A Higher-Calorie Refeeding Protocol Does Not Increase Adverse Outcomes in Adult Patients with Eating Disorders - 31/07/18
, Jan Hill, Grad Dip Nutr Diet, MPH, APD ∗, Shane Jeffrey, Grad Dip Nutr Diet, APD ∗, Susan Patterson, Grad Cert Rural Health, DIC, PhD, Amanda Davis, Grad Dip Nutr Diet, APD ∗, Warren Ward, MBBS, FRANZCP, Grad Cert Mgmt, Michelle Palmer, PhD (Nutr&Diet), APD ∗, Sandra Capra, PhD, FDAAAbstract |
Background |
Patients with eating disorders (EDs) are often considered a high-risk population to refeed. Current research advises using “start low, go slow” refeeding methods (∼1,000 kcal/day, advancing ∼500 kcal/day every 3 to 4 days) in adult patients with severe EDs to prevent the development of refeeding syndrome (RFS), typically characterized by decreases in serum electrolyte levels and fluid shifts.
Objective |
To compare the incidence of RFS and related outcomes using a low-calorie protocol (LC) (1,000 kcal) or a higher-calorie protocol (HC) (1,500 kcal) in medically compromised adult patients with EDs.
Design |
This was a retrospective pre-test–post-test study.
Participants/setting |
One hundred and nineteen participants with EDs, medically admitted to a tertiary hospital in Brisbane, Australia, between December 2010 and January 2017, were included (LC: n=26, HC: n=93). The HC refeeding protocol was implemented in September 2013.
Main outcome measures |
Differences in prevalence of electrolyte disturbances, hypoglycemia, edema, and RFS diagnoses were examined.
Statistical analysis performed |
χ2 tests, Kruskal-Wallis H test, analysis of variance, and independent t tests were used to compare data between the two protocols.
Results |
Descriptors were similar between groups (LC: 28±9 years, 96% female, 85% with anorexia nervosa, 31% admitted primarily because of clinical symptoms of exacerbated ED vs HC: 27±9 years, 97% female, 84% with anorexia nervosa, 44% admitted primarily because of clinical symptoms of exacerbated ED, P>0.05). Participants refed using the LC protocol had higher incidence rates of hypoglycemia (LC: 31% vs HC: 10%, P=0.012), with no statistical or clinical differences in electrolyte disturbances (LC: 65% vs HC: 45%, P=0.079), edema (LC: 8% vs HC: 6%, P=0.722) or diagnosed RFS (LC: 4% vs HC: 1%, P=0.391).
Conclusions |
A higher-calorie refeeding protocol appears to be safe, with no differences in rates of electrolyte disturbances or clinically diagnosed RFS and a lower incidence of hypoglycemia. Future research examining higher-calorie intakes, similar to those studied in adolescent patients, may be beneficial.
Le texte complet de cet article est disponible en PDF.Keywords : Aggressive refeeding, Anorexia nervosa, Eating disorders, Nutrition, Refeeding syndrome
Plan
| STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors. |
|
| FUNDING/SUPPORT This work was supported by the Royal Brisbane and Women’s Hospital, Brisbane, Australia, and an Australian Postgraduate Award. |
Vol 118 - N° 8
P. 1450-1463 - août 2018 Retour au numéro
Article précédent
- Association between Fruit and Vegetable Consumption and Risk of Hypertension in Middle-Aged and Older Korean Adults
- Jiwon Kim, Jihye Kim
- Body Composition Measurement in Bronchiectasis: Comparison between Bioelectrical Impedance Analysis, Skinfold Thickness Measurement, and Dual-Energy X-ray Absorptiometry before and after Pulmonary Rehabilitation
- Esperanza Doña, Casilda Olveira, Francisco Javier Palenque, Nuria Porras, Antonio Dorado, Rocío Martín-Valero, Ana M. Godoy, Francisco Espíldora, Victoria Contreras, Gabriel Olveira
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?