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 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.

Eating Disorders. Review Of Current Treatment Options For Anorexia Nervosa, Focused On Psychotherapy And Pharmacological Treatment

2016 ◽  
Vol 33 (S1) ◽  
pp. S432-S432
Author(s):  
B. Sánchez Sánchez ◽  
P. Muñoz-Calero Franco ◽  
N. Rodriguez Criado ◽  
J.F. Cruz Fourcade ◽  
R. Martín Aragón ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Pharmacological Treatment ◽  
Treatment Options ◽  
Signs And Symptoms ◽  
Current Treatment ◽  
Cognitive Behavioral ◽  
Nutritional Rehabilitation ◽  
Clinical Practices ◽  
Major Health Problem ◽  
Competing Interest

IntroductionAnorexia nervosa is a disorder of eating behavior that is a major health problem on our society. It is characterized by three main criteria: self-induced starvation, desire for thinness or fear of obesity, and the presence of medical signs and symptoms due to improper feeding. This work is focused on its treatment. The biopsychosocial approach allows the design and application of effective therapeutic strategies and a multidisciplinary team collaboration is essential.ObjectivesResearch of current pharmacological and psychotherapy treatments options of the disease.Material and methodsLiterature review based on articles and publications on this topic.ResultsIn anorexia nervosa, it is necessary to establish a therapeutic alliance between doctor and patient. Patient usually feels no motivation to improve. The different treatments options to combine, in terms of the patient status, are: nutritional rehabilitation, cognitive-behavioral, family and interpersonal psychotherapies and pharmacological treatment. It can be carried out at the ambulatory, at the day-hospital or by medical stay, even beyond patient will.ConclusionsNowadays, the nutritional rehabilitation is the best treatment established and it is the core treatment. About the psychotherapies, the cognitive-behavioral is the most used because it has exposed better results in all different studies proved and in clinical practices, followed by the family therapy which is the responsible of the patient family's treatment. Pharmacological treatment should not be used systematically and its exclusive use is not enough to resolve anorexia nervosa as there are needed also other treatments combined.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals A case of refeeding syndrome in pregnancy with anorexia nervosa

2017 ◽  
Vol 11 (2) ◽  
pp. 95-97 ◽  
Author(s):  
Hiroaki Soyama ◽  
Morikazu Miyamoto ◽  
Takahiro Natsuyama ◽  
Masashi Takano ◽  
Hidenori Sasa ◽  
...  
Keyword(s):  
Anorexia Nervosa ◽  
Cesarean Section ◽  
Calorie Restriction ◽  
Caloric Intake ◽  
Primiparous Woman ◽  
Refeeding Syndrome ◽  
Additional Risk ◽  
Severe Fatigue ◽  
Electrolyte Replacement ◽  
In Pregnancy

Refeeding syndrome very rarely develops during pregnancy. A 35-year-old primiparous woman pregnant with twins complained of severe fatigue at 19 weeks’ gestation. She was admitted to our hospital in a malnourished condition because of repeated self-induced vomiting due to anorexia nervosa. Just after hospitalization, she voluntarily increased her caloric intake significantly above the recommended prescribed diet, without medical permission. Nine days later, she developed refeeding syndrome. Electrolyte replacement and calorie restriction were started and her condition gradually improved. The healthy twin babies were born by cesarean section at 36 weeks’ gestation. Acute increases in caloric intake by previously malnourished pregnant women with anorexia nervosa may induce refeeding syndrome. Women with the binge eating/purging subtype of anorexia nervosa may be at additional risk due to alternating phases of starvation and overeating.

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 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.

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.

