A Higher-Calorie Refeeding Protocol Does Not Increase Adverse Outcomes in Adult Patients with Eating Disorders

Matthews, Kylie; Hill, J.; Jeffrey, Shane; Patterson, Susan; Davis, Amanda; Ward, Warren; Palmer, Michelle; Capra, Sandra

doi:10.1016/j.jand.2018.01.023

Cited by 29 publications

(82 citation statements)

References 32 publications

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“…For extremely underweight adult patients, there are currently only a few studies examining higher caloric refeeding, and therefore no commonly accepted, reliable recommendations regarding the value and safety of accelerated refeeding strategies exist. In a recent study on 119 adults with AN, higher initial caloric refeeding (i.e., 1500 instead of 1000 kcal/d) was described to provide additional nourishment, to medically stabilize patients, and to prevent RS [17]. The authors concluded that future research is needed to examine whether higher-calorie intakes (i.e., 2000 kcal/d), similar to those studied in adolescent patients, may also be beneficial to treat adult patients.…”

Section: Introduction: Refeeding and Refeeding Syndromementioning

confidence: 99%

Outcomes of an Accelerated Inpatient Refeeding Protocol in 103 Extremely Underweight Adults with Anorexia Nervosa at a Specialized Clinic in Prien, Germany

Koerner

Haas

Heese

et al. 2020

JCM

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Background: In mildly to moderately malnourished adolescent patients with anorexia nervosa (AN), accelerated refeeding protocols using higher initial calory supply coupled with phosphate supplements were not associated with a higher incidence of refeeding syndrome (RS). It is unclear whether this is also a feasible approach for extremely malnourished, adult AN patients. Methods: Outcomes of a clinical refeeding protocol involving a targeted initial intake of ≥2000 kcal/day, routine supplementation of phosphate and thiamine as well as close medical monitoring, were evaluated. A retrospective chart review including AN patients with a body mass index (BMI) <13 kg/m² was conducted, to describe changes in weight, BMI, and laboratory parameters (phosphate, creatine kinase, hematocrit, sodium, liver enzymes, and blood count) over four weeks. Results: In 103 female patients (age, mean ± standard deviation (SD) = 23.8 ± 5.3 years), BMI between admission and follow-up increased from 11.5 ± 0.9 to 13.1 ± 1.1 kg/m² and total weight gain within the first four weeks was 4.2 ± 2.0 kg (mean, SD). Laboratory parameter monitoring indicated no case of RS, but continuous normalization of blood parameters. Conclusions: Combined with close medical monitoring and electrolyte supplementation, accelerated refeeding may also be applied to achieve medical stabilization in extremely underweight adults with AN without increasing the risk of RS.

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Section: Introduction: Refeeding and Refeeding Syndromementioning

confidence: 99%

Outcomes of an Accelerated Inpatient Refeeding Protocol in 103 Extremely Underweight Adults with Anorexia Nervosa at a Specialized Clinic in Prien, Germany

Koerner

Haas

Heese

et al. 2020

JCM

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“…All four studies were non‐randomised cohort studies, three were retrospective 24‐26 and one prospective with historical controls 27 . Two studies 25,27 were non‐concurrent due to comparisons between previous and current refeeding protocols. All papers were published after the year 2000, with the earliest collected data from January 1, 1996 24 …”

Section: Resultsmentioning

confidence: 99%

“…Zuercher et al 24 did not report if males were omitted due to exclusion criteria or simply due to no male admissions at the facility, whereas Robb et al 26 specifically excluded male participants. Similarly, most participants were female in the remaining two studies 25,27 (96% [n = 115/119] to 98% females [n = 55/56]). Three studies were conducted in the United States, 24,26,27 participants were of predominantly Caucasian ethnicity and diagnosed with anorexia nervosa.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies were conducted in the United States, 24,26,27 participants were of predominantly Caucasian ethnicity and diagnosed with anorexia nervosa. Matthews et al 25 was the only study conducted in Australia, did not specify ethnicity and included participants with a range of eating disorder sub‐types: anorexia nervosa (HE: 84% [n = 78/93] vs LE: 85% [n = 22/26]), bulimia nervosa (HE: 8% [n = 7/93] vs LE: 0% [n = 0/26]) and Other Specified Feeding and Eating Disorders (HE: 9% [n = 8/93] vs LE: 15% [n = 4/26]). Robb et al 26 and Matthews et al 25 exclusively included adolescent participants or adult participants, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Matthews et al 25 was the only study conducted in Australia, did not specify ethnicity and included participants with a range of eating disorder sub‐types: anorexia nervosa (HE: 84% [n = 78/93] vs LE: 85% [n = 22/26]), bulimia nervosa (HE: 8% [n = 7/93] vs LE: 0% [n = 0/26]) and Other Specified Feeding and Eating Disorders (HE: 9% [n = 8/93] vs LE: 15% [n = 4/26]). Robb et al 26 and Matthews et al 25 exclusively included adolescent participants or adult participants, respectively. Garber et al 27 and Zuercher et al 24 included both adolescent and adult participants.…”

