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A systematic review of approaches to refeeding in patients with anorexia nervosa
Author(s) -
Garber Andrea K.,
Sawyer Susan M.,
Golden Neville H.,
Guarda Angela S.,
Katzman Debra K.,
Kohn Michael R.,
Le Grange Daniel,
Madden Sloane,
Whitelaw Melissa,
Redgrave Graham W.
Publication year - 2016
Publication title -
international journal of eating disorders
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.785
H-Index - 138
eISSN - 1098-108X
pISSN - 0276-3478
DOI - 10.1002/eat.22482
Subject(s) - refeeding syndrome , hypophosphatemia , anorexia nervosa , calorie , psycinfo , medicine , observational study , parenteral nutrition , pediatrics , malnutrition , medline , randomized controlled trial , intensive care medicine , eating disorders , psychiatry , surgery , political science , law
Objective Given the importance of weight restoration for recovery in patients with anorexia nervosa (AN), we examined approaches to refeeding in adolescents and adults across treatment settings. Methods Systematic review of PubMed, PsycINFO, Scopus, and Clinical Trials databases (1960–2015) using terms refeeding, weight restoration, hypophosphatemia, anorexia nervosa, anorexia, and anorexic . Results Of 948 screened abstracts, 27 met these inclusion criteria: participants had AN; reproducible refeeding approach; weight gain, hypophosphatemia or cognitive/behavioral outcomes. Twenty‐six studies (96%) were observational/prospective or retrospective and performed in hospital. Twelve studies published since 2010 examined approaches starting with higher calories than currently recommended (≥1400 kcal/d). The evidence supports 8 conclusions: 1) In mildly and moderately malnourished patients, lower calorie refeeding is too conservative; 2) Both meal‐based approaches or combined nasogastric+meals can administer higher calories; 3) Higher calorie refeeding has not been associated with increased risk for the refeeding syndrome under close medical monitoring with electrolyte correction; 4) In severely malnourished inpatients, there is insufficient evidence to change the current standard of care; 5) Parenteral nutrition is not recommended; 6) Nutrient compositions within recommended ranges are appropriate; 7) More research is needed in non‐hospital settings; 8) The long‐term impact of different approaches is unknown; Discussion Findings support higher calorie approaches to refeeding in mildly and moderately malnourished patients under close medical monitoring, however the safety, long‐term outcomes, and feasibility outside of hospital have not been established. Further research is also needed on refeeding approaches in severely malnourished patients, methods of delivery, nutrient compositions and treatment settings.