A Higher-Calorie Refeeding Protocol Does Not Increase Adverse Outcomes in Adult Patients with Eating Disorders
| Autor: | Sandra Capra, Warren Ward, Jan Hill, Susan Patterson, Michelle Palmer, Kylie Matthews, Amanda Davis, Shane Jeffrey |
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| Rok vydání: | 2017 |
| Předmět: |
0301 basic medicine
Adult Male medicine.medical_specialty Calorie Adolescent Population Anorexia Hypoglycemia Refeeding syndrome Feeding and Eating Disorders 03 medical and health sciences Young Adult 0302 clinical medicine Clinical Protocols Risk Factors Internal medicine medicine Humans 030212 general & internal medicine Refeeding Syndrome education Retrospective Studies education.field_of_study 030109 nutrition & dietetics Nutrition and Dietetics business.industry Incidence (epidemiology) Incidence Australia General Medicine Water-Electrolyte Balance medicine.disease Hospitalization Eating disorders Anorexia nervosa (differential diagnoses) Female medicine.symptom business Energy Intake Food Science Diet Therapy |
| Zdroj: | Journal of the Academy of Nutrition and Dietetics. 118(8) |
| ISSN: | 2212-2672 |
| Popis: | 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 χ 2 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. |
| Databáze: | OpenAIRE |
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