Original articleHigher Calorie Diets Increase Rate of Weight Gain and Shorten Hospital Stay in Hospitalized Adolescents With Anorexia Nervosa
Section snippets
Study design and participants
This prospective observational study used a quasi-experimental design to compare a lower calorie group (800–1,200 calories) including former study participants as historical controls and higher calorie group (1,400–2,400 calories) including newly enrolled participants. Participants were age 9–20 years old, diagnosed with AN [15], met criteria for hospitalization [16] and had no previous admissions for AN. Exclusion criteria included pregnancy, diagnosis of bulimia nervosa, and/or thought
Results
We followed 56 adolescents over a mean (±SEM) of 14.9 (±.9) days. The overall study population was 98% female, mean age 16.2 (±.3) years (12.3–20.9), 76% non-Hispanic white, 6% Asian/Pacific Islander, and 19% other race/ethnicity. Mean %MBMI was 79.2 (±1.5), mean BMI was 16.1 (±.3) kg/m2 (range 11.1–21.8). Participants were bradycardic and hypothermic consistent with hospital admission criteria [16]. Markers of hydration status were within normal limits [20]. As shown in Table 1, the only
Discussion
This study compared moderately malnourished adolescents with AN during refeeding on higher calorie diets starting around 1,800 calories and advancing by about 120 calories per day in the first week versus lower calorie diets starting around 1,100 calories and advancing by approximately 100 calories per day. Our previously published [11] data from participants on lower calorie diets are included here for comparison, because these diets are still recommended and widely used in the United States
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2024, Journal of King Saud University - ScienceCharacterization of refeeding protocols for under 18 years old hospitalized patients with anorexia nervosa: A systematic review
2023, General Hospital PsychiatryRefeeding Hypophosphatemia in Hospitalized Adolescents With Anorexia Nervosa
2022, Journal of Adolescent HealthCitation Excerpt :In the United States, lower energy approaches typically began between 900 and 1,200 kcal/day and advanced by 200 kcal every other day [26]; however, recommendations started as low as 200–600 kcal/day in Europe and the United Kingdom [27–30] These “start low and go slow” [31] approaches have been linked to the so-called “underfeeding syndrome”, characterized by poor weight gain, prolonged illness, and even death due to overly cautious refeeding [29]. Clinical practice is shifting toward higher energy refeeding, starting between 1,400 and 2,400 kcal/day, often starting around 1,500 kcal/day [17,20,22–24,31]. A recent RCT in adolescents and young adults hospitalized with AN found that higher calorie refeeding, starting at 2,000 kcal/day, restored medical stability 3 days earlier, reduced hospital stay by 4 days, saved $ 20,000 USD in hospital charges without an increased risk of refeeding hypophosphatemia or rehospitalization in the year following the initial admission, as compared to lower calorie refeeding starting at 1,400 kcal/day [18,21].
Impact of calorie intake and refeeding syndrome on the length of hospital stay of patients with malnutrition: a systematic review and meta-analysis
2022, Clinical NutritionCitation Excerpt :The nutritional support protocols used in the studies are shown in supplemental material Table S2. Eleven studies [22–24,31–37,42] mentioned a specific nutritional therapy protocol, five studies [31,35–37,42] stated the following published guidelines among them. Four studies [22,35,36,42] changed the protocol based on the risk of refeeding syndrome.
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