Advertisement

NOTICE: We are experiencing technical issues with Academy members trying to log into the JAND site using Academy member login credentials. We are working to resolve the issue as soon as possible. Alternatively, if you are an Academy member, you can access the JAND site by registering for an Elsevier account and claiming access using the links at the top of the JAND site. Email us at [email protected] for assistance. Thanks for your patience!

Nutrition Therapy during Initiation of Refeeding in Underweight Children and Adolescent Inpatients with Anorexia Nervosa: A Systematic Review of the Evidence

Published:February 07, 2014DOI:https://doi.org/10.1016/j.jand.2013.11.022

      Abstract

      Restoration of weight and nutritional rehabilitation are recognized as fundamental steps in the therapeutic treatment of children and adolescent inpatients with anorexia nervosa (AN). However, current recommendations on initial energy requirements for this population are inconsistent, with a clear lack of empirical evidence. Thus, the aim of our study was to systematically review, assess, and summarize the available evidence on the effect of differing nutrition therapies prescribed during refeeding on weight restoration in hospitalized children and adolescents (aged 19 years and younger) with diagnosed AN. Searches were conducted in Scopus, Web of Science, Global Health (CABI), PubMed, and the Cochrane database for articles published in English up to May 2012, and complemented by a search of the reference lists of key publications. Seven observational studies investigating a total of 403 inpatients satisfied the inclusion criteria. The range of prescribed energy intakes varied from 1,000 kcal to >1,900 kcal/day with a progressive increase during the course of hospitalization. It appeared that additional tube feeding increased the maximum energy intake and led to greater interim or discharge weight; however, this was also associated with a higher incidence of adverse effects. Overall, the level of available evidence was poor, and therefore consensus on the most effective and safe treatment for weight restoration in inpatient children and adolescents with AN is not currently feasible. Further research on refeeding methods is crucial to establish the best practice approach to treatment of this population.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Journal of the Academy of Nutrition and Dietetics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Klump K.L.
        • Bulik C.M.
        • Kaye W.H.
        • Treasure J.
        • Tyson E.
        Academy for eating disorders position paper: Eating disorders are serious mental illnesses.
        Int J Eat Disord. 2009; 42: 97-103
      1. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. American Psychiatric Association, Arlington, VA2013
        • van Son G.E.
        • van Hoeken D.
        • Bartelds A.I.M.
        • van Furth E.F.
        • Hoek H.W.
        Time trends in the incidence of eating disorders: A primary care study in The Netherlands.
        Int J Eat Disord. 2006; 39: 565-569
        • Madden S.
        • Morris A.
        • Zurynski Y.A.
        • Kohn M.
        • Elliot E.J.
        Burden of eating disorders in 5-13-year-old children in Australia.
        Med J Aust. 2009; 190: 410-414
        • Agras W.S.
        • Brandt H.A.
        • Bulik C.M.
        • et al.
        Report of the National Institutes of Health workshop on overcoming barriers to treatment research in anorexia nervosa.
        Int J Eat Disord. 2004; 35: 509-521
        • Guarda A.S.
        Treatment of anorexia nervosa: Insights and obstacles.
        Psychol Behav. 2008; 94: 113-120
      2. National Istitute for Clinical Excellence. CG9. Eating disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. http://www.nice.org.uk/nicemedia/live/10932/29220/29220.pdf. Published January 2004. Accessed February 5, 2012.

        • Herpertz-Dahlmann B.
        • Salbach-Andrae H.
        Overview of treatment modalities in adolescent anorexia nervosa.
        Child Adolesc Psychiatr Clin N Am. 2009; 18: 131-145
      3. Royal College of Psychiatrists. CR168. Junior MARSIPAN: Management of really sick patients under 18 with anorexia nervosa. http://www.rcpsych.ac.uk/publications/collegereports/cr/cr168.aspx. Published January 2012. Accessed March 24, 2012.