Editorial

2011 ◽  
Vol 10 (2) ◽  
Author(s):  
Chris Roseveare ◽  
Keyword(s):  
Anorexia Nervosa ◽  
Case Series ◽  
Good News ◽  
Close Monitoring ◽  
Refeeding Syndrome ◽  
Great Opportunity ◽  
Acute Medicine ◽  
The Past ◽  
High Dependency ◽  
The Impact

Welcome to the first summer edition of Acute Medicine which became a ‘quarterly’ journal this year. Some readers may be relieved to have survived the passing of spring, with Bank Holidays and a Royal wedding bringing the challenges of 7 day working into sharp focus. There have been times in the past when it felt like acute medicine was the only in-patient speciality with its ‘finger in the dyke’ during holiday periods. The recent e-mail traffic on this issue suggests that greater planning and support from other hospital specialities may have helped limit the impact of the lost ‘working days’ in April. It certainly felt much better than Christmas – perhaps the good weather also helped! Weekend and out-of-hours working are likely to be key areas for acute medicine over coming years. As numbers of trainees obtaining CCTs rises we have a great opportunity to bid for greater consultant numbers; this should enable us to extend the hours of consultant-led acute medical care on AMUs across the UK while maintaining a work-life balance – and our sanity! The interface with specialities on the AMU is another area which has been creating discussion over recent months. A workshop at the Edinburgh SAM meeting last autumn spawned a plenary session on this subject at the spring meeting in Bristol. Two articles in this edition provide different perspectives on this problem. Charlotte Cannon describes the service in Swindon where patients on the AMU remain under the care of the acute medical team; Jo Southgate’s model in Norwich involves much earlier involvement by speciality teams, facilitated by much larger numbers of speciality consultants. Both models have their merits and have been developed to deal with the specific local challenges; earlier involvement of speciality teams may improve continuity of care for those who remain in hospital, but this may be at the expense of delays to treatment and discharge decisions for those who do not. Readers may find the experiences described in these papers helpful in developing their own services. Patients with anorexia nervosa commonly present on the acute medical take and can be difficult to manage. The case series and review published in this edition may help acute physicians to understand better how to prevent, identify and manage refeeding syndrome in these patients. This potentially fatal condition appears to be particularly common where malnutrition relates to anorexia nervosa, affecting 13 of 14 patients in this series despite very careful control of nutritional intake. Three patients required high dependency care. The need for close monitoring of electrolyte levels and raised awareness of the serious nature of the condition appear to be the key messages from this paper. Finally, a piece of good news for aspiring authors who may be considering submission to Acute Medicine. The journal was recently approved for listing on MEDLINE, and articles will now be archived on-line on PubMed. This is a great step forward and I hope will lead to a further increase in the number of high quality submissions we receive. I would like to pass on my thanks to all of those who have been involved in making the journal a success over the past 10 years and helping to take us up to this new level. We remain particularly keen to publish more AMU-based research articles, and those describing completed audit cycles which demonstrate improved practice – so please keep them coming!

scholarly journals Nutritional Rehabilitation: Practical Guidelines for Refeeding the Anorectic Patient

2010 ◽  
Vol 2010 ◽  
pp. 1-7 ◽  
Author(s):  
Philip S. Mehler ◽  
Amy B. Winkelman ◽  
Debbie M. Andersen ◽  
Jennifer L. Gaudiani
Keyword(s):  
Caloric Intake ◽  
Rehabilitation Program ◽  
Colonic Transit ◽  
Nutritional Rehabilitation ◽  
Refeeding Syndrome ◽  
Permanent Disability ◽  
Practical Guidelines ◽  
Risk Patients ◽  
Weight Restoration ◽  
Anorectic Patient

Weight restoration is crucial for successful treatment of anorexia nervosa. Without it, patients may face serious or even fatal medical complications of severe starvation. However, the process of nutritional rehabilitation can also be risky to the patient. The refeeding syndrome, a problem of electrolyte and fluid shifts, can cause permanent disability or even death. It is essential to identify at-risk patients, to monitor them carefully, and to initiate a nutritional rehabilitation program that aims to avoid the refeeding syndrome. A judicious, slow initiation of caloric intake, requires daily management to respond to entities such as liver inflammation and hypoglycemia that can complicate the body's conversion from a catabolic to an anabolic state. In addition, nutritional rehabilitation should take into account clinical characteristics unique to these patients, such as gastroparesis and slowed colonic transit, so that measures can be taken to ameliorate the physical discomforts of weight restoration. Adjunct methods of refeeding such as the use of enteral or parenteral nutrition may play a small but important role in a select patient group who cannot tolerate oral nutritional rehabilitation alone.

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