Shifting Paradigms: Continuous Nasogastric Feeding With High Caloric Intakes in Anorexia Nervosa

Agostino, Holly; Erdstein, Julius; Meglio, Giuseppina Di

doi:10.1016/j.jadohealth.2013.06.005

Cited by 61 publications

(155 citation statements)

References 17 publications

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“…Furthermore, similar experiences have been recently published (28,29), showing no increase in the refeeding syndrome incidence. However, in order to reach that effect, they have more often resorted to nasogastric feeding, which can damage the psychological engagement with the patients (30,31).…”

Section: Discussionsupporting

confidence: 77%

Abordaje nutricional de pacientes ingresados con anorexia nerviosa

Miguelsanz¹,

Hinojal²,

Uribe

et al. 2016

Nutr Hosp

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ResumenLa anorexia nerviosa (AN) es el trastorno del comportamiento alimentario más prevalente en niños y adolescentes; su tratamiento es largo y complejo, e involucra a múltiples profesionales. La rehabilitación nutricional y la recuperación de un peso corporal normal es uno de los objetivos centrales en las fases iniciales del tratamiento del paciente ingresado. Sin embargo, las recomendaciones actuales sobre los requerimientos energéticos iniciales para estos pacientes son inconsistentes, con una clara ausencia de estudios controlados, evidencia científi ca disponible y consenso global sobre la forma de realimentación más efectiva y segura en adolescentes ingresados con anorexia nerviosa (AN). Clásicamente se han recomendado una realimentación conservadora para prevenir el síndrome de realimentación. No obstante, han aparecido recientemente varios trabajos recomendado una ingesta calórica inicial más elevada, sin observar más complicaciones ni síndrome de realimentación, y asociadas a estancias medias más cortas. Presentamos aquí nuestra experiencia en el tratamiento de la AN restrictiva con un tratamiento progresivo conservador. Hemos obtenido buenos resultados con este abordaje, bien tolerando por los pacientes, y sin observar complicaciones. Gracias a él, el equipo médico pudo establecer más fácilmente un acuerdo sobre los objetivos terapéuticos con el paciente. AbstractAnorexia nervosa (AN) is the most prevalent of eating disorders in children and adolescents, and its treatment is long and complex, involving a multidisciplinary team. Nutritional rehabilitation and restoration of a healthy body weight is one of the central goals in the initial stages of inpatient treatment. However, current recommendations on initial energy requirements for these patients are inconsistent, with a clear lack of controlled studies, available scientifi c evidence and global consensus on the most effective and safe refeeding practices in hospitalized adolescents with anorexia nervosa (AN). Conservative refeeding recommendations have been classically established in order to prevent the refeeding syndrome. Nevertheless, various works have recently appeared advocating a higher initial caloric intake, without observing more complications or refeeding syndrome, and allowing a shorter average stay. We present our experience in the treatment of restricting AN with a conservative progressive treatment. We have obtained good results with this approach, which was well tolerated by patients, with no observing complications. As a consequence, the medical team could establish a pact about the therapeutic goals with the patients in an easier way.

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Section: Discussionsupporting

confidence: 77%

Abordaje nutricional de pacientes ingresados con anorexia nerviosa

Miguelsanz¹,

Hinojal²,

Uribe

et al. 2016

Nutr Hosp

View full text Add to dashboard Cite

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“…Agostino et al (2013) utilized a similar NG feeding approach, but began with a slightly lower caloric level of 1,500 or 1,800 kcal day −1 depending on age. Weight gain was greater in the group that received continuous NG feeding for 7 days and then transitioned to include meals, as compared to historical controls who received only meals …”

Section: Combined Approach With Nasogastric Plus Oral Refeedingmentioning

confidence: 86%

A systematic review of approaches to refeeding in patients with anorexia nervosa

Garber

Sawyer

Golden

et al. 2015

Intl J Eating Disorders

178

161

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Objective: Recent studies describe refeeding in anorexia nervosa (AN) using various methods to deliver higher calorie loads than is currently recommended. We systematically examined approaches to refeeding in hospitalized patients with AN Methods: Systematic review of PubMed, PsycINFO, Scopus, and Clinical Trials databases from 1960–2015 using the terms refeeding, weight restoration, hypophosphatemia, anorexia nervosa, anorexia, and anorexic. Results: 948 abstracts were retrieved using the search criteria and were included if they described a refeeding protocol in hospitalized patients with AN with sufficient detail to allow replication. Twenty-two papers were included in the final review. Most studies were in adolescents and were observational or retrospective; the majority of studies since 2010 have reported on refeeding approaches beginning with higher calories or advancing caloric prescriptions faster than current treatment recommendations. Discussion: The available evidence supported seven conclusions, summarized here: 1) In moderately malnourished patients with AN, higher calorie feeding is feasible; 2) Meal-only approaches or combined nasogastric plus meal-feeding approaches can deliver higher calorie feeds in hospital; 3) In severely malnourished patients with AN, there is insufficient evidence to support any change to current standards of care for refeeding hospitalized patients; 4) Higher calorie approaches to refeeding appear safe under close medical supervision and with correction of electrolyte abnormalities; 5) The impact of differing approaches to refeeding on long-term outcomes is unknown; 6) TPN is not recommended unless no other form of refeeding is possible; and 7) Meals and liquid formulas with nutrient compositions within recommended ranges are appropriate for refeeding.

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“…Previously, recommendations were to restrict the number of calories fed initially in an attempt to prevent metabolic complications . More recent studies in people, however, show that underfeeding may prolong the period over which refeeding complications occur . Providing a continuous source of nutrition such as a CRI via nasogastric tube in the early phase of refeeding may increase early weight gain and shorten hospital stay without exacerbating metabolic complications …”

Section: Discussionmentioning

confidence: 99%

Hypoglycemia associated with refeeding syndrome in a cat

DeAvilla

Leech

2016

J Vet Emergen Crit Care

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Hypoglycemia has not been reported previously as a complication of refeeding in a cat. Frequent monitoring of electrolyte, mineral, and blood glucose concentrations is essential to successful management of refeeding syndrome. The ideal refeeding strategy is unknown at this time. Evidence suggests that a diet low in carbohydrate decreases the likelihood of metabolic derangements commonly associated with refeeding.

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Shifting Paradigms: Continuous Nasogastric Feeding With High Caloric Intakes in Anorexia Nervosa

Cited by 61 publications

References 17 publications

Abordaje nutricional de pacientes ingresados con anorexia nerviosa

Abordaje nutricional de pacientes ingresados con anorexia nerviosa

A systematic review of approaches to refeeding in patients with anorexia nervosa

Hypoglycemia associated with refeeding syndrome in a cat

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