        • Steinhausen H.C.
        • Grigoroiu-Serbanescu M.
        • Boyadjieva S.
        • Neumarker K.J.
        • Metzke C.W.
        Course and predictors of rehospitalization in adolescent anorexia nervosa in a multisite study.
        Int J Eat Disord. 2008; 41: 29-36
        • Golden N.H.
        • Meyer W.
        Nutritional rehabilitation of anorexia nervosa. Goals and dangers.
        Int J Adolesc Med Health. 2004; 16: 131-144
        • Gowers S.G.
        • Edwards V.J.
        • Fleminger S.
        • et al.
        Treatment aims and philosophy in the treatment of adolescent anorexia nervosa in Europe.
        Eur Eat Disord Rev. 2002; 10: 271-280
        • Cockfield A.
        • Philpot U.
        Feeding size 0: The challenges of anorexia nervosa. Managing anorexia from a dietitian's perspective.
        Proc Nutr Soc. 2009; 68: 281-288
        • Lund B.C.
        • Hernandez E.R.
        • Yates W.R.
        • Mitchell J.R.
        • McKee P.A.
        • Johnson C.L.
        Rate of inpatient weight restoration predicts outcome in anorexia nervosa.
        Int J Eat Disord. 2009; 42: 301-305
        • Lock J.
        • Litt I.
        What predicts maintenance of weight for adolescents medically hospitalized for anorexia nervosa?.
        Eat Disord. 2003; 11: 1-7
        • Katzman D.K.
        Medical complications in adolescents with anorexia nervosa: A review of the literature.
        Int J Eat Disord. 2005; 37: S52-S59
        • Sala L.
        • Mirabel-Sarron C.
        • Gorwood P.
        • Pham-Scottez A.
        • Blanchet A.
        • Rouillon F.
        The level of associated depression and anxiety traits improves during weight regain in eating disorder patients.
        Eat Weight Disord. 2011; 16: E280-E284
        • Reiter C.S.
        • Graves L.
        Nutrition therapy for eating disorders.
        Nutr Clin Pract. 2010; 25: 122-136
        • Hatch A.
        • Madden S.
        • Kohn M.R.
        • et al.
        In first presentation adolescent anorexia nervosa, do cognitive markers of underweight status change with weight gain following a refeeding intervention?.
        Int J Eat Disord. 2010; 43: 295-306
        • Rome E.S.
        • Ammerman S.
        • Rosen D.S.
        • et al.
        Children and adolescents with eating disorders: The state of the art.
        Pediatrics. 2003; 111: e98-e108
        • Baran S.A.
        • Weltzin T.E.
        • Kaye W.H.
        Low discharge weight and outcome in anorexia nervosa.
        Am J Psychiatry. 1995; 152: 1070-1072
        • Sylvester C.J.
        • Forman S.F.
        Clinical practice guidelines for treating restrictive eating disorder patients during medical hospitalization.
        Curr Opin Pediatr. 2008; 20: 390-397
        • Beumont P.
        • Hay P.
        • Beumont D.
        • et al.
        Australian and New Zealand clinical practice guidelines for the treatment of anorexia nervosa.
        Aust N Z J Psychiatry. 2004; 38: 659-670
        • Ebeling H.
        • Tapanainen P.
        • Joutsenoja A.
        • et al.
        A practice guideline for treatment of eating disorders in children and adolescents.
        Ann Med. 2003; 35: 488-501
        • Golden N.H.
        • Katzman D.K.
        • Kreipe R.E.
        • et al.
        Eating disorders in adolescents: Position paper of the Society for Adolescent Medicine.
        J Adolesc Health. 2003; 33: 496-503
        • Rosen D.S.
        Identification and management of eating disorders in children and adolescents.
        Pediatrics. 2010; 126: 1240-1253
        • Tresley J.
        • Sheean P.M.
        Refeeding syndrome: Recognition is the key to prevention and management.
        J Am Diet Assoc. 2008; 108: 2105-2108
        • Ornstein R.M.
        • Golden N.H.
        • Jacobson M.S.
        • Shenker I.R.
        Hypophosphatemia during nutritional rehabilitation in anorexia nervosa: Implications for refeeding and monitoring.
        J Adolesc Health. 2003; 32: 83-88
        • Kohn M.R.
        • Golden N.H.
        • Shenker I.R.
        Cardiac arrest and delirium: Presentations of the refeeding syndrome in severely malnourished adolescents with anorexia nervosa.
        J Adolesc Health. 1998; 22: 239-243
        • Kohn M.R.
        • Madden S.
        • Clarke S.D.
        Refeeding in anorexia nervosa: Increased safety and efficiency through understanding the pathophysiology of protein calorie malnutrition.
        Curr Opin Pediatr. 2011; 23: 390-394
        • Schwartz B.I.
        • Mansbach J.M.
        • Marion J.G.
        • Katzman D.K.
        • Forman S.F.
        Variations in admission practices for adolescents with anorexia nervosa: A North American sample.
        J Adolesc Health. 2008; 43: 425-431
      4. Rocks T, Pelly F, Wilkinson P. The nutritional management of anorexia nervosa in children and adolescent inpatients: The current practice of Australian dietitians [published online ahead of print July 31, 2013]. Nutr Diet. http://dx.doi.org/10.1111/1747-0080.12058.

