Management of the malnourished patient: it’s now time to revise the guidelines

Kohn, Michael; Golden, Neville H.

doi:10.1186/s40337-022-00539-4

Cited by 2 publications

(2 citation statements)

References 30 publications

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“…Additionally, Gentile et al [28] measured the resting metabolic rate of 33 patients with AN with a BMI of 11.2 ± 0.7 kg/m 2 and reported it to be 776 ± 145 kcal/ day. Although not an exact analogy, simply dividing these values by the patients' average admission weight yields values of 24.9 ± 1.5 kcal/kg/day and 26.7 ± 5.0 kcal/kg/ Recent recommendations advocate initiating refeeding with a high caloric intake (1400 kcal/day or more) and escalating it rapidly, as this approach did not increase the risk of complications; rather, it reduced the hospital stays [30]. However, such nutritional therapies are designed for patients with a BMI of 15-17 kg/m 2 [31][32][33][34] whose pathophysiology differs from that of severe malnutrition.…”

Section: Risk Of Undernutritionmentioning

confidence: 99%

Severe hypoglycemia with reduced liver volume as an indicator of end-stage malnutrition in patients with anorexia nervosa: a retrospective observational study

Matsunaga,

Riku,

Shimizu

et al. 2024

J Eat Disord

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Background Hypophosphatemia due to excessive carbohydrate administration is considered the primary pathogenesis of refeeding syndrome. However, its association with liver injury and hypoglycemia, often seen in severe malnutrition before re-nutrition, remains unclear. Autophagy reportedly occurs in the liver of patients with severe malnutrition. This study aimed to clarify the pathophysiology of liver injury and hypoglycemia by focusing on liver volume. Methods Forty-eight patients with anorexia nervosa with a body mass index (BMI) of < 13 kg/m2 were included (median BMI: 10.51 kg/m2 on admission). Liver volume was measured in 36 patients who underwent abdominal computed tomography (CT), and the “estimated liver weight/ideal body weight” was used as the liver volume index. Seventeen blood test items were analyzed during the first 60 days. Results Liver volume significantly decreased when abdominal CTs were conducted shortly before or after hypoglycemia compared to when the scans were performed during periods without hypoglycemia. Five patients with severe hypoglycemia on days 13–18 after admission had a very low nutritional intake; of them, four showed a marked decrease in liver volume. Severe hypoglycemia was accompanied by low serum triglycerides and liver dysfunction. Patients experiencing hypoglycemia of blood glucose levels < 55 mg/dL (< 3.05 mmol/L) (32 patients; median lowest BMI: 9.45 kg/m2) exhibited significantly poorer blood findings for most of the 17 items, except serum phosphorus and potassium, than did those not experiencing hypoglycemia (16 patients; median lowest BMI: 11.2 kg/m2). All patients with a poor prognosis belonged to the hypoglycemia group. Empirically, initiating re-nutrition at 500 kcal/day (20–25 kcal/kg/day), increasing to 700–800 kcal/day after a week, and then gradually escalating can reduce serious complications following severe hypoglycemia. Conclusions Liver volume reduction accompanied by hypoglycemia, low serum triglyceride levels, and liver dysfunction occurs when the body's stored energy sources are depleted and external nutritional intake is inadequate, suggesting that the liver was consumed as a last resort to obtain energy essential for daily survival. This pathophysiology, distinct from refeeding syndrome, indicates the terminal stage of malnutrition and is a risk factor for complications and poor prognosis. In treatment, extremely low nutrient levels should be avoided.

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Section: Risk Of Undernutritionmentioning

confidence: 99%

Severe hypoglycemia with reduced liver volume as an indicator of end-stage malnutrition in patients with anorexia nervosa: a retrospective observational study

Matsunaga,

Riku,

Shimizu

et al. 2024

J Eat Disord

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“…It is strongly advised that these patients be treated by a multidisciplinary team that includes at least a psychological therapist and a family doctor, but in hospital care, additional support such as a registered dietician, specialist physician, psychiatrist, nurses, physiotherapist, occupational therapist, and social worker is required. Nurses and other medical personnel play an important role in the management treatment approach by restricting mobility, requiring bed rest, monitoring fluid balance and physical symptoms (pulse, blood pressure, temperature), supervising mealtimes (at least 1 hour after eating), showers, and toilets (patients being alone can consider a perfect opportunity to engage in behaviors such as purging, excessive physical exercises or water loading for a false weight gain) (Kohn and Golden, 2022;McIntosh et al, 2022;Tse et al, 2022). Even though some may argue that these guidelines are immoral, procedures like these may help patients avoid a variety of undesired behaviors aimed at opposing weight gain and damaging the healing process.…”

Section: Eating Disorder Managementmentioning

confidence: 99%

Eating Disorders: Causes, Symptoms, Diagnosis and Management

agarwal¹

2022

Preprint

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Eating disorders, which are well-known in society as a significant mental health issue, have beencategorized as feeding and eating disorders in DSM-5 and the 11th version of ICD. In addition toanorexia and bulimia nervosa, the new categorization incorporates binge eating disorder as well asavoidant-restrictive food intake disorder (ARFID). They are regarded significant conditions withsubstantial morbidity and mortality risks that disproportionately impact the young group. Accordingto current studies, there is an upsurge in both age and sex demographics. A variety of genetic andphysiological variables, an insecure personality type, impulsive tendencies, dysfunctional emotionmanagement, and society's ideal of slimness have all been linked to the development of thesediseases. Throughout the psychotherapeutic therapies for all forms of eating disorders, a dualapproach with a focus on the symptom and the underlying issues is required. It is critical to evaluatecomorbid psychiatric and medical symptoms. With reference to the increased categories, furtherresearch and novel treatment approaches are required.

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Management of the malnourished patient: it’s now time to revise the guidelines

Cited by 2 publications

References 30 publications

Severe hypoglycemia with reduced liver volume as an indicator of end-stage malnutrition in patients with anorexia nervosa: a retrospective observational study

Severe hypoglycemia with reduced liver volume as an indicator of end-stage malnutrition in patients with anorexia nervosa: a retrospective observational study

Eating Disorders: Causes, Symptoms, Diagnosis and Management

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