Refeeding Low Weight Hospitalized Adolescents With Anorexia Nervosa

O’Connor, Graeme; Nicholls, Dasha; Hudson, Lee; Singhal, Atul

doi:10.1177/0884533615627267

Cited by 65 publications

(69 citation statements)

References 49 publications

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“…Findings from this study, similar to those of other recent literature in this area, support a move towards less conservative refeeding in adolescent AN 4,23 . These results provide additional evidence to suggest that medical instability should not be assumed in all low weight, malnourished adolescents, but should be objectively assessed and managed on a case by case basis 9 .…”

Section: Recommendationssupporting

confidence: 90%

“…A concern reported widely in the literature is that of the 'underfeeding-syndrome', whereby the 'start low and advance slow' approach to refeeding postpones weight recovery and worsens treatment outcomes in adolescent with AN 8,23,26 . There is increasing evidence supporting the bene ts of higher energy feeding in terms of reducing length of hospital stay and initiating early weight gain without increasing refeeding complications 4,30 . Despite the potential bene ts of more rapid refeeding, there is a lack of high quality evidence to support the hypothesis that detrimental effects may be caused by slow refeeding 3 .…”

Section: Impact Of Refeeding Methods On Outcomesmentioning

confidence: 99%

“…However, in more recent years, there has been a growing body of evidence supporting less conservative refeeding practices in this group 3,4 . Inconclusive evidence on how to safely refeed malnourished patients has resulted in widely variable and inconsistent refeeding practices 5,6 .…”

Section: Introductionmentioning

confidence: 99%

“…Although a lack of intervention studies has previously hindered advancements in refeeding practices in this group, a recent study has become the rst randomised controlled trial (RCT) in this area. O'Connor and colleagues, found in 2016 that higher energy starting rates were associated with greater weight initial gain, without increased incidence of RS, suggesting that higher calorie feeding may be safe and preferable 4 . Similar conclusions have been drawn from multiple other recent studies in this area.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Refeeding Outcomes Over 5-Years in A Specialist Adolescent Eating Disorder Center in The UK: A Retrospective Chart Review Study.

Brennan¹,

Chapman²,

Illingworth³

2020

Preprint

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Background and aims: Refeeding syndrome (RS) is a serious clinical syndrome, its early identification is key to safe management. The aim of this study was to evaluate existing practices in a highly specialist centre for eating disorders and compare refeeding management, nutritional, and clinical outcomes in cases admitted to secondary care with those managed in primary care.Methods: Retrospective analysis of electronic case records of adolescent patients at moderate – high risk of developing refeeding syndrome and treated for anorexia nervosa by a specialist eating disorder centre in London over a 5-year period. Statistical analysis compared refeeding methods used in this population to establish if there were differences in refeeding methods used within the sample and if so, how they impacted on outcomes. Results: Adolescents admitted to inpatient care had significantly lower energy intakes (374kcal/d ± 205 compared with 621kcal/d ± 348, p = 0.001 ) and higher rates of weight loss at assessment (0.86kg/week ± 0.7 compared with 0.38kg/week ± 0.7, p = 0.003), without significant differences in other markers of medical instability. Incidence of RS symptoms did not differ significantly between groups and, similarly, no statistically significant difference was found between groups in treatment outcomes, measured by discharge weight (kg) and percentage median BMI (41.5kg ± 8.3 compared with 43.7kg ± 7.7, p = 0.322 and 81.6% ± 8.5 compared with 82.3% ± 9.7, p = 0.622). Conclusions: Findings from this study support the hypothesis that refeeding adolescents with AN, at high risk of developing RS, with higher energy feeds than that advised by national guidance, in the absence of prophylactic phosphate supplementation or incremental energy increases, does not increase the risk of developing refeeding complications. These findings support recent evidence that advocates a less conservative refeeding approach and a review of current national guidance.

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Section: Recommendationssupporting

confidence: 90%

Section: Impact Of Refeeding Methods On Outcomesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Evaluation of Refeeding Outcomes Over 5-Years in A Specialist Adolescent Eating Disorder Center in The UK: A Retrospective Chart Review Study.

