Newer Approaches to Acute Nutritional Rehabilitation for Patients With Anorexia Nervosa

2018 ◽  
pp. 344-358
Author(s):  
Andrea K. Garber ◽  
Michael Kohn
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Standard Approach ◽  
Nutritional Rehabilitation ◽  
Refeeding Syndrome ◽  
Restrictive Eating ◽  
Wide Variability

Refeeding in the hospital is recommended for patients with malnutrition and medical instability secondary to restrictive eating disorders. For decades, the standard approach to refeeding was lower calorie diets, aimed at minimizing risk for the refeeding syndrome. Emerging data indicate that this approach may be too conservative, and that higher calorie refeeding is feasible. This approach is being rapidly translated into practice with wide variability in routes of delivery and electrolyte correction. This article reviews the current research on refeeding, with particular attention to gaps in the evidence that must be filled before new refeeding recommendations can be developed.

scholarly journals Higher Caloric Refeeding Is Safe in Hospitalised Adolescent Patients with Restrictive Eating Disorders

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Elizabeth K. Parker ◽  
Sahrish S. Faruquie ◽  
Gail Anderson ◽  
Linette Gomes ◽  
Andrew Kennedy ◽  
...  
Keyword(s):  
Eating Disorders ◽  
Weight Gain ◽  
Statistical Significance ◽  
Caloric Intake ◽  
Tube Feeding ◽  
Retrospective Chart Review ◽  
Refeeding Syndrome ◽  
Restrictive Eating ◽  
Weight Restoration ◽  
The Mean

Introduction. This study examines weight gain and assesses complications associated with refeeding hospitalised adolescents with restrictive eating disorders (EDs) prescribed initial calories above current recommendations.Methods. Patients admitted to an adolescent ED structured “rapid refeeding” program for >48 hours and receiving ≥2400 kcal/day were included in a 3-year retrospective chart review.Results. The mean (SD) age of the 162 adolescents was 16.7 years (0.9), admission % median BMI was 80.1% (10.2), and discharge % median BMI was 93.1% (7.0). The mean (SD) starting caloric intake was 2611.7 kcal/day (261.5) equating to 58.4 kcal/kg (10.2). Most patients (92.6%) were treated with nasogastric tube feeding. The mean (SD) length of stay was 3.6 weeks (1.9), and average weekly weight gain was 2.1 kg (0.8). No patients developed cardiac signs of RFS or delirium; complications included 4% peripheral oedema, 1% hypophosphatemia (<0.75 mmol/L), 7% hypomagnesaemia (<0.70 mmol/L), and 2% hypokalaemia (<3.2 mmol/L). Caloric prescription on admission was associated with developing oedema (95% CI 1.001 to 1.047;p=0.039). No statistical significance was found between electrolytes and calories provided during refeeding.Conclusion. A rapid refeeding protocol with the inclusion of phosphate supplementation can safely achieve rapid weight restoration without increased complications associated with refeeding syndrome.

scholarly journals Avoiding deaths in hospital from anorexia nervosa: the MARSIPAN project

2012 ◽  
Vol 36 (3) ◽  
pp. 109-113 ◽  
Author(s):  
Paul Robinson
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Adult Patients ◽  
Refeeding Syndrome ◽  
The Family ◽  
Key Issues ◽  
Medical Teams ◽  
Medical Wards

SummaryThe MARSIPAN (MAnagement of Really SIck Patients with Anorexia Nervosa) project was established in response to reports of patients admitted to medical wards and proving refractory to treatment, sometimes dying on the ward. Psychiatrists, physicians and other clinicians in nutrition and eating disorders were brought together to discuss key issues in the assessment and management of such patients. The resulting guidance report, which applies to adult patients over 18, addresses: assessment of risk, where to treat the patient, specialist support for medical teams, key elements of treatment, namely (a) safe refeeding to avoid refeeding syndrome and underfeeding syndrome, (b) management of problematic behaviours, (c) support for the family, and (d) transfer to a specialist eating disorder unit when appropriate and possible.

scholarly journals L’INTERVENTO NUTRIZIONALE NEI DISTURBI DEL COMPORTAMENTO ALIMENTARE

