Outcomes of an inpatient refeeding protocol in youth with anorexia nervosa: Rady Children’s Hospital San Diego/University of California, San Diego

Abstract

BackgroundCurrent guidelines for nutritional rehabilitation in hospitalized restrictive eating disorder patients recommend a cautious approach to refeeding. Several studies suggest that higher calorie diets may be safe and effective, but have traditionally excluded severely malnourished patients. The goal of this study was to evaluate the safety of a higher calorie nutritional rehabilitation protocol (NRP) in a broad sample of inpatients with restrictive eating disorders, including those who were severely malnourished.MethodsA retrospective chart review was conducted among eating disorder inpatients between January 2015 and March 2016. Patients were started on a lower calorie diet (≤1500 kcals/day) or higher calorie diet (≥1500 kcals/day). Calorie prescription on admission was based on physician clinical judgement. The sample included patients aged 8–20 years with any DSM-5 restrictive eating disorder. Those who were severely malnourished (<75% expected body weight [EBW]) or required tube feeding during admission were included. Multivariable regression models were used to determine whether level of nutritional rehabilitation was associated with hypophosphatemia, hypomagnesemia, or hypokalemia.ResultsThe sample included 87 patients; mean age was 14.4 years (S.D. 32.7); 29% were <75% EBW. The majority (75.8%) was started on higher calorie diets (mean 1781 kcal/day). Controlling for rate of calorie change, initial %EBW, age, race/ethnicity, insurance, diagnosis, and NG/NJ tube placement, higher calorie diets were not associated with hypophosphatemia, hypomagnesemia, or hypokalemia on admission or within the first 72 h. Increased risk of hypophosphatemia on admission was associated with lower baseline %EBW.ConclusionA higher calorie NRP was tolerated in this broad population of inpatients with restrictive eating disorders. Lower %EBW on admission was a more important predictor of hypophosphatemia than initial calorie level. Larger studies are required to demonstrate the safety of higher calorie diets in severely malnourished patients.

Translating evidence-based treatment for digital health delivery: a protocol for family-based treatment for anorexia nervosa using telemedicine

“…The Family Assessment Device (FAD [ 52 ];) is a 60-item self-report measure that explores family functioning in seven subscales: problem-solving, communication, roles, affective responsiveness, affective involvement, behaviour control, and general functioning. There is evidence of a relationship between family functioning, communication, and problem-solving subscales and remission at the end of FBT [ 53 ].…”

Having an Eating Disorder and Still Being Able to Flourish? Examination of Pathological Symptoms and Well-Being as Two Continua of Mental Health in a Clinical Sample

“…Well-being has been considered as an important component of recovery in psychological treatments (Fava, 1996 ) and specific therapies for improving well-being among clinical populations have been developed (Fava et al, 1998 , 2005 ; Fava and Ruini, 2003 ; Gilbert, 2009 ; Bolier et al, 2013 ; Weiss et al, 2016 ). Even though persons who are recovered from an ED consider several aspects of well-being as fundamental criteria for ED recovery in addition to symptom remission (de Vos et al, 2017 ), the important role of well-being for mental health has been widely neglected in research among ED patients (Tomba et al, 2014 ). Some researchers have focused on health-related components among ED patients, such as quality of life or subjective well-being (de la Rie et al, 2005 , 2007 ; Doll et al, 2005 ; Jenkins et al, 2011 ; Mond et al, 2012 ; Tomba et al, 2014 ).…”

Treatment of eating disorders in child and adolescent psychiatry

“…Many clinicians are afraid of the socalled refeeding syndrome with severe cardiac, renal and neurological complications. However, a recent observational study [19], a systematic review of 27 studies with adults and adolescents [20 & ] and a small RCT [21 && ], did not find any difference in the occurrence of the refeeding syndrome in adolescents started on a lower vs. a higher caloric diet. The systematic review came to the following conclusions: lower caloric refeeding is too conservative for mildly and moderately starved patients; both meal-based refeeding approaches and combined nastrogastric tube feeding and meals can provide a high supply of energy; higher calorie refeeding has not been associated with increased risk for the refeeding syndrome under close medical observation, including electrolyte balancing; there is insufficient evidence to change the current clinical practice for severely emaciated patients, for example administering an initially low supply of energy; parenteral nutrition is not recommended; components of nutrition (e.g.…”