Anorexia Refeeding Guidelines Are Challenged

“Low and slow” may not be the way to go.

Current widely used guidelines for refeeding hospitalized teens with anorexia nervosa (AN) have been challenged by a team of researchers at the University of California, San Francisco (UCSF). According to the researchers, teens who are hospitalized do not gain considerable weight during their first week in the hospital when current refeeding guidelines are followed (J Adolesc Health, January 2012).

Current guidelines from the American Psychiatric Association, American Dietetic Association, and other groups state that patients should start with approximately 1200 kcal/day and advance slowly by 200 kcal/day every other day. The “start low and go slow” approach is taken to avoid the refeeding syndrome, a potentially deadline condition that results from rapid shifts in electrolyte levels during refeeding.

Andrea Garber, PhD, RD, who led the study, and her colleagues in the Division of Adolescent Medicine at UCSF, found that the current recommendations for refeeding were not effective among a group of 35 teenage girls, most of whom were Caucasian. The girls had been admitted to the hospital with low blood pressure, low body mass indexes, low heart rate and low body temperature. A large proportion of the girls received low-calorie diets based on the current guidelines. The girls received 6 small meals per day and were given high-calorie liquid supplements when they refused food. Heart rates were checked continuously and electrolyte levels were measured twice a day. Even though those who had the low-calorie diets did not develop refeeding syndrome, approximately 83% initially lost significant amounts of weight and had no overall weight gain until the eighth day of hospitalization.

Although 94% of study participants started on less than 1400 kcal per day, the study included diets that ranged from 800 kcal to 2200 kcal to analyze the effect of increasing calories.

Low-calorie refeeding led to greater weight loss

The University of California researchers found that girls who were started on low-calorie diets lost considerably more weight in the hospital, while the higher-calorie diets resulted in a shorter time in the hospital. In fact, Dr. Garber noted that for each 100 additional kilocalories, the hospital stay was one day shorter.

Thus, the authors feel that the current guidelines for refeeding teenage patients with AN are too cautious. Other issues were also raised by the study. For example, while insurance costs may be reduced as a result of shorter hospital stays, patients may not be ready to be discharged. No adverse effects were reported among the girls who were on higher-calorie diets.