Brennan¹,

Chapman²,

Illingworth³

2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Refeeding of a severely malnourished child needs to follow published guidelines and be undertaken by a team knowledgeable of the risks of both underfeeding and overfeeding. The Junior MARSIPAN report gives detailed guidance on refeeding,8 and a recent randomised controlled trial (RCT) suggests a reasonably high initial calorie intake (≥1200 kcal) except in those at ultra high risk 9. As metabolic rate increases, so will energy requirements.…”

Section: Initiating Meal Plansmentioning

confidence: 99%

Assessment and treatment of eating disorders in children and adolescents

2016

Self Cite

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Feeding and eating disorders (FEDs) are serious mental health disorders that cause impairments in physical health, development, cognition and psychosocial function and can go undetected for months or years. They are characterised by disturbed eating behaviour associated with concerns about weight and shape or by disinterest in food, phobic avoidance or avoidance due to sensory aspects of food. Restrictive forms of FEDs lead to significant weight loss requiring intervention. Without specific knowledge of these conditions, they can evade detection, delaying time to diagnosis and treatment and potentially influencing outcome. This review article focuses on the key factors involved in the psychiatric assessment and treatment of four feeding or eating disorders (EDs): anorexia nervosa, avoidant-restrictive food intake disorder, bulimia nervosa and binge eating disorder. They have been chosen for discussion as they are most likely to be encountered in both a psychiatric and paediatric setting. It emphasises the importance of a family-focused, developmentally appropriate and multidisciplinary approach to care. It does not address aspects of medical assessment and treatment. Other feeding or EDs not included in this article are pica, rumination disorder, other specified feeding and eating disorder and unspecified feeding and eating disorder.

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Short-term Outcomes of the Study of Refeeding to Optimize Inpatient Gains for Patients With Anorexia Nervosa

et al. 2021

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IMPORTANCEThe standard of care for refeeding inpatients with anorexia nervosa, starting with low calories and advancing cautiously, is associated with slow weight gain and protracted hospital stay. Limited data suggest that higher-calorie refeeding improves these outcomes with no increased risk of refeeding syndrome.OBJECTIVE To compare the short-term efficacy, safety, and cost of lower-calorie vs higher-calorie refeeding for malnourished adolescents and young adults with anorexia nervosa. DESIGN, SETTING, AND PARTICIPANTSIn this multicenter randomized clinical trial with prospective follow-up conducted at 2 inpatient eating disorder programs at large tertiary care hospitals, 120 adolescents and young adults aged 12 to 24 years hospitalized with anorexia nervosa or atypical anorexia nervosa and 60% or more of median body mass index were enrolled from February 8, 2016, to March 7, 2019. The primary analysis was a modified intent-to-treat approach. INTERVENTIONS Higher-calorie refeeding, beginning at 2000 kcal/d and increasing by 200 kcal/d vs lower-calorie refeeding, beginning at 1400 k/cal and increasing by 200 kcal every other day.MAIN OUTCOMES AND MEASURES Main outcomes were end-of-treatment outcomes; the primary end point of this trial will be clinical remission over 12 months. Short-term efficacy was defined a priori as time to restore medical stability in the hospital, measured by the following 6 indices: 24-hour heart rate of 45 beats/min or more, systolic blood pressure of 90 mm Hg or more, temperature of 35.6 °C or more, orthostatic increase in heart rate of 35 beats/min or less, orthostatic decrease in systolic blood pressure of 20 mm Hg or less, and 75% or more of median body mass index for age and sex. The prespecified safety outcome was incidence of electrolyte abnormalities; cost efficacy was defined as savings associated with length of stay. RESULTSBecause 9 participants withdrew prior to treatment, the modified intention-to-treat analyses included 111 participants (93%; 101 females [91%]; mean [SD] age, 16.4 [2.5] years). Higher-calorie refeeding restored medical stability significantly earlier than lower-calorie refeeding (hazard ratio, 1.67 [95% CI, 1.10-2.53]; P = .01). Electrolyte abnormalities and other adverse events did not differ by group. Hospital stay was 4.0 days shorter (95% CI, −6.1 to −1.9 days) among the group receiving higher-calorie refeeding, which was associated with a

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Refeeding Low Weight Hospitalized Adolescents With Anorexia Nervosa

Abstract: Refeeding adolescents with AN with a higher energy intake was associated with greater weight gain but without an increase in complications associated with refeeding when compared with a more cautious refeeding protocol-thus challenging current refeeding recommendations.

Cited by 65 publications

References 49 publications

Evaluation of Refeeding Outcomes Over 5-Years in A Specialist Adolescent Eating Disorder Center in The UK: A Retrospective Chart Review Study.

Evaluation of Refeeding Outcomes Over 5-Years in A Specialist Adolescent Eating Disorder Center in The UK: A Retrospective Chart Review Study.

Assessment and treatment of eating disorders in children and adolescents

Short-term Outcomes of the Study of Refeeding to Optimize Inpatient Gains for Patients With Anorexia Nervosa

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