Original articleShifting Paradigms: Continuous Nasogastric Feeding With High Caloric Intakes in Anorexia Nervosa
Section snippets
Methods
A retrospective review of patients admitted to the Montreal Children's Hospital for restrictive eating disorders during the period of December 1, 2003 to December 1, 2011 was conducted. Ethical approval was obtained from the MCH Research Ethics Board.
Beginning in May 2010, eating disorder specialists at the MCH adopted a standardized continuous NG tube refeeding protocol. All patients admitted for treatment of restrictive eating disorders have a NG tube inserted on arrival to the medical ward.
Results
The two cohorts did not differ significantly in sex, age, admission body mass index, or percent of ideal body weight at admission (Table 1). The mean (SD) initial caloric intake of the bolus-fed cohort was 1,069 kcal/ day with a range of 800–1,500 kcal/day and a mode of 1,000 kcal/day. The NG cohort's initial caloric prescription was significantly higher with a mean of 1,617, a range of 1,200–2,000 kcal/day and a mode of 1,500 kcal/day. The mean caloric goal was significantly lower in the NG
Discussion
This study provides further evidence to support the treatment of undernourished inpatients with restrictive eating disorders with a higher initial caloric intake (60%–75% of estimated needs) to achieve rapid and safe nutritional rehabilitation. Recently published descriptive clinical studies support the view that it can be safe and, in fact, desirable to start malnourished patients at a higher daily caloric intake (compared with the current standard of initiating a low caloric meal plan at
Acknowledgments
Elise Mok for assistance with statistical analysis and the Montreal Children's Hospital Adolescent Medicine Division for its assistance in preliminary data collection.
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Novel approaches for the assessment of relative body weight and body fat in diagnosis and treatment of anorexia nervosa: A cross-sectional study
2019, Clinical NutritionCitation Excerpt :The causes of AN are complex, which makes effective therapeutic approaches difficult [4–9]. Current treatment strategies focus primarily on rapid weight restoration [7–9], and are based on two key determinants that influence energy metabolism [3]: increased energy intake taking into consideration any possible refeeding complications [7,10–12], including the administration of artificial nutrient-enriched dietary supplements to achieve the energy requirements for weight gain [2,7,9]; restrict physical activity and exercise to reduce energy expenditure [2,7–9], and avoid over-exercise [13], hyperactivity [14], hypermetabolism [7], and compulsive and compensatory behavior that may lead to an increased risk of adverse physiological outcomes [13–17]. However, some therapeutic approaches support supervised physical activity in the recovery process [3,16,18], since beneficial effects on the individual's well-being and positive influences on body composition have been reported [3,14,16,18–20].
A Higher-Calorie Refeeding Protocol Does Not Increase Adverse Outcomes in Adult Patients with Eating Disorders
2018, Journal of the Academy of Nutrition and DieteticsCitation Excerpt :Although further research is required to assess whether manipulating macronutrient content lessens the risk of hypoglycemic episodes, use of continuous enteral feeds does appear to prevent hypoglycemic events in medically compromised adult patients with EDs. Similar to findings by Gentile,17 enteral nutrition was also well tolerated by all participants, even those classified as having extreme malnutrition, such as Participant C. However, in contrast to findings by Garber and colleagues,10 Agostino and colleagues,11 and Robb and colleagues,37 the present study demonstrated no significant differences in weight gain during medical admission between groups (P=0.103-0.410). Because these studies focused on adolescent patients (aged 14.8 to 16.2 years), the results may suggest that weight gain does not occur as quickly in the adult population, irrespective of initial calorie intake.
Financial Disclosure: Internal funding was provided by the Division of Adolescent Medicine and Pediatric Gynecology, Montreal Children's Hospital. No external funding was secured for this study. The authors have no financial relationships relevant to this article to disclose.
Conflict of Interest: The authors have no conflicts of interest to disclose.