The medical risks of severe anorexia nervosa during initial re-feeding and medical stabilisation

Davies, Jennie E.; Cockfield, Annette; Brown, Andrea; Corr, Jean; Smith, Danielle M.; Munro, Calum

doi:10.1016/j.clnesp.2016.09.005

Cited by 22 publications

(33 citation statements)

References 26 publications

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“…After securing blood samples for laboratory tests, the patients were first provided with proper hydration and nutrition during their stay at the hospital to reduce as much as possible the risk of fatal somatic complications. At the same time, the patients received psychological treatment and some of them also received pharmacological treatment, including antidepressants for patients exhibiting depressed mood and/or anxiolytic drugs, for patients who exhibited some symptoms of anxiety disorders, especially obsessions and/or compulsions [ 7 , 23 , 24 ]. Some of patients, who suffered from gastrointestinal problems, received also medications that support the digestive system.…”

Section: Methodsmentioning

confidence: 99%

Neuropeptide B and Vaspin as New Biomarkers in Anorexia Nervosa

Grzelak

Tyszkiewicz‐Nwafor

Dutkiewicz

et al. 2018

BioMed Research International

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Introduction The aim of the study was to assess the correlation between the levels of neuropeptide B (NPB), neuropeptide W (NPW), vaspin (VAS), and the total antioxidant status (TAS) in the blood, as well as nutritional status of patients with anorexia nervosa (AN). Materials and Methods The study covered a cohort of 76 female teenagers, including 46 females with extreme AN and 30 healthy peers (CONTR) aged 12-17. Results AN persons were characterized by higher (in comparison to CONTR) NPB and VAS concentrations and lower values of TAS levels, body weight, and anthropometric values. Positive correlations between NPB and VAS levels were noted in the AN group (R=0.33; p<0.001) as well as between concentrations of NPW and VAS in the same group (R=0.49; p<0.001). Furthermore, positive correlations existed between NPB and NPW concentrations across the whole studied population (AN+CONTR; R=0.75; p<0.000001), AN (R=0.73; p<0.000001) and CONTR (R=0.90; p<0.0005). Conclusions In detailed diagnostics of AN it is worth considering testing NPB and VAS levels.

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Section: Methodsmentioning

confidence: 99%

Neuropeptide B and Vaspin as New Biomarkers in Anorexia Nervosa

Grzelak

Tyszkiewicz‐Nwafor

Dutkiewicz

et al. 2018

BioMed Research International

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“…Findings from this study, similar to those of other recent literature in this area, support a move towards less conservative refeeding in adolescent AN 4,23 . These results provide additional evidence to suggest that medical instability should not be assumed in all low weight, malnourished adolescents, but should be objectively assessed and managed on a case by case basis 9 . A greater understanding of the physiological response to refeeding of adolescents with AN is essential to improve and update current guidance 1 .…”

Section: Recommendationsmentioning

confidence: 76%

“…Recent literature shows that thresholds for medical indicators of admission, such as those advised in Junior MARSIPAN, are based on expert opinion without clear evidence and that a review of these indicators is warranted 28,29 . There is also evidence to suggest that objective physical risks are modest in even the most severe cases on AN and that a high medical risk should not be assumed in most cases but based on objective assessments 9 .…”

Section: Differences In Characteristics Of Groupsmentioning

confidence: 99%

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

Brennan¹,

Chapman²,

Illingworth³

2020

Preprint

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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.

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“…This usually conducts to a shorter hospital stay. In general, the results of these studies show that the refeeding is safe and effective in these patients if the supervision is adequate and follows a specific protocol [25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40].…”

Section: Resultsmentioning

confidence: 99%

Nutritional Management and Outcomes in Malnourished Medical Inpatients: Anorexia Nervosa

Cuerda

Vasiloglou

Arhip

2019

JCM

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Background: Anorexia Nervosa (AN) is a psychiatric disorder characterised by a physical and psychosocial deterioration due to an altered pattern on the intake and weight control. The severity of the disease is based on the degree of malnutrition. The objective of this article is to review the scientific evidence of the refeeding process of malnourished inpatients with AN; focusing on the clinical outcome. Methods: We conducted an extensive search in Medline and Cochrane; on April 22; 2019; using different search terms. After screening all abstracts; we identified 19 papers that corresponded to our inclusion criteria. Results: The article focuses on evidence on the characteristics of malnutrition and changes in body composition; energy and protein requirements; nutritional treatment; physical activity programmes; models of organisation of the nutritional treatment and nutritional support related outcomes in AN patients. Conclusion: Evidence-based standards for clinical practice with clear outcomes are needed to improve the management of these patients and standardise the healthcare process.

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The medical risks of severe anorexia nervosa during initial re-feeding and medical stabilisation

Cited by 22 publications

References 26 publications

Neuropeptide B and Vaspin as New Biomarkers in Anorexia Nervosa

Neuropeptide B and Vaspin as New Biomarkers in Anorexia Nervosa

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

Nutritional Management and Outcomes in Malnourished Medical Inpatients: Anorexia Nervosa

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