Refeeding Patients with Moderate and Severe Eating Disorders: A Retrospective Cohort Study

2021 ◽  
Vol 6 (2) ◽  
Author(s):  
Rabito GS ◽  
◽  
Blalock DV ◽  
Beaty LR ◽  
Harr BL ◽  
...  
Keyword(s):  
Eating Disorder ◽  
Liver Function Tests ◽  
Registered Dietitians ◽  
Refeeding Syndrome ◽  
Eating Disorder Treatment ◽  
Meal Plan ◽  
Nutrition Rehabilitation ◽  
Life Threatening ◽  
Weight Restoration ◽  
Elevated Liver Function Tests

Background: Anorexia Nervosa (AN) is a life-threatening mental illness that can cause significant medical complications, including the potentially fatal refeeding syndrome. Registered dietitians (RDs) are a critical part of an eating disorder multidisciplinary team that focuses treatment on safe weight restoration and nutrition rehabilitation. Method: This study is a description of how the nutrition rehabilitation protocol of 395 adult patients diagnosed with AN and admitted to residential eating disorder treatment is implemented, how the protocol is sustained throughout a patient’s treatment stay to achieve desired weight gain, and how the patients’ biochemical and clinical progress proceeded between admission and discharge, including laboratory results and body mass index (BMI). Results: One hundred twenty-six patients required phosphorus supplementation for refeeding hypophosphatemia (RH); admission BMI was not significantly different between those with and without RH. The 15% of patients who required enteral nutrition at any point during their admission gained significantly less weight than patients who only received an oral meal plan. 34.4% of patients admitted with starvation induced hepatitis, 28.6% experienced refeeding hepatitis at some point, 21.0% of patients had elevated liver function tests 2 weeks into refeeding and 28.6% at discharge. Conclusions: This study demonstrated overall effectiveness in achieving weight restoration goals with aggressive kcal increases without a single incidence of refeeding syndrome and infrequent RH. No significant biochemical changes were observed during refeeding. With close medical supervision and concurrent RD oversight, a refeeding approach with consistent calorie increases that is more aggressive than previously recommended appears to be safe.

scholarly journals Gastrointestinal Complications of Refeeding in Anorexia Nervosa

2016 ◽  
Vol 2 (1) ◽  
Author(s):  
Nathalia Marie Trees
Keyword(s):  
Anorexia Nervosa ◽  
Delayed Gastric Emptying ◽  
Medical Complications ◽  
Nutritional Rehabilitation ◽  
Refeeding Syndrome ◽  
Gastrointestinal Complications ◽  
Nutrition Rehabilitation ◽  
Life Threatening ◽  
Weight Restoration ◽  
Eating Disorder Behaviors

Anorexia nervosa (AN) is a complicated and life-threatening mental illness. Restoration of weight and nutrition rehabilitation are key elements for the treatment of AN. However, gastrointestinal (GI) complications often develop due to eating disorder behaviors, concomitant malnutrition, and during the refeeding process. These problems may give rise to significant medical complications and contribute to increased difficulties with refeeding and weight restoration. This review aims to describe common GI complications in AN including delayed gastric emptying, gastric dilatation, superior mesenteric artery (SMA) syndrome, refeeding hepatitis, and refeeding syndrome. Recommendations for clinicians refeeding a patient with AN are provided. Knowledge of these GI manifestations is required for correct management and successful nutritional rehabilitation of patients with AN.

Cardiac changes in anorexia nervosa

2016 ◽  
Vol 26 (4) ◽  
pp. 623-628 ◽  
Author(s):  
Michael A. Spaulding-Barclay ◽  
Jessica Stern ◽  
Philip S. Mehler
Keyword(s):  
Weight Loss ◽  
Anorexia Nervosa ◽  
Treatment Outcome ◽  
Eating Disorder ◽  
Medical Complications ◽  
Cardiac Complications ◽  
Successful Treatment Outcome ◽  
Comprehensive Literature Review ◽  
Life Threatening ◽  
Weight Restoration

AbstractIntroductionAnorexia nervosa is an eating disorder, which is associated with many different medical complications as a result of the weight loss and malnutrition that characterise this illness. It has the highest mortality rate of any psychiatric disorder. A large portion of deaths are attributable to the cardiac abnormalities that ensue as a result of the malnutrition associated with anorexia nervosa. In this review, the cardiac complications of anorexia nervosa will be discussed.MethodsA comprehensive literature review on cardiac changes in anorexia nervosa was carried out.ResultsThere are structural, functional, and rhythm-type changes that occur in patients with anorexia nervosa. These become progressively significant as ongoing weight loss occurs.ConclusionCardiac changes are inherent to anorexia nervosa and they become more life-threatening and serious as the anorexia nervosa becomes increasingly severe. Weight restoration and attention to these cardiac changes are crucial for a successful treatment outcome.

