Does Aggressive Refeeding in Hospitalized Adolescents With Anorexia Nervosa Result in Increased Hypophosphatemia?

Whitelaw, Melissa; Gilbertson, Heather; Lam, Pei‐Yoong; Sawyer, Susan Μ

doi:10.1016/j.jadohealth.2009.11.207

Cited by 128 publications

(212 citation statements)

References 24 publications

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“…In another study, adolescent patients were started on 1,900-2,200 kcal/day, increasing their kcal to a minimum of 2,700 kcal/day, with further increases as needed for continued weight restoration. Weight gain achieved in this study was 2.6 kg during the first two weeks of refeeding [23]. In addition, Madden et al's study also supports more aggressive refeeding using continuous nasogastric feeds for the first 24-72 hours of hospitalization.…”

Section: Guidance On Refeedingsupporting

confidence: 69%

Practical methods for refeeding patients with anorexia nervosa

A¹,

Em²,

Johnson³

et al. 2017

Integr Food Nutr Metab

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Anorexia nervosa (AN) is a complex mental health disorder that may result in life threatening medical complications if not properly treated. Refeeding and weight restoration are the primary goals of treatment in AN. A multidisciplinary team is essential during this process in order to properly monitor and address complications that can arise during refeeding. There are benefits and drawbacks to different approaches to refeeding and weight restoration, however, recent research supports more aggressive approaches to refeeding and weight restoration. This review explores recommendations for methods of refeeding from various professional organizations, current standards of practice, as well as management of complications that may arise during the refeeding process. Abbreviations and symbols IntroductionThe Diagnostic and Statistical Manual of Mental Disorders, 5 th Edition defines anorexia nervosa (AN) as the restriction of energy intake relative to requirements leading to significantly low body weight, in conjunction with an extreme fear of gaining weight and a distorted view of body weight and shape [1]. AN is defined as either restricting type (AN-R) or binge-eating/purging type (AN-BP). AN-R occurs "when weight loss is accomplished primarily through dieting, fasting and/or excessive exercise". AN-BP is diagnosed "when during the last three months the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or misuse of laxatives, diuretics, or enemas)" The severity of AN is defined by body mass index (BMI): mild: BMI > 17 kg/m 2 , moderate: BMI 16-16.99 kg/ m 2 , severe: BMI 15-15.99 kg/m 2 , and extreme: BMI <15 kg/m 2 .The overall prevalence of AN is estimated to be 1-2% of females between the ages of 15-35. Males have a rate of 0.1% and the overall female to male ratio is 1:20 [2][3][4]. AN has the highest mortality rate of any psychiatric disorder, with a reported mortality rate of 5.6% [5]. Medical complications related to the disorder result in 50% of the deaths in individuals with AN, and at least half of the remainder of the deaths have resulted from suicide. The peak occurrence of AN is during adolescence and early adulthood. Longitudinal studies have identified body dissatisfaction, dieting and picky eating as possible predictors for eating disorders. Additionally, multivariate studies have found obsessive-compulsive personality disorder as well as generalized anxiety indicate to have a strong predictive value for AN [3].

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Section: Guidance On Refeedingsupporting

confidence: 69%

Practical methods for refeeding patients with anorexia nervosa

A¹,

Em²,

Johnson³

et al. 2017

Integr Food Nutr Metab

View full text Add to dashboard Cite

show abstract

“…Recent studies have affirmed the safety of more aggressive nutrition approaches in ED treatment. [141][142][143][144][145][146] RDs can help reinforce these concepts; in newer approaches registered dieticians meet with caregivers to answer questions rather than with patients individually.…”

