IC 79.00 63.08 3.528
p=0.002*
0.58
EDI3-IPC 72.58 55.32 3.354
p=0.003*
0.56
EDI 3-APC 70.61 57.96 3.216
p=0.004*
0.54
BMI at admission (Kg/m2) 15.18 2.15
BMI at discharge (Kg/m2) 17.42 1.53
PhA at admission 4.97 0.78
PhA at discharge
Body weight at admission (Kg)
Body weight at discharge (Kg)
Fat free mass at admission (Kg)
Fat free mass at discharge (Kg)
Fat mass at admission (Kg)
Fat mass at discharge (Kg)
5.61
37.6
49.8
34.1
38.2
3.5
11.6
0.60
5.2
4.3
4.1
5.4
1.7
4.2
Duration of treatment (months) 12.4 4.7
Table 2. Group mean changes in BMI/PhA/assessment scores between admission and
discharge. BMI=Body Mass Index. PhA=phase angle. MMPI=Multiphasic Personality Inventory.
Hs=hypochondria. D=depression. Hy=hysteria. Pd=psychopathic deviate. Mf=masculine-
feminine interests. Pa=paranoia. Pt=psychasthenia. Sc=schizophrenia. Ma=mania. Si=social
introversion/extroversion. BUT-GSI=Body Uneasiness Test-Global Score Index. EDI-3=Eating
Disorder Inventory. IC=Ineffectiveness. IPC=Interpersonal Problems, APC=Affective Problems.
OC=Overcontrol. GPMC=General Psychological Maladjustment. EDRC=Eating Disorder Risk.
Bolded values are significant (p<0.005).
Admission Discharge T statistic Effect size
(Cohen’s d)
BMI 15.18 17.42 -5.187
p<0.001*
0.71
PhA 4.97 5.61 -3.407
p=0.003*
0.59
MMPI-Hs 65.29 60.42 1.280
p=0.227
0.36
MMPI-D 71.57 61.17 2.256
p=0.045*
0.56
MMPI-Hy 61.74 57.17 0.664
p=0.520
0.19
MMPI-Pd 63.40 62.92 0.376
p=0.714
0.11
MMPI-Mf 47.31 49.17 -1.436
p=0.179
0.39
MMPI-Pa 65.17 62.00 0.321
p= 0.754
0.09
MMPI-Pt 64.83 56.17 1.601 0.43
BMI at admission (Kg/m2) 15.18 2.15
BMI at discharge (Kg/m2) 17.42 1.53
PhA at admission 4.97 0.78
PhA at discharge
Body weight at admission (Kg)
Body weight at discharge (Kg)
Fat free mass at admission (Kg)
Fat free mass at discharge (Kg)
Fat mass at admission (Kg)
Fat mass at discharge (Kg)
5.61
37.6
49.8
34.1
38.2
3.5
11.6
0.60
5.2
4.3
4.1
5.4
1.7
4.2
Duration of treatment (months) 12.4 4.7
Table 2. Group mean changes in BMI/PhA/assessment scores between admission and
discharge. BMI=Body Mass Index. PhA=phase angle. MMPI=Multiphasic Personality Inventory.
Hs=hypochondria. D=depression. Hy=hysteria. Pd=psychopathic deviate. Mf=masculine-
feminine interests. Pa=paranoia. Pt=psychasthenia. Sc=schizophrenia. Ma=mania. Si=social
introversion/extroversion. BUT-GSI=Body Uneasiness Test-Global Score Index. EDI-3=Eating
Disorder Inventory. IC=Ineffectiveness. IPC=Interpersonal Problems, APC=Affective Problems.
OC=Overcontrol. GPMC=General Psychological Maladjustment. EDRC=Eating Disorder Risk.
Bolded values are significant (p<0.005).
14
Thompson, J.K., Smolak, L., 2001. Body image, eating disorders and obesity in youth.
Assessment, prevention and treatment. Washington, DC.
Table 1. Patient’s characteristics and the duration of treatment. BMI=Body Mass Index.
PhA=Phase Angle. SD=standard deviation.
Mean SD
Age (years) 27.41 6.07

9. • abbattimento lista d’attesa
• snellimento procedure di ricovero
• formulazioni di PTI e PTR condivisi per percorsi
di cura

10. Aree di criticità Regionali
• mancanza di dati epidemiologici
• mancanza di programmazione centrale
• assenza di riferimenti normativi specifici per i
D.A. sia sui criteri di accreditamento

11. Dal Numero al Soggetto

14. ”tesa dall’alto attraverso tutto il cielo e la terra, una luce diritta come una colonna,
molto simile all’arcobaleno, ma piú intensa e piú pura. Vi erano arrivati dopo un giorno
di marcia e colà avevano veduto, in mezzo alla luce, tese dal cielo, le estremità dei suoi
legami. Era questa luce a tenere avvinto il cielo e, come le gomene esterne delle
triremi, a tenere insieme tutta la circonferenza. Alle estremità era sospeso il fuso di
Ananke, per il quale giravano tutte le sfere.
Platone X Libro Repubblica
Nel mito di Er di Platone ogni anima è posta di fronte alle Moire, figure che
rappresentano il controllo del tempo. Le moire sono Lachesi (il tempo passato) Cloto
(il presente) e Atropo (futuro). La prima accoglie le anime, secondo Platone, con
questa espressione: “Non sarà un demone a scegliere voi, ma sarete voi a scegliervi il
vostro demone.”

15. • Venezia
• Torino
• Genova
• Savona
• Bologna
• Firenze
• Ancona
• Napoli
• Foggia
• Siracusa