Enteral Nutrition for Feeding Severely Underfed Patients with Anorexia Nervosa

Abstract

Severe undernutrition nearly always leads to marked changes in body spaces (e.g., alterations of intra-extracellular water) and in body masses and composition (e.g., overall and compartmental stores of phosphate, potassium, and magnesium). In patients with severe undernutrition it is almost always necessary to use oral nutrition support and/or artificial nutrition, besides ordinary food; enteral nutrition should be a preferred route of feeding if there is a functional accessible gastrointestinal tract. Refeeding of severely malnourished patients represents two very complex and conflicting tasks: (1) to avoid “refeeding syndrome” caused by a too fast correction of malnutrition; (2) to avoid “underfeeding” caused by a too cautious rate of refeeding. The aim of this paper is to discuss the modality of refeeding severely underfed patients and to present our experience with the use of enteral tube feeding for gradual correction of very severe undernutrition whilst avoiding refeeding syndrome, in 10 patients aged 22 ± 11.4 years and with mean initial body mass index (BMI) of 11.2 ± 0.7 kg/m2. The mean BMI increased from 11.2 ± 0.7 kg/m2 to 17.3 ± 1.6 kg/m2 and the mean body weight from 27.9 ± 3.3 to 43.0 ± 5.7 kg after 90 days of intensive in-patient treatment (p < 0.0001). Caloric intake levels were established after measuring resting energy expenditure by indirect calorimetry, and nutritional support was performed with enteral feeding. Vitamins, phosphate, and potassium supplements were administered during refeeding. All patients achieved a significant modification of BMI; none developed refeeding syndrome. In conclusion, our findings show that, even in cases of extreme undernutrition, enteral feeding may be a well-tolerated way of feeding.

Outcomes of an inpatient refeeding protocol in youth with anorexia nervosa: Rady Children’s Hospital San Diego/University of California, San Diego

“…Many of these groups started patients on prophylactic phosphorus supplementation which may have helped prevent the development of electrolyte abnormalities or clinical refeeding syndrome [10, 12, 13]. The use of NG tubes for nutritional rehabilitation was also not associated with adverse outcomes [12, 16, 17]. Overall, these studies suggest that starting at a higher calorie level and advancing quickly may be considered in moderately malnourished (75–85% of expected body weight) adolescents and young adults with AN.…”

Abordaje nutricional de pacientes ingresados con anorexia nerviosa

“…Besides, most authors state that refeeding syndrome depends more on the degree of malnutrition at admission, than on the speed of caloric intake (6,21,32). As a matter of fact, even at low caloric intakes, refeeding syndrome has still been documented (8,29).…”

Nutritional rehabilitation in anorexia nervosa: the role and scope of dietitian’s work in a therapeutic team

“…Aktualnie opublikowano wiele prac mających na celu ustalenie minimalnej podaży energii, która by to umożliwiła [33,34,35,36]. Niektórzy badacze podkreślają, że ustalenie minimalnej podaży energii, która umożliwia zwiększenie masy ciała u pacjentów z anoreksją zależy od podtypu choroby.…”

“…Należy jednak zaznaczyć, że badacze nie są zgodni co do optymalnej wartości potrzebnej do przyrostu 1 kg masy ciała u pacjentów z restrykcyjnym typem anoreksji. I tak, zdaniem Gentile [33] należy dostarczyć dodatkowo od 3500 do 7000 kcal. Natomiast Mehler i wsp.…”