Section: Recovery Goalsmentioning

confidence: 99%

Eating Disorders in Children and Adolescents: State of the Art Review

2014

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This is the 3rd in our series on Adolescent Health. abstract Despite their high prevalence, associated morbidity and mortality, and available treatment options, eating disorders (EDs) continue to be underdiagnosed by pediatric professionals. Many adolescents go untreated, do not recover, or reach only partial recovery. Higher rates of EDs are seen now in younger children, boys, and minority groups; EDs are increasingly recognized in patients with previous histories of obesity. Medical complications are common in both full and subthreshold EDs and affect every organ system. No single cause of EDs has emerged, although neurobiological and genetic predispositions are emerging as important. Recent treatment paradigms acknowledge that they are not caused by families or chosen by patients. EDs present differently in pediatric populations, and providers should have a high index of suspicion using new Diagnostic and Statistical Manual, 5th edition diagnostic criteria because early intervention can affect prognosis. Outpatient family-based treatment focused on weight restoration, reducing blame, and empowering caregivers has emerged as particularly effective; cognitive behavioral therapy, individual therapy, and higher levels of care may also be appropriate. Pharmacotherapy is useful in specific contexts. Full weight restoration is critical, often involves high-calorie diets, and must allow for continued growth and development; weight maintenance is typically inappropriate in pediatric populations. Physical, nutritional, behavioral, and psychological health are all metrics of a full recovery, and pediatric EDs have a good prognosis with appropriate care. ED prevention efforts should work toward aligning with families and understanding the impact of antiobesity efforts. Primary care providers can be key players in treatment success.

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“…5 Patients deemed at significant risk for refeeding syndrome were commenced on rehydration therapy or modified meal plan. Regular food and drinks were offered; nasogastric feeding was used when patients were unable to eat the prescribed amount.…”

Section: Inpatient Refeeding Protocol For Anmentioning

confidence: 99%

Restrictive Eating Disorders Among Adolescent Inpatients

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Recent case reports have described acute life-threatening complications in adolescents who present to health services having lost large amounts of weight but who are not underweight. Little is known about the frequency of life-threatening complications in these adolescents.WHAT THIS STUDY ADDS: Over 6 years, we found more than a fivefold increase in the incidence of hospitalized adolescents who, apart from not being underweight, have diagnostic features of anorexia nervosa. This group experienced a similar profile of acute complications of anorexia nervosa. abstract BACKGROUND AND OBJECTIVES: Clinicians are increasingly observing adolescents who have lost large amounts of weight, experience typical cognitions and acute medical complications of anorexia nervosa (AN), yet do not meet diagnostic criteria for AN owing to weight. We refer to this category of Eating Disorder Not Otherwise Specified as EDNOS-Wt. We set out to describe the changing incidence of EDNOS-Wt compared with AN, and to compare the characteristics of these 2 groups in a cohort that required hospitalization after weight loss. METHODS:A 6-year retrospective cohort study (2005 to 2010) was undertaken of first admissions of 12-to 19-year-old patients to a tertiary children' s hospital using Diagnostic Statistical Manual of Mental Disorders, Fourth Edition (DSM IV) AN or EDNOS-Wt. Clinical, biochemical, and nutritional data were collected up to day 28 of admission.RESULTS: Ninety-nine adolescents were admitted; 73 had AN and 26 had EDNOS-Wt. Mean (SD) age at admission was 15.2 years (1.3) and 87% were female. In 2005, EDNOS-Wt represented 8% of admissions; by 2009 this proportion had increased to 47%. Hypophosphatemia developed in 41% of AN and in 39% of EDNOS-Wt patients. The lowest mean pulse rate in AN was 45.1 bpm compared with 47.1 bpm in EDNOS-Wt patients. CONCLUSIONS:We have experienced more than a fivefold increase in the proportion of adolescents who have EDNOS-Wt admitted over this 6-year period. Despite not being underweight, EDNOS-Wt patients experienced a similar profile of life-threatening complications of weight loss as patients who have AN. Higher-weight adolescents who have extensively lost weight require careful medical assessment.

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Does Aggressive Refeeding in Hospitalized Adolescents With Anorexia Nervosa Result in Increased Hypophosphatemia?

Cited by 128 publications

References 24 publications

Practical methods for refeeding patients with anorexia nervosa

Practical methods for refeeding patients with anorexia nervosa

Eating Disorders in Children and Adolescents: State of the Art Review

Restrictive Eating Disorders Among Adolescent Inpatients

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