A Prospective Examination of Weight Gain in Hospitalized Adolescents With Anorexia Nervosa on a Recommended Refeeding Protocol

Abstract

Purpose Current refeeding recommendations for adolescents hospitalized with anorexia nervosa (AN) are conservative, starting with low calories and advancing slowly to avoid refeeding syndrome. The purpose of this study was to examine weight change and clinical outcomes in hospitalized adolescents with AN on a recommended refeeding protocol. Methods Adolescents aged 13.1–20.5 years were followed during hospitalization for AN. Weight, vital signs, electrolytes, and 24-hour fluid balance were measured daily. Percent median body mass index (%MBMI) was calculated as 50th percentile BMI for age and gender. Calories were prescribed on admission and were increased every other day. Results Thirty-five subjects with a mean (SD) age of 16.2 (1.9) years participated over 16.7 (6.4) days. Calories increased from 1,205 (289) to 2,668 (387). No subjects had refeeding syndrome; 20% had low serum phosphorus. Percent MBMI increased from 80.1 (11.5) to 84.5 (9.6); overall gain was 2.10 (1.98) kg. However, 83% of subjects initially lost weight. Mean %MBMI did not increase significantly until day 8. Higher calories prescribed at baseline were significantly associated with faster weight gain (p = .003) and shorter hospital stay (p = .030) in multivariate regression models adjusted for %MBMI and lowest heart rate on admission. Conclusions Hospitalized adolescents with AN demonstrated initial weight loss and slow weight gain on a recommended refeeding protocol. Higher calorie diets instituted at admission predicted faster weight gain and shorter hospital stay. These findings support the development of more aggressive feeding strategies in adolescents hospitalized with AN. Further research is needed to identify caloric and supplementation regimens to maximize weight gain safely while avoiding refeeding syndrome.

Eating Disorders in Children and Adolescents: State of the Art Review

“…Recent studies have affirmed the safety of more aggressive nutrition approaches in ED treatment. [141][142][143][144][145][146] RDs can help reinforce these concepts; in newer approaches registered dieticians meet with caregivers to answer questions rather than with patients individually.…”

Abordaje nutricional de pacientes ingresados con anorexia nerviosa

“…In order to prevent this syndrome, current recommendations for refeeding in anorexia nervosa (AN) are conservative, beginning around 1,000-1,200 calories (26). Nevertheless, some authors have denounced an "underfeeding syndrome" (22,23).…”

“…After this, Garber et al compared moderately malnourished adolescents with AN during refeeding on higher calorie diets starting around 1,800 calories (1,400-2,400) and advancing by about 120 calories per day in the first week, versus lower calorie diets starting around 1,100 calories (800-1,200) and advancing by approximately 100 calories per day (21,26). Higher calorie diets increased the rate of weight gain and shortened the stay for hospitalized adolescents with AN, although they had a greater tendency to receive phosphate supplementation to avoid refeeding syndrome, and 45% of participants had a low serum phosphorus level.…”

Practical methods for refeeding patients with anorexia nervosa

“…In addition, higher caloric refeeding, when administered under medical monitoring, was not associated with increased risk of refeeding syndrome when electrolyte abnormalities were corrected [17]. Patients with higher caloric prescriptions, at the initiation of refeeding, experienced significantly faster weight gain and shorter hospital stays [18]. Another study determined that when a more conservative, low calorie refeeding approach was utilized, patients lost weight during the first week of refeeding due to inability for initial low caloric meal plans to meet the patients' basic energy needs [19].…”