Anorexia Nervosa, Anxiety, and the Clinical Implications of Rapid Refeeding

Kezelman, Sarah; Crosby, Ross D.; Rhodes, Paul; Hunt, Caroline; Anderson, Gail; Clarke, Simon; Touyz, Stephen

doi:10.3389/fpsyg.2018.01097

Cited by 9 publications

(35 citation statements)

References 41 publications

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“…For example, in Australian studies medical wards tended to include high levels of psychiatric treatment alongside medical treatment. 26 Any hospital admission was signi cantly longer (P<0.0001) for a YP requiring NG feeding compared to those managing an oral diet in a German retrospective cohort study. 37 However, this study does not discuss the reasons NG was implemented.…”

Section: Length Of Stay Associated With Ng Feedingmentioning

confidence: 93%

“…9,17,28,29,31,[35][36][37]47 Other studies implemented NG feeding as standard practice. [21][22][23]26,39 YP were often admitted to hospital for medical instability 9,17,22,28,39,23,20,47,25 with medical instability being treated using NG either continuously or for sustained periods of time. 22,44,23,20,24,25,26 In other cases, NG was implemented due to acute refusal of food or inability to meet oral intake.…”

Section: Prevalence and Epidemiologymentioning

confidence: 99%

“…[21][22][23]26,39 YP were often admitted to hospital for medical instability 9,17,22,28,39,23,20,47,25 with medical instability being treated using NG either continuously or for sustained periods of time. 22,44,23,20,24,25,26 In other cases, NG was implemented due to acute refusal of food or inability to meet oral intake. 43,9,10,17,28,31 According to Maginot and colleagues 17 NG was more likely to be required in severely malnourished patients where patients were treated by NG due to inability to manage oral intake in hospital.…”

Section: Prevalence and Epidemiologymentioning

confidence: 99%

“…35,36 In Australian based studies, NG was given due to refusal of oral intake in two studies 9,10 as well as to treat medical instability. 26,47 A retrospective cohort study 24 compared NG given continuously or as a nocturnal supplement with oral intake. Studies from North America also focused on medical instability for NG use.…”

Section: Settingmentioning

confidence: 99%

“…Kezelman and colleagues (Australia) 2018 26 used validated measures of anxiety and depression to assess the impact of these symptoms and core ED symptoms on weight restoration, using NG in adjunct to oral intake as part of a rapid refeeding regime. During admission symptoms reduced but this was not attributed to weight restoration in itself suggesting a high calorie rapid refeeding schedule would not exacerbate or ameliorate ED and other psychiatric symptoms.…”

Section: Nutritional Information Of Enteral Nutrition Administered VImentioning

confidence: 99%

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A Systematic Review of Enteral Feeding by Nasogastric Tube in Young People with Eating Disorders

Hindley¹,

orcid²,

Fenton³

et al. 2021

Preprint

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BackgroundAdolescents with severe restrictive eating disorders often require enteral feeding to provide lifesaving treatment.Nasogastric feeding (NGF) is a method of enteral nutrition often used in inpatient settings to treat medical instability, to supplement minimal oral intake or to boost nutritional intake. This systematic review sets out to describe current practice for NGF. MethodsA systematic review following PRISMA guidelines was conducted by searching AMED, EMBASE and MEDLINE databases from 2000-2020. Inclusion terms were: enteral feeding by nasogastric tube, under 18 years, eating disorders, and primary research. Exclusion terms: mental disorders other than eating disorders; non-primary research; no outcomes specific to NG feeding and over 18 years. Titles and abstracts were screened by all authors before reviewing full length articles. Quality assessment, including risk of bias, was conducted by all authors. Results29 studies met the full criteria. 86% of studies were deemed high or medium risk of bias due to the type of study: 34.4% retrospective cohort and 10.3% RCT; 17.2% were qualitative. Studies identified 1) a wide range of practices in different countries, settings, and the reason for initiation; 2) In the UK, standard practice is to introduce NGF if either oral intake is not met or patients are medically unstable; 3) NGF may enable greater initial weight gain due to increased caloric intake; 4) there are 3 main types of feeding regime: continuous, nocturnal and bolus; 5) high calorie feeds are not typically associated with increased risk of refeeding syndrome; 6) complications included nasal irritation, epistaxis, electrolyte disturbance, distress and tube removal; 7) length of stay in hospital is dependent on reason of initiating NGF; 8) psychiatric and medical wards differ in approach; 9) concurrent therapy is often used to facilitate NGF.ConclusionsNGF is currently often implemented in specialist settings where oral intake has been refused or insufficient, in hospital due to medical instability, nocturnally to supplement day-time oral intake, or continuously as standard protocol. Due to high risk of bias as a result of the nature of the studies conducted in adolescents with ED, recommendations for clinical practice cannot yet be justified.