2020 ◽  
Author(s):  
Maria Letizia Petroni
Keyword(s):  
Quality Of Life ◽  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Hospital Setting ◽  
Nutritional Intervention ◽  
Outpatient Setting ◽  
Therapeutic Education ◽  
Motor Rehabilitation ◽  
Nutritional Rehabilitation

The nutritional intervention is a cornerstone of the treatment of eating disorders. Most serious cases are being treated first by parenteral and/or enteral nutrition, carefully to prevent the re-feeding syndrome that can have fatal consequences. Once patient is clinically stable, integrated intervention can be started: medical, nutritional, psychological, motor, rehabilitation and therapeutic education may take place initially in a hospital setting and then in an outpatient setting. The nutritional rehabilitation in anorexia nervosa can be conducted with the mode of the mechanical feeding or with that of desensitization of anxiety by food. Goal is the gradual normalization of weight and nutrition and improving the quality of life of the patient.

Anorexia Nervosa and Pregnancy: A Case Report

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
L.C. Castro ◽  
S. Moreira ◽  
A. Lopes ◽  
M. Branco
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Pregnancy Complications ◽  
Eating Behaviour ◽  
Perinatal Outcomes ◽  
Obstetric Care ◽  
Future Research ◽  
Restrictive Eating ◽  
Risk Pregnancy ◽  
The Impact

Background:Several studies report that women with a history of eating disorders are at higher risk of pregnancy complications and major adverse perinatal outcomes.Aim:To report a case of anorexia nervosa during pregnancy, in order to underline the impact of eating disorders on pregnancy.Methods:Case study and review of the literature.Results:A 32 year old woman was hospitalized in an obstetric service of a general hospital for high risk pregnancy complications. She maintained a disturbed eating behaviour, with periods of restrictive eating and bulimic-purging episodes. She was underweight, did not reach the recommended weight gain during pregnancy and showed intrauterine growth restriction. The Psychiatry Liasion Unit was asked to follow the case during the obstetric hospitalization.Discussion:Pregnant women with eating disorders have higher risk of pregnancy and neonatal complications. Pregnancy is a privileged opportunity to maximize intervention in eating disorders, since women show higher levels of motivation for therapy. Some cases of anorexia nervosa may warrant special obstetric care to ensure adequate prenatal nutrition and fetal development. Since there are few studies on this topic and they report conflicting results, it is a relevant area for future research.

scholarly journals Anorexia Nervosa—What Has Changed in the State of Knowledge about Nutritional Rehabilitation for Patients over the Past 10 Years? A Review of Literature

Nutrients ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 3819
Author(s):  
Katarzyna Jowik ◽  
Marta Tyszkiewicz-Nwafor ◽  
Agnieszka Słopień
Keyword(s):  
Anorexia Nervosa ◽  
Healing Process ◽  
Caloric Intake ◽  
Current Treatment ◽  
Review Of Literature ◽  
Nutritional Rehabilitation ◽  
Long Term Effects ◽  
Refeeding Syndrome ◽  
The Past ◽  
Potential Benefits

Anorexia nervosa (AN) is a psycho-metabolic disorder with a high risk of somatic complications such as refeeding syndrome (RFS) and carries the highest mortality rate of all psychiatric illnesses. To date, the consensus on the care for patients with AN has been based on recommendations for a combination of alimentation and psychotherapy. It is important to establish an initial caloric intake that will provide weight gain and minimize the risk of complications in the treatment of undernourished patients. Research over the past few years suggests that current treatment recommendations may be too stringent and should be updated. The aim of this paper is to systematize the current reports on nutritional rehabilitation in AN, to present the results of studies on the safe supplementation of patients and its potential impact on improving prognosis and the healing process. This review of literature, from 2011–2021, describes the changing trend in the nutritional protocols used and the research on their efficacy, safety, and long-term effects. In addition, it presents previous reports on the potential benefits of introducing vitamin, pro-and prebiotic and fatty acid supplementation.

scholarly journals LA CLINICA DEI DISTURBI DEL COMPORTAMENTO ALIMENTARE: L’INTERVENTO PSICOLOGICO°

