scholarly journals A Retrospective Analysis Evaluating the Outcome of Parenteral Nutrition in the Treatment of Anorexia Nervosa in Korea

2020 ◽  
Vol 9 (11) ◽  
pp. 3711
Author(s):  
Jeong-Kyung Ko ◽  
You-Kyung Lee ◽  
Jong Chun Na ◽  
Dong-Yeon Kim ◽  
Youl-Ri Kim
Keyword(s):  
Anorexia Nervosa ◽  
Weight Gain ◽  
Parenteral Nutrition ◽  
Early Stage ◽  
Caloric Intake ◽  
Tube Feeding ◽  
Average Hospital ◽  
Weight Gains ◽  
Similar Weight ◽  
Nasogastric Tube Feeding

The objective of this study was to investigate the clinical efficacy of parenteral nutrition (PN) as supplemental feeding for patients with anorexia nervosa (AN). This study was conducted by reviewing the medical records of patients with AN who were hospitalized at a non-specialized ward. A total of 129 patients with AN were recruited, consisting of 67 patients received PN with oral refeeding and 62 patients received oral refeeding alone. We compared the weight gain at discharge and after discharge between the groups. As a result, at admission, the patients given supplementary PN had lower body mass indices and lower caloric intake than the patients without PN. The mean duration of PN was 8.5 days, which amounted to about a third of the average hospital stay with no difference between the groups. Both groups had similar weight gains during hospitalization, but the patients with PN had higher weight gains than the patients without PN at one and three months after discharge. In conclusion, the results suggest that supplementary PN in the early stage of refeeding might initiate weight gain in AN when nasogastric tube feeding is not possible. Randomized controlled trials are needed to be further tested of PN in treatment of AN.

Failure to Thrive in Infants and Toddlers

2018 ◽  
Author(s):  
Madhura Y Phadke ◽  
Anthony F Porto
Keyword(s):  
Weight Gain ◽  
Parenteral Nutrition ◽  
Enteral Feeding ◽  
Feeding Habits ◽  
Caloric Intake ◽  
Tube Feeding ◽  
Failure To Thrive ◽  
Outpatient Basis ◽  
Living Situation ◽  
Increased Risk

Failure to thrive (FTT) is a broad term that is used to document an abnormal pattern of weight gain over time. There is no single definition for FTT, but all proposed definitions use anthropometric parameters such as weight gain or weight for length. The term FTT has been falling out of favor, and the term weight/growth faltering is becoming more common to describe this clinical entity. The underlying problem in FTT is inadequate usable calories. The primary mechanisms leading to FTT are impaired absorption, increased metabolic demands, and inadequate caloric intake. Inadequate caloric intake is the most common of these mechanisms, although FTT is often a combination of the three. The diagnostic evaluation of FTT must take into account the multifactorial nature of this clinical sign. A comprehensive history is essential for diagnosis and should include specific questions about the child’s living situation and feeding habits. The physical examination must include accurate weight and length measurements. Clinicians should look for signs of abuse or neglect, dysmorphic features, abnormal skin or nail findings, digital clubbing, or other signs of chronic disease. Laboratory investigations are rarely revealing in FTT but should be considered if there is a high index of suspicion for underlying disease. Treatment in FTT favors a multidisciplinary approach. The primary goal of treatment is restoration of normal growth velocity. Children with FTT are at increased risk for growth and cognitive problems in later childhood, although the clinical significance of these findings is not well understood. The mainstay of treatment is increasing calories in the diet. Enteral feeding, orally or via a tube, is always preferred over parenteral feeding due to a better safety profile, ease of feeding, and lower cost. Parenteral nutrition is an acceptable way to meet caloric needs in infants and children when enteral nutrition is not possible. Children with FTT and malnutrition should be monitored closely for refeeding syndrome, which results from fluid and electrolyte shifts in malnourished children. In general, FTT can be treated on an outpatient basis with close follow-up. Indications for hospitalization include severe malnutrition/dehydration and concern for child endangerment. This review contains 7 figures, 8 tables and 26 references Key words: enteral feeding, failure to thrive, growth charts, nutrition, parenteral nutrition, poor weight gain, tube feeding, weight loss

