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

Abstract

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

Intensive Treatments in Adolescent Anorexia Nervosa

“…However, according to our own experience, young girls (we refer to female patients, because most patients with AN are of female sex; however, male patients with AN are also included) often do not tolerate larger meal portions during the first days of the hospital stay. In comparison the patients in the study by Garber et al [ 7 ], our patients are normally younger (15.06 vs. 16.4 years on average in our previous study [ 22 ]), which might prevent them from consuming larger amounts of food. In Garber et al’s US study, refused food was replaced with a high-energy liquid formula, while we prefer our patients to start eating normal food.…”

“…Young people with AN have a higher probability of being admitted to the hospital than adults [ 3 ]. Moreover, the number of patients with atypical AN requiring medical hospitalization has risen sharply, accounting for approximately one-third of patients in hospital inpatient ED programs [ 7 , 12 ].…”

“…Medical stability was restored significantly earlier in the high-calorie diet group than in the low-calorie diet group, and hospital stay was shortened by 4 days in the high-calorie refeeding group. Adverse events did not occur more frequently in the experimental high-calorie diet group [ 7 ]. The one-year follow-up results of this study have yet to be reported.…”

“…One of the main explanations is an increase in overweight and obesity in youth during recent decades resulting in the initiation of a strict diet to maximize weight loss. Recent studies comparing patients with AN and atypical AN have demonstrated a similar poor nutritional and medical status in both groups [ 7 ].…”

Essstörungen im Kindes- und Jugendalter

“…Dabei konnten signifikante Befunde an 8 Genorten auf 6 Chromosomen identifiziert werden[31]. Genauso interessant wie die Lokalisation der Genpolymorphismen waren aber genetische Korrelationen, die -neben statistisch signi-Die Gefahr eines Refeeding-Syndroms ist deutlich niedriger als angenommen[8].Bei einem sehr niedrigen BMI kann prophylaktisch eine Phosphat-und Thiaminsubstitution erfolgen (S3-Leitlinien). Wenn dem Patienten das Essen sehr schwerfällt bzw.…”