2020 ◽  
Author(s):  
Enrico Molinari
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Collaborative Work ◽  
Well Being ◽  
Fundamental Question ◽  
Restrictive Eating ◽  
Political Experience ◽  
Personal Experiences ◽  
Unpleasant Emotion

Eating disorders represent a field of investigation and intervention of considerable interest for psychology. This is an extraordinarily complex area. When working with these patients, it is crucial to consider a multifactorial etiopathogenetic framework. As anyone who has ever worked with eating disorder will know, the words “challenge” and “body image” have a particularly important role, both in research and clinical practice. appearance. Of all other Eating Disorders, Anorexia Nervosa (AN) will be presented today. Its prevalence ranges between 0,28% and 1%, with a high mortality rate and its onset is related to the presence of a multiplicity of genetic, neurobiological and psychosocial interrelated factors. One fundamental question is: what are the objectives to achieve for each specific individual who show AN symptoms? Treatment should be directed towards as many areas as possible in order to increase the chances of success and ensure the patient’s greater psychophysical well-being. A collaborative work between nutritionists, physicians, psychologists, psychiatrists, patients themselves and their families, could turn the cure into an aesthetic, ethical and political experience. The narration of their own personal experiences is an essential moment in the treatment of patients with eating disorders. Keeping in mind that the restrictive eating behavior, which is typical in AN, seems aimed at avoiding unpleasant emotion and that the real expert of the disorder is always the patient himself, it is essential to build a relationship that promotes change.

Feeding and Eating Disorders

2017 ◽  
Author(s):  
Patricia Westmoreland ◽  
Phillip S Mehler
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Food Intake ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Restrictive Eating ◽  
Dsm 5 ◽  
Feeding And Eating Disorders

Feeding and eating disorders are defined by persistent disturbance of eating (or behaviors related to eating) with subsequent changes in consumption or absorption of nutrition that are detrimental to physical health and social functioning. The following eating disorders are described in the DSM-5: anorexia nervosa, bulimia nervosa, binge eating disorder, pica, rumination disorder, avoidant/restrictive food intake disorder (ARFID), other specified feeding or eating disorder (OSFED), and unspecified feeding or eating disorder (USFED). ARFID, OSFED, USFED, rumination disorder, and binge eating disorder are new additions to the manual and are first described in the DSM-5. The DSM-5 also provides severity specifiers—mild, moderate, severe, and extreme—for the diagnoses of bulimia nervosa and anorexia nervosa. This review describes the eating disorders enumerated in the DSM-5 and provides information regarding their genesis and course. This review contains 8 tables and 79 references Key words: avoidant/restrictive eating disorder, binge eating disorder, DSM-5, eating disorder, other specified feeding or eating disorder, pharmacotherapy, pica rumination, psychotherapy, unspecified feeding or eating disorder

scholarly journals Skeletal effects and refeeding syndrome in anorexia nervosa

2020 ◽  
pp. 585-587
Author(s):  
Naomi VĂDUVA ◽  
Lehel PUSKAS ◽  
Andreea-Liana RĂCHIȘAN ◽  
Anamaria Magdalena TOMȘA ◽  
Andreea Alexandra ALDEA ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Therapeutic Approach ◽  
Nutritional Support ◽  
Nutritional Rehabilitation ◽  
Key Factors ◽  
Refeeding Syndrome ◽  
Laboratory Findings ◽  
Life Threatening ◽  
Weight Restoration ◽  
Skeletal Effects

Purpose Anorexia nervosa (AN) is a psychiatric disorder which can lead to numerous medical complications. In the clinical practice, during weight restoration, it is relatively common to observe potentially fatal complications, such as refeeding syndrome (RS). The objective of this case report is to highlight some key factors regarding nutritional support and the therapeutic approach in AN to avoid life-threatening complications, for example severe hypophosphatemia. Methods We present the case of a 14-year-old girl suffering from AN, who was admitted to our hospital with lethargy, emaciation with bitemporal wasting, hirsutism and pitting lower extremity edema. Results Based on the laboratory findings, the concerning condition of the patient was attributed to hypophosphatemia (1,64 mg/dl) caused by RS. Conclusions Refeeding syndrome is a potentially lethal condition in the case of AN patients. Hypophosphatemia, which is a result of the refeeding syndrome, is a relatively common complication of overly aggressive nutritional rehabilitation. Physicians who are involved in treating this condition, should be aware of this potentially life-threatening syndrome, and assess their therapeutic approach accordingly Keywords: anorexia nervosa, hypophosphatemia, refeeding syndrome, nutritional support,

