Nasogastric Tube Feeding for Individuals With Anorexia Nervosa

Kells, Meredith; Kelly‐Weeder, Susan

doi:10.1177/1078390316657872

Cited by 22 publications

(19 citation statements)

References 65 publications

(128 reference statements)

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“…A 2014 review of 7 observational studies with children and adolescents found relatively increased in‐treatment weight gain, as well as caloric intake, with NG nutrition. A 2016 review of 19 refeeding studies (including 2 RCTs) found increased short‐term weight gain with NG nutrition compared with OO intake. Finally, another 2016 review of various refeeding approaches for patients with AN, including 10 studies incorporating supplemental NG nutrition into meal‐based methods, found that NG feeding was useful for increasing caloric intake.…”

Section: Discussionmentioning

confidence: 99%

Enteral Nutrition via Nasogastric Tube for Refeeding Patients With Anorexia Nervosa: A Systematic Review

2018

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Weight restoration is an important first step in treating patients with anorexia nervosa (AN), because it is essential for medical stabilization and reversal of long-term complications. Tube feeding may help facilitate weight restoration, but its role in treatment remains unclear. This study aimed to review the literature describing the efficacy, safety, tolerance, and long-term effects of nasogastric (NG) refeeding for patients with AN. Four electronic databases were systematically searched through May 2018. Boolean search terms included "anorexia nervosa," "refeeding," and "nasogastric tube feeding." Ten studies were eligible for inclusion: 8 retrospective chart reviews, 1 prospective cohort, and 1 randomized controlled trial. Nine of the studies were performed in-hospital. In 8 studies, NG nutrition resulted in an average rate of weight gain exceeding 1 kg/wk. In 4 of 5 studies including an oral-only control group, mean weekly weight gain and caloric intake were significantly higher in tube-fed patients. Six studies provided prophylactic phosphate supplementation, all with <1% occurrence rate of refeeding hypophosphatemia. Seven studies reported on other physiological disturbances, 6 evaluated medical and gastrointestinal side effects, 3 considered psychological outcomes, and 4 assessed patients postdischarge. Results indicated that NG feeding was not associated with an increased risk for adverse outcomes. Overall, in these studies, NG nutrition was considered safe and well tolerated, and effectively increased caloric intake and rate of weight gain in patients with AN. However, results are limited by weaknesses in study designs, and more rigorous methods are needed for development of evidence-based, standardized refeeding protocols.

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Section: Discussionmentioning

confidence: 99%

Enteral Nutrition via Nasogastric Tube for Refeeding Patients With Anorexia Nervosa: A Systematic Review

2018

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“…Our literature review found various narrative reviews concerning somatic aspects of AN, but only a few recent systematic reviews concerning multi-organic somatic medications. In fact, most systematic reviews are concerned with the effects of weight gain or pharmacological treatments (hormone replacement, biphosphonates, teriparatide, and vitamin K) on bone mineral density and secondary osteoporosis [39,44,49,50] or they concerned nutritional therapeutic modalities and their impact on weight changes [42,46], or the efficacy of nasogastric enteral nutrition and adverse effects [47,52,53]. Most of the studies involved small samples, with heterogeneity within and among studies concerning evaluations, biomarkers and age range, with heterogeneous adolescent and adult populations, and various durations, often with an insufficient follow-up.…”

Section: Resultsmentioning

confidence: 99%

“…One systematic review [47] including 18 studies and 1427 adolescent and adult AN patients (1406 F/21 M), evaluated physiological and psychiatric outcomes and patient adherence to nasogastric feeding (NG). It can be noted that 95% of the studies were conducted in inpatient medical or psychiatric units and only one study concerned ambulatory patients [109].…”

Section: Resultsmentioning

confidence: 99%

Medication in AN: A Multidisciplinary Overview of Meta-Analyses and Systematic Reviews

Blanchet

Guillaume

Bat-Pitault

et al. 2019

JCM

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Drugs are widely prescribed for anorexia nervosa in the nutritional, somatic, and psychiatric fields. There is no systematic overview in the literature, which simultaneously covers all these types of medication. The main aims of this paper are (1) to offer clinicians an overview of the evidence-based data in the literature concerning the medication (psychotropic drugs and medication for somatic and nutritional complications) in the field of anorexia nervosa since the 1960s, (2) to draw practical conclusions for everyday practise and future research. Searches were performed on three online databases, namely MEDLINE, Epistemonikos and Web of Science. Papers published between September 2011 and January 2019 were considered. Evidence-based data were identified from meta-analyses, if there were none, from systematic reviews, and otherwise from trials (randomized or if not open-label studies). Evidence-based results are scarce. No psychotropic medication has proved efficacious in terms of weight gain, and there is only weak data suggesting it can alleviate certain psychiatric symptoms. Concerning nutritional and somatic conditions, while there is no specific, approved medication, it seems essential not to neglect the interest of innovative therapeutic strategies to treat multi-organic comorbidities. In the final section we discuss how to use these medications in the overall approach to the treatment of anorexia nervosa.

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“…In restrictive eating disorders where patients are underweight, therapists may insist on weight gain at all costs, including strategies for intensive nutritional rehabilitation such as nasogastric tube feeding that involves no behavioral learning and may actually impede such learning. A review of the efficacy of tube feeding in AN suggests that short-term weight gain is generally achieved without concurrent improvement in psychiatric symptoms or evidence of long-term sustainability ( Kells and Kelly-Weeder, 2016 ). A comparison of feeding methods in anorexia found no advantage in efficacy for tube feeding over ordinary oral intake of food or liquid supplements, and a wide range of disadvantages ( Hart et al, 2013 ).…”

Section: A Feedback Model Of Eating Disorders: Mind Body and Behavimentioning

confidence: 99%

Treating Eating: A Dynamical Systems Model of Eating Disorders

Troscianko

Leon

2020

Front. Psychol.

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Mainstream forms of psychiatric talk therapy and cognitive behavioral therapy (CBT) do not reliably generate lasting recovery for eating disorders. We discuss widespread assumptions regarding the nature of eating disorders as fundamentally psychological disorders and highlight the problems that underlie these notions, as well as related practical problems in the implementation of mainstream treatments. We then offer a theoretical and practical alternative: a dynamical systems model of eating disorders in which behavioral interventions are foregrounded as powerful mediators between psychological and physical states. We go on to present empirical evidence for behavioral modification specifically of eating speed in the treatment of eating disorders, and a hypothesis accounting for the etiology and progression, as well as the effective treatment, of the full spectrum of eating problems. A dynamical systems approach mandates that in any dietary and lifestyle change as profound as recovery from an eating disorder, acknowledgment must be made of the full range of pragmatic (psychological, cultural, social, etc.) factors involved. However, normalizing eating speed may be necessary if not sufficient for the development of a reliable treatment for the full spectrum of eating disorders, in its role as a mediator in the complex feedback loops that connect the biology and the psychology with the behaviors of eating.

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Nasogastric Tube Feeding for Individuals With Anorexia Nervosa

Abstract: NG feeding promotes short-term weight gain; however, long-term outcomes are poorly understood. Future research, using rigorous methods, is still needed to inform practice.

Cited by 22 publications

References 65 publications

Enteral Nutrition via Nasogastric Tube for Refeeding Patients With Anorexia Nervosa: A Systematic Review

Enteral Nutrition via Nasogastric Tube for Refeeding Patients With Anorexia Nervosa: A Systematic Review

Medication in AN: A Multidisciplinary Overview of Meta-Analyses and Systematic Reviews

Treating Eating: A Dynamical Systems Model of Eating Disorders

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