Reprinted from Eating Disorders Review
July/August 2011 Volume 22, Number 4
©2011 Gürze Books
Refeeding anorexia nervosa (AN) patients can be safer and more efficient once the pathophysiology of protein-calorie malnutrition is better understood, according to Dr. M.R. Kohn and co-workers at the University of Sydney, Australia (Current Opinion in Pediatrics 2011 Jun 8. [Epub ahead of print].
According to the authors, the time-honored notion of “starting low and going slow” with the prescription of daily calories seems unlikely to be essential for preventing refeeding syndrome. When the authors reviewed recent publications, they found that this approach does not necessarily make the refeeding process safer. On the contrary, it typically results in weight loss, extends hospitalization time, and delays nutritional recovery.
The dietary composition of macronutrients, in particular avoiding a high proportion of calories from carbohydrates, appears to be more important than is the absolute number of calories. And, the means of initial refeeding appears increasingly important in this process, particularly following reports of postprandial hypoglycemia.
The authors propose that the current guidelines for refeeding AN patients be revised, considering the evidence of the use of continuous feeding strategies with fewer than 40% of calories from carbohydrates. This approach has important implications for the prevention of the refeeding syndrome as well as for the safety and efficiency of refeeding of children and adolescents with AN in the hospital.