A systematic review of approaches to refeeding in patients with anorexia nervosa
- 12 December 2015
- journal article
- review article
- Published by Wiley in International Journal of Eating Disorders
- Vol. 49 (3), 293-310
- https://doi.org/10.1002/eat.22482
Abstract
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.Keywords
This publication has 84 references indexed in Scilit:
- Enteral Nutrition for Feeding Severely Underfed Patients with Anorexia NervosaNutrients, 2012
- Moderators and mediators of remission in family-based treatment and adolescent focused therapy for anorexia nervosaBehaviour Research and Therapy, 2012
- An Eleven Site National Quality Improvement Evaluation of Adolescent Medicine-Based Eating Disorder Programs: Predictors of Weight Outcomes at One Year and Risk Adjustment AnalysesJournal of Adolescent Health, 2011
- Refeeding in anorexia nervosaCurrent Opinion in Pediatrics, 2011
- Food Choice and Diet Variety in Weight-Restored Patients with Anorexia NervosaJournal of the American Dietetic Association, 2011
- The refeeding syndrome and glucose loadInternational Journal of Eating Disorders, 2011
- Randomized Clinical Trial Comparing Family-Based Treatment With Adolescent-Focused Individual Therapy for Adolescents With Anorexia NervosaArchives of General Psychiatry, 2010
- Refeeding Syndrome: A Literature ReviewGastroenterology Research and Practice, 2010
- Insulin, glucose, and pancreatic polypeptide responses to a test meal in restricting type anorexia nervosa before and after weight restorationAmerican Journal of Physiology-Endocrinology and Metabolism, 2007
- Illuminating multiple perspectives: meanings of nasogastric feeding in anorexia nervosaEuropean Eating Disorders Review, 2005