        • Leichner M.
        • Standish K.
        • Leichner P.
        Strategies for supporting youth with eating disorders when intensive treatment is needed.
        B C Med J. 2005; 47: 49-55
        • Lock J.
        Treatment of adolescent eating disorders: Progress and challenges.
        Minerva Psichiatr. 2010; 51: 207-216
        • Bulik C.M.
        • Berkman N.D.
        • Brownley K.A.
        • Sedway J.A.
        • Lohr K.N.
        Anorexia nervosa treatment: A systematic review of randomized controlled trials.
        Int J Eat Disord. 2007; 40: 310-320
        • Liberati A.
        • Altman D.G.
        • Tetzlaff J.
        • et al.
        The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: Explanation and elaboration.
        BMJ. 2009; 151: W65-W94
        • Moher D.
        • Tricco A.C.
        Issues related to the conduct of systematic reviews: A focus on the nutrition field.
        Am J Clin Nutr. 2008; 88: 1191-1199
        • Whelan K.
        • Myers C.E.
        Safety of probiotics in patients receiving nutritional support: A systematic review of case reports, randomized controlled trials, and nonrandomized trials.
        Am J Clin Nutr. 2010; 91: 687-703
      5. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. American Psychiatric Association, Washington, DC2000
      6. World Health Organization. International Statistical Classification of Diseases and Health Related Problems, ICD-10, Version 2010. http://apps.who.int/classifications/icd10/browse/2010/en. Updated 2010. Accessed January 5, 2012.

        • Mallen C.
        • Peat G.
        • Croft P.
        Quality assessment of observational studies is not commonplace in systematic reviews.
        J Clin Epidemiol. 2006; 59: 765-769
        • Sanderson S.
        • Tatt I.D.
        • Higgins J.P.
        Tools for assessing quality and susceptibility to bias in observational studies in epidemiology: A systematic review and annotated bibliography.
        Int J Epidemiol. 2007; 36: 666-676
        • Jarde A.
        • Losilla J.M.
        • Vives J.
        Suitability of three different tools for the assessment of methodological quality in ex post facto studies.
        Int J Clin Health Psychol. 2012; 12: 97-108
        • Crowe M.
        • Sheppard L.
        A review of critical appraisal tools show they lack rigor: Alternative tool structure is proposed.
        J Clin Epidemiol. 2011; 64: 79-89
      7. Higgins JP, Green S, eds. Cochrane handbook for systematic reviews of interventions, Version 5.1.0. Updated March 2011. http://www.cochrane-handbook.org. Accessed September 2, 2012.