Failure to Thrive in Infants and Toddlers

2017 ◽  
Author(s):  
Madhura Y Phadke ◽  
Anthony F Porto
Keyword(s):  
Weight Gain ◽  
Parenteral Nutrition ◽  
Enteral Feeding ◽  
Feeding Habits ◽  
Caloric Intake ◽  
Tube Feeding ◽  
Failure To Thrive ◽  
Outpatient Basis ◽  
Living Situation ◽  
Increased Risk

Failure to thrive (FTT) is a broad term that is used to document an abnormal pattern of weight gain over time. There is no single definition for FTT, but all proposed definitions use anthropometric parameters such as weight gain or weight for length. The term FTT has been falling out of favor, and the term weight/growth faltering is becoming more common to describe this clinical entity. The underlying problem in FTT is inadequate usable calories. The primary mechanisms leading to FTT are impaired absorption, increased metabolic demands, and inadequate caloric intake. Inadequate caloric intake is the most common of these mechanisms, although FTT is often a combination of the three. The diagnostic evaluation of FTT must take into account the multifactorial nature of this clinical sign. A comprehensive history is essential for diagnosis and should include specific questions about the child’s living situation and feeding habits. The physical examination must include accurate weight and length measurements. Clinicians should look for signs of abuse or neglect, dysmorphic features, abnormal skin or nail findings, digital clubbing, or other signs of chronic disease. Laboratory investigations are rarely revealing in FTT but should be considered if there is a high index of suspicion for underlying disease. Treatment in FTT favors a multidisciplinary approach. The primary goal of treatment is restoration of normal growth velocity. Children with FTT are at increased risk for growth and cognitive problems in later childhood, although the clinical significance of these findings is not well understood. The mainstay of treatment is increasing calories in the diet. Enteral feeding, orally or via a tube, is always preferred over parenteral feeding due to a better safety profile, ease of feeding, and lower cost. Parenteral nutrition is an acceptable way to meet caloric needs in infants and children when enteral nutrition is not possible. Children with FTT and malnutrition should be monitored closely for refeeding syndrome, which results from fluid and electrolyte shifts in malnourished children. In general, FTT can be treated on an outpatient basis with close follow-up. Indications for hospitalization include severe malnutrition/dehydration and concern for child endangerment. Key words: enteral feeding, failure to thrive, growth charts, nutrition, parenteral nutrition, poor weight gain, tube feeding, weight loss

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.

Efficacy of voluntary nasogastric tube feeding in female inpatients with anorexia nervosa

2003 ◽  
Vol 27 (4) ◽  
pp. 268-276 ◽  
Author(s):  
JN Zuercher ◽  
EJ Cumella ◽  
BK Woods ◽  
M Eberly ◽  
JK Carr
Keyword(s):  
Anorexia Nervosa ◽  
Nasogastric Tube ◽  
Tube Feeding ◽  
Nasogastric Tube Feeding

Modification of Caloric Intake in Anorexia Nervosa: An Experimental Analysis

1973 ◽  
Vol 32 (1) ◽  
pp. 75-78 ◽  
Author(s):  
Thomas E. Elkin ◽  
Michel Hersen ◽  
Richard M. Eisler ◽  
James G. Williams
Keyword(s):  
Anorexia Nervosa ◽  
Experimental Analysis ◽  
Single Case ◽  
Caloric Intake ◽  
Food Presentation ◽  
Single Case Design ◽  
Reinforcement System ◽  
Weight Gains ◽  
Effects Of Feedback ◽  
Case Design

The effects of feedback, reinforcement, and increased food presentation on caloric intake were sequentially examined in an experimental single-case design with an anorexia nervosa patient. Although feedback on weight and a point-reinforcement system for weight gains led to increased consumption, augmenting the amount of food presented in combination with feedback and reinforcement resulted in the most dramatic change in caloric intake.

