Current anorexia nervosa refeeding recommendations ‘suboptimal’
MedWire News: Adolescents hospitalized with anorexia nervosa (AN) who receive treatment based on current recommendations for refeeding fail to gain significant weight during the first week of hospitalization, suggest study findings.
According to lead study author Andrea Garber (University of California, San Francisco, USA) the finding represents a "missed opportunity" and "shows that the current recommendations are just not effective."
"Studies show that weight gain during hospitalization is crucial for patients' long-term recovery," she said in an associated press release, adding: "We have to make the most out of their short time in the hospital."
For the study, Garber and team followed up 35 adolescents aged 13.1-20.5 years during their hospitalization for AN. Weight, vital signs, electrolytes, and 24-hour fluid balance were measured daily.
Patients were administered a standard oral refeeding protocol based on three meals and three snacks per day. Diets started at approximately 1200 calories and calories were advanced by, on average, 200 calories every other day to prevent refeeding syndrome - a life-threatening condition resulting from rapid electrolyte shifts during re-introduction of nutrition.
Overall, patients spent 16.7 days in the hospital, and had a mean body mass index (BMI) of 16.3 kg/m2 upon admission. The majority of patients (94%) were started on a diet of 1400 calories or less.
A significant increase in percent median BMI (%MBMI) was seen at discharge compared with baseline (80.1 to 84.5%). Patients gained on average 2.42 kg by the end of discharge, corresponding to a daily increase of 0.15 kg.
When the researchers examined the trend of weight change of the hospitalization period, they found that 83% of patients initially lost weight.
Compared with the first day of hospitalization, %MBMI was significantly lower on days 2 and 3, with no significant difference seen between days 4 and 7. A significant increase in weight gain was seen from day 8, which continued until discharge. Of note, the average prescribed diet reached 1966 calories by day 8.
An average of 800 mL fluid loss was observed during the first 3 days in hospital, which returned to normality (fluid balance) after day 10. Initial fluid loss and initial body weight loss during the first 3 days in hospital were inversely correlated.
Multivariate regression analysis adjusting for %MBMI and lowest heart rate on day 1 showed that a higher calorie starting diet predicted a faster rate of weight gain and shorter stay in hospital. For every 100-calorie increase in the prescribed diet at baseline, the rate of %MBMI gain increased significantly by 0.02% per day, and the length of hospital stay decreased significantly by 0.9 days.
Despite the negative findings, Garber cautioned against advocating shorter treatment time: "Shorter is not necessarily better… We have to consider the potential implications down the line, both psychological and emotional."
Nevertheless, the researchers say the findings are promising as no adverse events were seen among the few patients who receive higher calorie diets: "If we can improve weight gain with higher calories, then we're on the right path."
The findings are published in the Journal of Adolescent Health.
By Ingrid Grasmo