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Section: Length Of Stay Associated With Ng Feedingmentioning

confidence: 93%

Section: Prevalence and Epidemiologymentioning

confidence: 99%

Section: Prevalence and Epidemiologymentioning

confidence: 99%

Section: Settingmentioning

confidence: 99%

Section: Nutritional Information Of Enteral Nutrition Administered VImentioning

confidence: 99%

See 3 more Smart Citations

A Systematic Review of Enteral Feeding by Nasogastric Tube in Young People with Eating Disorders

Hindley¹,

orcid²,

Fenton³

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

Length of stay for anorexia nervosa: Systematic review and meta‐analysis

Kan

Hawkings

Cribben

et al. 2021

Euro Eating Disorders Rev

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Objective: Evidence regarding global trends in length of stay for patients with anorexia nervosa is limited. The aim of this study is to conduct a meta-analysis examining the length of stay for anorexia nervosa patients globally, and to investigate moderators of the variance.Method: Medline, EMBASE and PsycINFO were searched for studies published up to January 2019. Two independent reviewers assessed the eligibility of each report based on predefined inclusion criteria. A meta-analysis was performed to calculate a pooled mean length of stay using the random-effects model. Subgroup analyses and meta-regression were conducted to explore potential sources of heterogeneity between studies.Results: Of 305 abstracts reviewed, 71 studies met the inclusion criteria, generating 111 datasets. The pooled mean length of stay (95% confidence interval) was 76.3 days (73.3, 79.4) using the random-effects model, with marked variation across countries and time. Heterogeneity between studies was explained by age and admission body mass index. Conclusions:This meta-analysis found that although clinical features do contribute to length of admissions for anorexia nervosa, there are also global and temporal variations. Future research should provide an in-depth analysis of why and how this variation exists and what the impact is on the well-being of people with anorexia nervosa.

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Does Relative Energy Deficiency in Sport (REDs) Syndrome Exist?

Jeukendrup,

Areta,

Van Genechten

et al. 2024

Sports Med

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Relative energy deficiency in sport (REDs) is a widely adopted model, originally proposed by an International Olympic Committee (IOC) expert panel in 2014 and recently updated in an IOC 2023 consensus statement. The model describes how low energy availability (LEA) causes a wide range of deleterious health and performance outcomes in athletes. With increasing frequency, sports practitioners are diagnosing athletes with “REDs,” or “REDs syndrome,” based largely upon symptom presentation. The purpose of this review is not to “debunk” REDs but to challenge dogmas and encourage rigorous scientific processes. We critically discuss the REDs concept and existing empirical evidence available to support the model. The consensus (IOC 2023) is that energy availability, which is at the core of REDs syndrome, is impossible to measure accurately enough in the field, and therefore, the only way to diagnose an athlete with REDs appears to be by studying symptom presentation and risk factors. However, the symptoms are rather generic, and the causes likely multifactorial. Here we discuss that (1) it is very difficult to isolate the effects of LEA from other potential causes of the same symptoms (in the laboratory but even more so in the field); (2) the model is grounded in the idea that one factor causes symptoms rather than a combination of factors adding up to the etiology. For example, the model does not allow for high allostatic load (psychophysiological “wear and tear”) to explain the symptoms; (3) the REDs diagnosis is by definition biased because one is trying to prove that the correct diagnosis is REDs, by excluding other potential causes (referred to as differential diagnosis, although a differential diagnosis is supposed to find the cause, not demonstrate that it is a pre-determined cause); (4) observational/cross-sectional studies have typically been short duration (< 7 days) and do not address the long term “problematic LEA,” as described in the IOC 2023 consensus statement; and (5) the evidence is not as convincing as it is sometimes believed to be (i.e., many practitioners believe REDs is well established). Very few studies can demonstrate causality between LEA and symptoms, most studies demonstrate associations and there is a worrying number of (narrative) reviews on the topic, relative to original research. Here we suggest that the athlete is best served by an unbiased approach that places health at the center, leaving open all possible explanations for the presented symptoms. Practitioners could use a checklist that addresses eight categories of potential causes and involve the relevant experts if and when needed. The Athlete Health and Readiness Checklist (AHaRC) we introduce here simply consists of tools that have already been developed by various expert/consensus statements to monitor and troubleshoot aspects of athlete health and performance issues. Isolating the purported effects of LEA from the myriad of other potential causes of REDs symptoms is experimentally challenging. This renders the REDs model somewhat immune to falsification and we may never definitively answer the question, “does REDs syndrome exist?” From a practical point of view, it is not necessary to isolate LEA as a cause because all potential areas of health and performance improvement should be identified and tackled.

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Anorexia Nervosa, Anxiety, and the Clinical Implications of Rapid Refeeding

Cited by 9 publications

References 41 publications

A Systematic Review of Enteral Feeding by Nasogastric Tube in Young People with Eating Disorders

A Systematic Review of Enteral Feeding by Nasogastric Tube in Young People with Eating Disorders

Length of stay for anorexia nervosa: Systematic review and meta‐analysis

Does Relative Energy Deficiency in Sport (REDs) Syndrome Exist?

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