Refeeding and weight restoration outcomes in anorexia nervosa: Challenging current guidelines

Redgrave, Graham W.; Coughlin, Janelle W.; Schreyer, Colleen C.; Martin, Lindsay; Leonpacher, Anne K.; Seide, Margaret; Verdi, Antonia M.; Pletch, Allisyn; Guarda, Ángela S.

doi:10.1002/eat.22390

Cited by 97 publications

(142 citation statements)

References 36 publications

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“…Expected rates of controlled weight gain are generally 0.5-1.4 kg per week. In significantly malnourished patients, nutritional replenishment may precipitate refeeding syndrome, with hypophosphatemia as the hallmark of this complication [37].…”

Section: Long-term Consequences In Adult Womenmentioning

confidence: 99%

Eating disorders in older women

et al. 2015

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Eating disorders (EDs) are disturbances that seriously endanger the physical health and often the lives of sufferers and affect their psychosocial functioning. EDs are usually thought of as problems afflicting teenagers. However, the incidence in older women has increased in recent decades. These cases may represent either late-onset disease or, more likely, a continuation of a lifelong disorder. The DSM-5 classification differentiates 4 categories of eating disorder: anorexia nervosa, bulimia nervosa, binge-eating disorders and other specified feeding and eating disorders. The weight loss and malnutrition resulting from EDs have widespread negative consequences for physical, mental and social health. The main risk factors for developing long-term consequences are the degree of weight loss and the chronicity of the illness. Most of the cardiac, neurological, pulmonary, gastric, haematological and dermatological complications of EDs are reversible with weight restoration. EDs are serious illnesses and they should never be neglected or treated only as a manifestation of the fashion for dieting or a woman's wish to achieve an imposed standard feminine figure. Additionally, EDs are associated with high risk of morbidity and mortality. The literature concerning EDs in older, postmenopausal women is very limited. The main aim of this paper is to ascertain the epidemiology and prognosis of EDs in older women, and to review their diagnosis and management.

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Section: Long-term Consequences In Adult Womenmentioning

confidence: 99%

Eating disorders in older women

et al. 2015

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“…Within this group, prescribed calorie level did not change the risk of electrolyte abnormalities associated with refeeding syndrome [11]. Studies have concluded that percent body weight on admissions was more associated with the development of hypophosphatemia than initial calorie prescription [9–11]. Two small descriptive studies examining patients presenting with a BMI < 12 (ranging in age from 11 to >40 years old) found that these patients could be safely refed with <1200 kcal per day, but did not assess the safety of a higher calorie diet [16, 17].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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.

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“…Correlational data strongly suggests that higher discharge BMI following hospital-based weight restoration is associated with lower rates of relapse [23][24][25][26]. Although inpatient treatment can be lifesaving, it is expensive and difficult to access [27].…”

Section: Introductionmentioning

confidence: 99%