        • Cuerda C.
        • Ruiz A.
        • Velasco C.
        • Breton I.
        • Camblor M.
        • Garcia-Peris P.
        How accurate are predictive formulas calculating energy expenditure in adolescent patients with anorexia nervosa?.
        Clin Nutr. 2007; 26: 100-106
        • Diamanti A.
        • Basso M.S.
        • Castro M.
        • et al.
        Clinical efficacy and safety of parenteral nutrition in adolescent girls with anorexia nervosa.
        J Adolesc Health. 2008; 42: 111-118
        • Heer M.
        • Mika C.
        • Grzella I.
        • Drummer C.
        • Herpertz-Dahlmann B.
        Changes in bone turnover in patients with anorexia nervosa during eleven weeks of inpatient dietary treatment.
        Clin Chem. 2002; 48: 754-760
        • Mika C.
        • Herpertz-Dahlmann B.
        • Heer M.
        • Holtkamp K.
        Improvement of nutritional status as assessed by multifrequency BIA during 15 weeks of refeeding in adolescent girls with anorexia nervosa.
        J Nutr. 2004; 134: 3026-3030
        • Robb A.S.
        • Silber T.J.
        • Orrell-Valente J.K.
        • et al.
        Supplemental nocturnal nasogastric refeeding for better short-term outcome in hospitalized adolescent girls with anorexia nervosa.
        Am J Psychiatry. 2002; 159: 1347-1353
        • Silber T.J.
        • Robb A.S.
        • Orrell-Valente J.K.
        • Ellis N.
        • Valadez-Meltzer A.
        • Dadson M.J.
        Nocturnal nasogastric refeeding for hospitalized adolescent boys with anorexia nervosa.
        J Dev Behav Pediatr. 2004; 25: 415-418
        • Whitelaw M.
        • Gilbertson H.
        • Lam P.-Y.
        • Sawyer S.M.
        Does aggressive refeeding in hospitalized adolescents with anorexia nervosa result in increased hypophosphatemia?.
        J Adolesc Health. 2010; 46: 577-582
        • Silber T.J.
        • Robb A.S.
        • Orrell-Valente J.K.
        Chapter 13: Nocturnal nasogastric refeeding in the nutritional rehabilitation of hospitalizes adolescents with anorexia nervosa: Rationale and methodology.
        in: Swain P.I. Focus on Eating Disorders Research. Nova Biomedical Books, New York, NY2003: 225-237
        • O'Connor G.
        • Goldin J.
        The refeeding syndrome and glucose load.
        Int J Eat Disord. 2011; 44: 182-185
        • Gunarathne T.
        • McKay R.
        • Pillans L.
        • Mckinlay A.
        • Crockett P.
        Refeeding syndrome in a patient with anorexia nervosa.
        BMJ. 2010; 340: c56
        • Mattar L.
        • Huas C.
        • Duclos J.
        • Apfel A.
        • Godart N.
        Relationship between malnutrition and depression or anxiety in anorexia nervosa: A critical review of the literature.
        J Affect Disord. 2011; 132: 311-318
        • Wallier J.
        • Vibert S.
        • Berthoz S.
        • Huas C.
        • Hubert T.
        • Godart N.
        Dropout from inpatient treatment for anorexia nervosa: Critical review of the literature.
        Int J Eat Disord. 2009; 42: 636-647
        • van Kuyck K.
        • Gerard N.
        • Van Laere K.
        • et al.
        Towards a neurocircuitry in anorexia nervosa: Evidence from functional neuroimaging studies.
        J Psychiatr Res. 2009; 43: 1133-1145
        • Fairburn C.G.
        Evidence-based treatment of anorexia nervosa.
        Int J Eat Disord. 2005; 37: S26-S30
        • Leclerc A.
        • Turrini T.
        • Sherwood K.
        • Katzman D.K.
        Evaluation of a nutrition rehabilitation protocol in hopsitalized adolescents with restrictive eating disoders.
        J Adolesc Health. 2013; 53: 585-589

      Biography

      T. Rocks is a doctoral degree student and a sessional lecturer/tutor, University of the Sunshine Coast, Sippy Downs, Queensland, Australia.

      Biography

      F. Pelly is an associate professor, School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia.

      Biography

      P. Wilkinson is manager, Accreditation, Recognition, and Education Services, Dietitians Association of Australia, Canberra, Australian Capital Territory, Australia.