Eating Disorder Comorbidity with OCD

2017 ◽  
Author(s):  
Marina Gershkovich ◽  
Olivia Pascucci ◽  
Joanna Steinglass
Keyword(s):  
Eating Disorders ◽  
Eating Disorder ◽  
Empirical Support ◽  
Future Research ◽  
Weight History ◽  
Eating Disorder Treatment ◽  
Weight Restoration ◽  
Disorder Treatment ◽  
Support Treatment ◽  
Shed Light

This chapter discusses the comorbidity of eating disorders with OCD, including epidemiology, neurobiology, clinical features, and treatment. These disorders frequently cooccur. There are hints that eating disorders and OCD may share underlying neural mechanisms of illness, but these neurobiological models are preliminary. Cooccurrence of eating disorders and OCD is more common in clinical populations than community samples, highlighting the importance of assessing eating and weight history among patients with OCD. Treatment for bulimia nervosa includes psychotherapy and medication options, all with good empirical support. Treatment for anorexia nervosa emphasizes behaviorally based approaches to weight restoration treatment, with no clear evidence for medication treatments. When these illnesses occur together, treatment focused on the eating disorder yields improvement in OCD symptoms. Integrating exposure and response prevention techniques into eating disorder treatment may yield synergistic improvement in both illnesses. Future research may shed light on shared and distinct neurobiological mechanisms of these illnesses.

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,

scholarly journals Beyond Refeeding: The Effect of Including a Dietitian in Eating Disorder Treatment. A Systematic Review

Nutrients ◽  
2021 ◽  
Vol 13 (12) ◽  
pp. 4490
Author(s):  
Yive Yang ◽  
Janet Conti ◽  
Caitlin M. McMaster ◽  
Phillipa Hay
Keyword(s):  
Eating Disorder ◽  
Multidisciplinary Team ◽  
Consistent Finding ◽  
Eating Disorder Treatment ◽  
Life Threatening ◽  
Definition Of ◽  
Index Weight ◽  
Outcome Type ◽  
Validated Instrument

Eating disorders are potentially life-threatening mental health disorders that require management by a multidisciplinary team including medical, psychological and dietetic specialties. This review systematically evaluated the available literature to determine the effect of including a dietitian in outpatient eating disorder (ED) treatment, and to contribute to the understanding of a dietitian’s role in ED treatment. Six databases and Google Scholar were searched for articles that compared treatment outcomes for individuals receiving specialist dietetic treatment with outcomes for those receiving any comparative treatment. Studies needed to be controlled trials where outcomes were measured by a validated instrument (PROSPERO CRD42021224126). The searches returned 16,327 articles, of which 11 articles reporting on 10 studies were included. Two studies found that dietetic intervention significantly improved ED psychopathology, and three found that it did not. Three studies reported that dietetic input improved other psychopathological markers, and three reported that it did not. One consistent finding was that dietetic input improved body mass index/weight and nutritional intake, although only two and three studies reported on each outcome, respectively. A variety of instruments were used to measure each outcome type, making direct comparisons between studies difficult. Furthermore, there was no consistent definition of the dietetic components included, with many containing psychological components. Most studies included were also published over 20 years ago and are now out of date. Further research is needed to develop consistent dietetic guidelines and outcome measures; this would help to clearly define the role of each member of the multidisciplinary team, and particularly the role of dietitians, in ED treatment.

Cost-utility analysis of eating disorder treatment

2011 ◽  
Author(s):  
V. Pohjolainen ◽  
P. Rasanen ◽  
R. P. Roine ◽  
H. Sintonen ◽  
K. Wahlbeck ◽  
...  
Keyword(s):  
Eating Disorder ◽  
Cost Utility ◽  
Cost Utility Analysis ◽  
Utility Analysis ◽  
Eating Disorder Treatment ◽  
Disorder Treatment

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.

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