The effect of oral refeeding compared with nasogastric refeeding on the quality of care for patients hospitalised with an eating disorder: A systematic review

Abstract

Aim The aim of this systematic review was to compare the benefits and harms of nasogastric and oral‐based refeeding on the quality of care, including effectiveness, safety, and patient experience, for patients hospitalised with an eating disorder. Methods A systematic search for studies measuring comparative data between nasogastric and oral refeeding methods was conducted in August 2021. Title and abstracts and remaining full texts were screened by both authors. Risk of bias was evaluated using the PEDro scale, and overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation narrative synthesis. Results Seven studies (one randomised controlled trial, five non‐randomised studies of interventions, and one qualitative study) with 917 participants were included. There was low certainty evidence that nasogastric refeeding resulted in no difference or a small increase in weekly weight gain, and moderate certainty of greater total weight gain, and very low certainty of increased length of stay compared to oral refeeding. There was no difference or a small increase in discharge weight and body mass index with nasogastric refeeding compared to oral refeeding. No serious adverse events were reported. Conclusion Patients selected for nasogastric refeeding have a longer duration of illness and lower admission weight, making it difficult to determine which refeeding approach is superior. However, the lack of clear difference in weekly weight gain and the lack of reported harms suggests that other factors such as the normalisation of eating behaviour may be taken into account when choosing the most appropriate refeeding method.

Essstörungen für den/die Gastroenterologen:in – was sich zu wissen lohnt

“…Sie spielt auch eine Rolle, wenn eine nasogastrale Sonde bei allfälliger Zwangsernährung nicht toleriert wird [40,49]. Es existiert bislang keine klare Richtlinie, wann eine Sondenernährung unumgänglich ist und wie die Nahrung in diesen Fällen zusammengesetzt sein soll [46,47,48].…”

“…Wenig überraschend hatten in den Studien jedoch Patienten umso eher eine Ernährungssonde, je tiefer der initiale BMI war. Als mögliche Vorteile der Sondenernährung zeigten sich die bessere Steuerbarkeit der Kalorienaufnahme, schnellere Gewichtszunahme und Verkürzung der Zeit, bis Patienten einer Psychotherapie zugeführt werden konnten [46,47,48]. Eine Ernährung via Sonde ist sicher zu bevorzugen, wenn funktionelle Störungen eine Weiterbeförderung der Nahrung behindern.…”

The United Nations Sustainable Development Goals: Aspirational or obtainable?

“…Also in this issue, the role of dietitians in medical nutrition therapy is exemplified by Bendall and Taylor, 15 who systematically review the literature to explore the relative benefit of oral versus nasogastric feeding for those hospitalised with malnutrition resulting from restrictive eating. A lack of clear difference in weight gain between the two methods of refeeding and with those selected for nasogastric feeding being admitted to the hospital with a lower starting body weight made it challenging to determine with any certainty that one method is superior to the other.…”