Gastrostomy Tube Supplementation for HIV-infected Children

PEDIATRICS ◽  
1995 ◽  
Vol 96 (4) ◽  
pp. 696-702
Author(s):  
Tracie L. Miller ◽  
Ester L. Awnetwant ◽  
Sylvia Evans ◽  
Vivien M. Morris ◽  
Isabel M. Vazquez ◽  
...  
Keyword(s):  
Nasogastric Tube ◽  
Caloric Intake ◽  
Tube Feeding ◽  
Gastrostomy Tube ◽  
Z Score ◽  
Cd4 Counts ◽  
Lower Weight ◽  
Z Scores ◽  
Hospital Days ◽  
Nasogastric Tube Feeding

Objective. Malnutrition is common in pediatric human immunodeficiency virus (HIV) infection, and little is known of effective nutritional interventions. We sought to determine whether enteral supplementation with gastrostomy tube feedings would provide improvements in weight, height, body composition, immune parameters, morbidity, and mortality. Methods. We collected clinical data on 23 HIV-in-fected children who were fed chronically by gastrostomy tube. The main outcome measures included weight, height, triceps skinfold thickness (TSF), arm-muscle circumference (AMC), hospital days, caloric intake, and CD4-positive T-lymphocyte count. Each of these parameters was measured or evaluated at four points: 6 months before nasogastric tube feeding, at the time nasogastric tube feeding was initiated, at the time gastrostomy tube feeding was initiated, and 6 months after gastrostomy tube feedings began. Results. Weight z score [-2.1 (0.14) to -1.58 (0.14)] and weight-for-height z score [-0.98 (0.16) to -0.15 (0.17)] improved with gastrostomy tube feedings. There was a trend toward improvement in weight z score with nasogastric tube feedings. Caloric intakes increased progressively with nasogastric and gastrostomy tube feedings. No improvement in height, TSF, AMC, hospital days, or CD4 counts was seen in the follow-up period. However, children who had the greatest increase in weight had the most improvement in fat stores (TSF) (r = .65, P = .002) and a decrease in hospital days after the gastrostomy tube was placed (r = -.48, P = .025). Higher age-adjusted CD4 counts and lower weight-for-height z scores at the time of enteral supplementation were significant predictors of a positive response to gastrostomy tube feedings(r = .85, P = .0001). Children who responded favorably had a 2.8-fold reduction in the risk of dying for every positive unit change in weight z score (P = .005). Conclusion. Gastrostomy tube supplementation for HIV-infected children can improve weight and fat mass when other oral methods fail. Weight gain is coincident with greater caloric intakes. HIV-infected children with higher CD4 counts and lower weight-for-height z scores are likely to respond favorably to gastrostomy tube feedings. Early nutritional intervention is indicated for HIV-infected children.

scholarly journals Weight Gain in Adults with Avoidant/Restrictive Food Intake Disorder Compared to Restrictive Anorexia Nervosa—Pilot Findings from a Longitudinal Study

Nutrients ◽  
2021 ◽  
Vol 13 (3) ◽  
pp. 871
Author(s):  
Magnus Fjeldstad ◽  
Torben Kvist ◽  
Magnus Sjögren
Keyword(s):  
Anorexia Nervosa ◽  
Weight Gain ◽  
Food Intake ◽  
Mean Values ◽  
Restorative Treatment ◽  
Baseline Weight ◽  
Inclusion Study ◽  
Similar Weight ◽  
Clinical Measures ◽  
Prospective Longitudinal

Background: Avoidant/Restrictive Food Intake Disorder (ARFID) is characterized by persistent failure to meet nutritional needs, absence of body image distortion and often low body weight. Weight restorative treatment in ARFID-adults is provided for as in Anorexia Nervosa (AN), while the effect is unknown. The aim was to compare weight gain between ARFID and restrictive subtype of AN (AN-R), including exploring impact of medical factors and psychopathology. Methods: Individuals with ARFID (n = 7; all cases enrolled over 5 years) and AN-R (n = 80) were recruited from the Prospective Longitudinal All-comers inclusion study in Eating Disorders (PROLED) during 5 years. All underwent weight restorative inpatient treatment. Clinical characteristics at baseline and weekly weight gain were recorded and compared. Results: There were no significant differences at baseline weight, nor in weight gain between groups. Anxiety was statistically significantly higher in AN-R at baseline. Conclusions: Although there were differences in several clinical measures at baseline (Autism Quotient, symptom checklist, mood scores and Morgan Russel Outcome Scale), only anxiety was higher in AN-R. No differences in weight gain were observed, although mean values indicate a faster weight gain in the ARFID group. Standard weight restorative treatment in this study in adults with ARFID has similar weight gaining effect as in AN-R.

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