Feeding and Eating Disorders

2017 ◽  
Author(s):  
Patricia Westmoreland ◽  
Phillip S Mehler
Keyword(s):  
Eating Disorders ◽  
Anorexia Nervosa ◽  
Eating Disorder ◽  
Food Intake ◽  
Bulimia Nervosa ◽  
Binge Eating ◽  
Binge Eating Disorder ◽  
Restrictive Eating ◽  
Dsm 5 ◽  
Feeding And Eating Disorders

Feeding and eating disorders are defined by persistent disturbance of eating (or behaviors related to eating) with subsequent changes in consumption or absorption of nutrition that are detrimental to physical health and social functioning. The following eating disorders are described in the DSM-5: anorexia nervosa, bulimia nervosa, binge eating disorder, pica, rumination disorder, avoidant/restrictive food intake disorder (ARFID), other specified feeding or eating disorder (OSFED), and unspecified feeding or eating disorder (USFED). ARFID, OSFED, USFED, rumination disorder, and binge eating disorder are new additions to the manual and are first described in the DSM-5. The DSM-5 also provides severity specifiers—mild, moderate, severe, and extreme—for the diagnoses of bulimia nervosa and anorexia nervosa. This review describes the eating disorders enumerated in the DSM-5 and provides information regarding their genesis and course. This review contains 8 tables and 79 references Key words: avoidant/restrictive eating disorder, binge eating disorder, DSM-5, eating disorder, other specified feeding or eating disorder, pharmacotherapy, pica rumination, psychotherapy, unspecified feeding or eating disorder

scholarly journals To Improve the Initial Inpatient Management of Adolescents Admitted with Severe Anorexia Nervosa: A Narrative Review and a Convenient Protocol

Nutrients ◽  
2022 ◽  
Vol 14 (1) ◽  
pp. 229
Author(s):  
Stephanie Proulx-Cabana ◽  
Marie-Elaine Metras ◽  
Danielle Taddeo ◽  
Olivier Jamoulle ◽  
Jean-Yves Frappier ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Caloric Intake ◽  
Tube Feeding ◽  
Narrative Review ◽  
Cardiac Monitoring ◽  
Current Evidence ◽  
Cardiac Complications ◽  
Nutritional Rehabilitation ◽  
Refeeding Syndrome ◽  
Pubmed Search

Inadequate nutritional rehabilitation of severely malnourished adolescents with Anorexia Nervosa (AN) increases the risk of medical complications. There is no consensus on best practices for inpatient nutritional rehabilitation and medical stabilization for severe AN. This study aimed to elaborate an admission protocol for adolescents with severe AN based on a comprehensive narrative review of current evidence. A Pubmed search was conducted in July 2017 and updated in August 2020, using the keywords severe AN or eating disorders (ED), management guidelines and adolescent. Relevant references cited in these guidelines were retrieved. A secondary search was conducted using AN or ED and refeeding protocol, refeeding syndrome (RS), hypophosphatemia, hypoglycemia, cardiac monitoring or cardiac complications. Evidence obtained was used to develop the admission protocol. Selective blood tests were proposed during the first three days of nutritional rehabilitation. Higher initial caloric intake is supported by evidence. Continuous nasogastric tube feeding was proposed for patients with a BMI < 12 kg/m2. We monitor hypoglycemia for 72 h. Continuous cardiac monitoring for bradycardia <30 BPM and systematic phosphate supplementation should be considered. Developing protocols is necessary to improve standardization of care. We provide an example of an inpatient admission protocol for adolescents with severe AN.

Sign in / Sign up

Export Citation Format

Share Document