The incidence of refeeding syndrome and the nutrition management of severely malnourished inpatients with eating disorders: An observational study.

Autor: Brodie E; Clinical Nutrition Department, The Royal Melbourne Hospital, Melbourne, Australia., van Veenendaal N; Clinical Nutrition Department, The Royal Melbourne Hospital, Melbourne, Australia., Platz E; Clinical Nutrition Department, The Royal Melbourne Hospital, Melbourne, Australia.; Eating Disorders Unit, The Royal Melbourne Hospital, Melbourne, Australia., Fleming J; Eating Disorders Unit, The Royal Melbourne Hospital, Melbourne, Australia., Gunn H; Consultation-Liaison Psychiatry-Inner West Area Mental Health Service, The Royal Melbourne Hospital, Melbourne, Australia., Johnson D; Department of General Medicine and Infectious Diseases, The Royal Melbourne Hospital, Melbourne, Australia.; Department of Medicine and Infectious Diseases, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia., Griffin H; Clinical Nutrition Department, The Royal Melbourne Hospital, Melbourne, Australia., Wittholz K; Clinical Nutrition Department, The Royal Melbourne Hospital, Melbourne, Australia.
Jazyk: angličtina
Zdroj: The International journal of eating disorders [Int J Eat Disord] 2024 Mar; Vol. 57 (3), pp. 661-670. Date of Electronic Publication: 2024 Jan 30.
DOI: 10.1002/eat.24151
Abstrakt: Objective: Nutritional rehabilitation and weight restoration are often critical for the treatment of eating disorders (ED), yet are restricted by the potential risk of refeeding syndrome (RFS). The primary objective was to determine the incidence of RFS. Secondary objectives were to explore predictive factors of RFS and describe its impact on treatment goals for patients with ED.
Method: This retrospective observational study reviewed the nutrition management for patients admitted to a quaternary hospital for ED treatment from 2018 to 2020. Data were collected during the first 4 weeks of admission and included anthropometry, energy prescription, incidence and severity of RFS, and electrolyte and micronutrient prescription. Outcomes included incidence of RFS, energy prescription and advancement, and weight change.
Results: Of 423 ED admissions, 217 patients (median [interquartile range, IQR] age 25 [21-30.5] years; 210 [97%] female) met inclusion criteria. Median (IQR) body mass index (BMI) on admission was 15.5 (14.1-17.3) kg/m 2 . The mean (standard deviation) length of admission was 35 (7.3) days. Median (IQR) initial energy prescription was 1500 (930-1500) kcal/day. Seventy-three (33%) patients developed RFS; 34 (16%) mild, 27 (12%) moderate, and 12 (5%) severe. There was no association between RFS severity and admission BMI, energy prescription, or prescription of prophylactic electrolytes or micronutrients. Lower admission weight was associated with RFS (odds ratio 0.96, 95% confidence interval [0.93-1.00], p = .035). Less than half of the participants met the weight gain target (>1 kg per week) in the first 3 weeks of admission.
Discussion: The incidence of severe RFS was low in this cohort and was associated with lower admission weight.
Public Significance: This study is one of the largest studies to utilize consensus-defined criteria to diagnose RFS among adult patients admitted for treatment of an ED. This population is still considered to be at risk of RFS and will require close monitoring. The results add to the growing body of research that restriction of energy prescription to prevent RFS may not require the level of conservatism traditionally practiced.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
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