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Review
. 2021 May;60(5):555-561.
doi: 10.1016/j.jaac.2020.09.010. Epub 2020 Sep 27.

Practice-Based Evidence and Clinical Guidance to Support Accelerated Re-Nutrition of Patients With Anorexia Nervosa

Verena Haas  1 , Michael Kohn  2 , Thorsten Körner  3 , Ulrich Cuntz  4 , Andrea K Garber  5 , Daniel Le Grange  6 , Ulrich Voderholzer  2 , Christoph U Correll  7
Affiliations
Review

Practice-Based Evidence and Clinical Guidance to Support Accelerated Re-Nutrition of Patients With Anorexia Nervosa

Verena Haas et al. J Am Acad Child Adolesc Psychiatry. 2021 May.

Abstract

Anorexia nervosa (AN) is characterized by underweight, and the primary goal of treatment is weight restoration. Treatment approaches (ie, hospitalization for weight recovery vs for medical stabilization) and settings (ie, medical/pediatric or psychiatric units) for patients with AN vary between and also within countries. Several specialized eating disorder units worldwide have established high-caloric refeeding (HCR) protocols for patients with AN. In observational studies, HCR shortens hospital stays and increases initial weight gain, the latter being associated with a favorable long-term prognosis. However, clinicians may still remain reluctant to accept this approach for fear of medical complications of HCR, including the risk of refeeding syndrome (RS).1 Research is building toward the development of evidence-based recommendations for safe and effective re-nutrition of underweight patients with AN. This focused review was based on clinical experience and describes 3 different protocols for nutritional management devised by experts from 3 different parts of the world (Australia, Germany, and the United States), in medical refeeding of patients with AN who have established HCR in their clinical units. In addition, and in order to understand energy requirements, empirical data on energy turnover of patients with AN from former metabolic studies are presented. To the best of our knowledge, there is no study reporting on HCR in a cohort of severely malnourished adolescents with AN (ie, with a mean body mass index [BMI] of <15 kg/m2). Therefore, to provide information about the treatment of extremely malnourished patients with AN, we included a recently published HCR protocol for adults with a BMI of <13 kg/m2.2.

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Conflict of interest statement

Disclosure: Dr. Haas has received grant support from the Swiss Anorexia Nervosa Foundation. Prof. Le Grange has received grant funding from the National Institutes of Health and royalties from Routledge and Guilford Press. He is the co-director of the Training Institute for Child and Adolescent Eating Disorders, LLC. Dr. Voderholzer has received grant support from the Swiss Anorexia Nervosa Foundation. Dr. Correll has been a consultant and/or advisor to or has received honoraria from: Acadia, Alkermes, Allergan, Angelini, Axsome, Gedeon Richter, the Gerson Lehrman Group, Indivior, IntraCellular Therapies, Janssen/JandJ, Karuna, LB Pharma, Lundbeck, MedAvanteProPhase, MedInCell, Medscape, Merck, Misubishi Tanabe Oharma, Mylan, Neurocrine, Noven, Otsuka, Pfizer, Recordati, Rovi, Servier, Sumitomo Dainippon, Sunovion, Supernus, Takeda, and Teva. He provided expert testimony for Janssen, and Otsuka. He served on a Data Safety Monitoring Board for , Lundbeck, Rovi, Supernus, and Teva. He has received rgrant support from Bendheim Foundation, Berlin Institute of Health, Janssen, National Institute of Mental Health, USA, Patient Centered Outcomes Research Institute, and Takeda. He is also a stock option holder of LB Pharma. Prof. Kohn and Drs. Körner, Cuntz, Garber have reported no biomedical financial interests or potential conflicts of interest.

Figures

FIGURE 1
FIGURE 1. Pathophysiology of refeeding syndrome
Note: Adapted and republished from Reber et al. (https://doi.org/10.3390/jcm8122202; published under Creative Commons license CC BY: https://creativecommons.org/licenses/by/4.0). ECV = extracellular volume.
See this image and copyright information in PMC

Comment in

References

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