Section: Resultsmentioning

confidence: 99%

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Goal energy intake for medically compromised patients with eating disorders: A systematic review

Chan

Jaffe

D'Souza

et al. 2021

Nutrition & Dietetics

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Aim Current Australian eating disorder guidelines recommend a “high” energy goal intake of 12 MJ/day, however, it is unclear whether a “high” energy goal is beneficial. This study aimed to investigate the impact of goal energy intakes <12 MJ/day (low energy) compared with ≥12 MJ/day (high energy) on body composition, midarm muscle circumference, frequency of medical complications, refeeding syndrome, length of stay, body mass index (BMI) and weight gain for patients with medically compromised eating disorders. Methods Five electronic databases (PubMed, CINAHL, Scopus, EMBASE and Web of Science) were searched in April, 2020. The certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation system. Results Four cohort studies were included (n = 656); three were rated positive and one neutral in terms of individual study bias. Evidence for the impact of higher and lower energy protocols on body fat percentage, midarm muscle circumference, frequency of medical complications, incidence of refeeding syndrome, length of stay, BMI and weight gain was of very low certainty. The certainty of evidence was downgraded to very low due to very serious risk of bias, inconsistency and imprecision. Conclusions This review found very low certainty of evidence to support the use of high energy goal intakes for patients with medically compromised eating disorders. More robust research is warranted to establish if there are clear clinical and psychological benefits of higher energy goal intakes.

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Rapid refeeding in anorexia nervosa: A dialectic balance

Staab

Campagna

et al. 2022

Intl J Eating Disorders

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Objective To examine the impact of our new rapid refeeding protocol on patients with anorexia nervosa (AN) in our Eating Disorders Program. We hypothesize that the new protocol would lead to a more rapid weight gain and a shorter length of stay, with no effect on medical complications or program completion. Method This cohort design included consecutive inpatients and day hospital patients admitted to the program with a BMI <18 kg/m2 and a diagnosis of AN between 2007 and 2020; N = 326 patients. Main outcomes measured were rate of weight gain and length of stay. Safety indicators included electrolyte disturbances and supplementation required, complications including refeeding syndrome and completion of the program. A p value <.05 was considered statistically significant. Results Total length of stay was 21 days shorter for patients on the rapid refeeding protocol compared to the traditional refeeding protocol. Patients on the new protocol gained 0.21 more kg/week compared to patients on the old protocol. There was no difference in completion rates between programs. Electrolyte imbalances were mild to moderate and easily treated with oral electrolyte supplementation. There were no deaths or cases of refeeding syndrome with either protocol. Discussion This is the first Canadian study to assess the effectiveness and safety of rapid refeeding in an adult population. Rapid refeeding protocols can be safely administered and are cost effective. Shorter hospital admissions are desirable to minimize possible regression and dependency on inpatient services and positively impacts patients' quality of life. Public Significance This study advances the idea that rapid refeeding in patients with anorexia nervosa can be administered safely and effectively with close medical monitoring. In addition, rapid refeeding leads to shorter hospital stays, with a cost‐savings to the health system. Shorter admissions are desirable to minimize possible regression and dependency on inpatient services and also positively impacts patients' quality of life.

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A Higher-Calorie Refeeding Protocol Does Not Increase Adverse Outcomes in Adult Patients with Eating Disorders

Cited by 29 publications

References 32 publications

Outcomes of an Accelerated Inpatient Refeeding Protocol in 103 Extremely Underweight Adults with Anorexia Nervosa at a Specialized Clinic in Prien, Germany

Outcomes of an Accelerated Inpatient Refeeding Protocol in 103 Extremely Underweight Adults with Anorexia Nervosa at a Specialized Clinic in Prien, Germany

Goal energy intake for medically compromised patients with eating disorders: A systematic review

Rapid refeeding in anorexia nervosa: A dialectic balance

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