A systematic review of approaches to refeeding in patients with anorexia nervosa

Andrea K. Garber, Susan M. Sawyer, Neville H. Golden, Angela S Guarda, Debra K. Katzman, Michael R. Kohn, Daniel Le Grange, Sloane Madden, Melissa Whitelaw, Graham Redgrave

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
JournalInternational Journal of Eating Disorders
DOIs
StateAccepted/In press - 2015

Fingerprint

Anorexia Nervosa
Hypophosphatemia
Meals
Refeeding Syndrome
Weights and Measures
Food
Parenteral Nutrition
Anorexia
Standard of Care
Research
PubMed
Electrolytes
Weight Gain
Inpatients
Clinical Trials
Databases
Safety
Therapeutics

Keywords

  • Anorexia nervosa
  • Hypophosphatemia
  • Length of stay
  • Medical complications
  • Medical stability
  • Nutritional rehabilitation
  • Refeeding
  • Refeeding syndrome
  • Weight restoration

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

A systematic review of approaches to refeeding in patients with anorexia nervosa. / 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.

In: International Journal of Eating Disorders, 2015.

Research output: Contribution to journalArticle

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. / A systematic review of approaches to refeeding in patients with anorexia nervosa. In: International Journal of Eating Disorders. 2015.
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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.",
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