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A Higher-Calorie Refeeding Protocol Does Not Increase Adverse Outcomes in Adult Patients with Eating Disorders.
- Source :
-
Journal of the Academy of Nutrition and Dietetics [J Acad Nutr Diet] 2018 Aug; Vol. 118 (8), pp. 1450-1463. Date of Electronic Publication: 2018 Apr 12. - Publication Year :
- 2018
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Abstract
- 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.<br />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.<br />Design: This was a retrospective pre-test-post-test study.<br />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.<br />Main Outcome Measures: Differences in prevalence of electrolyte disturbances, hypoglycemia, edema, and RFS diagnoses were examined.<br />Statistical Analysis Performed: χ <superscript>2</superscript> tests, Kruskal-Wallis H test, analysis of variance, and independent t tests were used to compare data between the two protocols.<br />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).<br />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.<br /> (Copyright © 2018 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Adolescent
Adult
Australia
Clinical Protocols
Diet Therapy adverse effects
Energy Intake
Feeding and Eating Disorders physiopathology
Female
Hospitalization statistics & numerical data
Humans
Incidence
Male
Refeeding Syndrome etiology
Retrospective Studies
Risk Factors
Water-Electrolyte Balance
Young Adult
Diet Therapy methods
Feeding and Eating Disorders diet therapy
Refeeding Syndrome epidemiology
Subjects
Details
- Language :
- English
- ISSN :
- 2212-2672
- Volume :
- 118
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Journal of the Academy of Nutrition and Dietetics
- Publication Type :
- Academic Journal
- Accession number :
- 29656932
- Full Text :
- https://doi.org/10.1016/j.jand.2018.01.023