Evaluation of Refeeding Outcomes Over 5-Years in A Specialist Adolescent Eating Disorder Center in The UK: A Retrospective Chart Review Study.

Abstract

Background and aims: Refeeding syndrome (RS) is a serious clinical syndrome, its early identification is key to safe management. The aim of this study was to evaluate existing practices in a highly specialist centre for eating disorders and compare refeeding management, nutritional, and clinical outcomes in cases admitted to secondary care with those managed in primary care.Methods: Retrospective analysis of electronic case records of adolescent patients at moderate – high risk of developing refeeding syndrome and treated for anorexia nervosa by a specialist eating disorder centre in London over a 5-year period. Statistical analysis compared refeeding methods used in this population to establish if there were differences in refeeding methods used within the sample and if so, how they impacted on outcomes. Results: Adolescents admitted to inpatient care had significantly lower energy intakes (374kcal/d ± 205 compared with 621kcal/d ± 348, p = 0.001 ) and higher rates of weight loss at assessment (0.86kg/week ± 0.7 compared with 0.38kg/week ± 0.7, p = 0.003), without significant differences in other markers of medical instability. Incidence of RS symptoms did not differ significantly between groups and, similarly, no statistically significant difference was found between groups in treatment outcomes, measured by discharge weight (kg) and percentage median BMI (41.5kg ± 8.3 compared with 43.7kg ± 7.7, p = 0.322 and 81.6% ± 8.5 compared with 82.3% ± 9.7, p = 0.622). Conclusions: Findings from this study support the hypothesis that refeeding adolescents with AN, at high risk of developing RS, with higher energy feeds than that advised by national guidance, in the absence of prophylactic phosphate supplementation or incremental energy increases, does not increase the risk of developing refeeding complications. These findings support recent evidence that advocates a less conservative refeeding approach and a review of current national guidance.