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Nutrition Approach for Inpatients With Anorexia Nervosa: Impact of a Clinical Refeeding Guideline
Author(s) -
Gjoertz Mathea,
Wang Jen,
Chatelet Solène,
Monney Chaubert Carole,
Lier Françoise,
Ambresin AnneEmmanuelle
Publication year - 2020
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1002/jpen.1723
Subject(s) - guideline , medicine , anorexia nervosa , odds ratio , refeeding syndrome , confidence interval , logistic regression , confounding , anorexia , pediatrics , eating disorders , malnutrition , psychiatry , pathology
Objective This study assesses the impact of a clinical refeeding guideline on weight restoration, length of stay, rate of refeeding complications, and rehospitalizations. Method This retrospective study included patient records of 107 participants aged 13–55 years with a diagnosis of AN, admitted for at least 7 days for renutrition before and after introduction of the refeeding guideline. Weight evolution graphs were rated by 2 clinical experts independently. Binary logistic regression models were erected to identify clinical outcomes associated independently with the guideline as well as to control for potential confounding by sociodemographic and clinical characteristics at admission. Results The proportion of patients achieving optimal weight gain after the first 2 weeks increased significantly from 6.3% pre‐guideline to 41.8% post guideline (adjusted odds ratio [AOR] = 37.6; 95% confidence interval [CI], 2.77–510.3; P = 0.006). Average length of hospitalization was reduced from 96.7 (SD 48.3) days pre‐guideline to 62.2 (SD 45.5) days post guideline (AOR = 0.99; 95% CI, 0.97–1.01; P = 0.18). None of the patients developed a full refeeding syndrome. There was no significant change in the rate of rehospitalization: 48.5% pre‐guideline to 43.2% post guideline (OR = 0.81; 95% CI, 0.36–1.84; P = 0.62). Discussion The clinical guideline proved highly effective in bolstering weight gain via intensive refeeding procedures while also being safe. Harmonizing clinical practices improves quality of care for patients with anorexia and, interestingly, may decrease costs by cutting average length of stay by a third without increasing the rehospitalization rate.