Outcomes of an inpatient refeeding protocol in youth with Anorexia Nervosa and atypical Anorexia Nervosa at Children's Hospitals and Clinics of Minnesota

Abstract

Background: Historically, inpatient protocols have adopted relatively conservative approaches to refeeding in Anorexia Nervosa (AN) in order to reduce the risk of refeeding syndrome, a potentially fatal constellation of symptoms. However, increasing evidence suggests that patients with AN can tolerate higher caloric prescriptions during treatment, which may result in prevention of initial weight loss, shorter hospital stays, and less exposure to the effects of severe malnutrition. Therefore the present study sought to examine the effectiveness of a more accelerated refeeding protocol in an inpatient AN and atypical AN sample.

Methods: Participants were youth (ages 10-22) with AN (n = 113) and atypical AN (n = 16) who were hospitalized for medical stabilization. A retrospective chart review was conducted to assess changes in calories, weight status (percentage of median BMI, %mBMI), and indicators of refeeding syndrome, specifically hypophosphatemia, during hospitalization. Weight was assessed again approximately 4 weeks after discharge.

Results: No cases of refeeding syndrome were observed, though 47.3 % of participants evidenced hypophosphatemia during treatment. Phosphorous levels were monitored in all participants, and 77.5 % were prescribed supplemental phosphorous at the time of discharge. Higher rates of caloric changes were predictive of greater changes in %mBMI during hospitalization. Rates of caloric and weight change were not related to an increased likelihood of re-admission.

Conclusions: Results suggest that a more accelerated approach to inpatient refeeding in youth with AN and atypical AN can be safely implemented and is not associated with refeeding syndrome, provided there is close monitoring and correction of electrolytes. These findings suggest that this approach has the potential to decrease length of stay and burden associated with inpatient hospitalization, while supporting continued progress after hospitalization.

Keywords: Adolescents; Anorexia Nervosa; Children; Hypophosphatemia; Refeeding.

Fig. 1

Displays the curvilinear change in %mBMI between admission and follow-up. ¹The mean length of stay (14.98 days) and mean days between discharge and follow-up (26.07 days) were summed to determine the range of values for the x-axis. Follow-up data points represented only patients who completed this assessment

Fig. 2

Changes in mean percentage of median BMI (%mBMI) during and after hospitalization. Figure 2 displays the results of the piecewise growth model illustrating the differing rates of change in %mBMI during and after hospitalization. ¹The mean length of stay (14.98 days) and mean days between discharge and follow-up (26.07) were summed to determine the range of values for the x-axis. Follow-up data points represented only patients who completed this assessment