Nutrition Therapy during Initiation of Refeeding in Underweight Children and Adolescent Inpatients with Anorexia Nervosa: A Systematic Review of the Evidence

• Published in: Journal of the Academy of Nutrition and Dietetics Vol. 114; no. 6; pp. 897 - 907
• Main Authors: Rocks, Tetyana, Pelly, Fiona, PhD, Wilkinson, Paul, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier 01.06.2014
• Subjects: Adolescent; Adult and adolescent clinical studies; Anorexia nervosa; Anorexia Nervosa - physiopathology; Anorexia Nervosa - rehabilitation; Anorexia Nervosa - therapy; Biological and medical sciences; Child; Diseases of the digestive system; Eating behavior disorders; Energy Intake; Enteral Nutrition - adverse effects; Evidence-Based Medicine; Feeding. Feeding behavior; Fundamental and applied biological sciences. Psychology; Gastroenterology and Hepatology; Humans; Internal Medicine; Intubation, Gastrointestinal - adverse effects; Medical sciences; Observational Studies as Topic; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Refeeding Syndrome - prevention & control; Thinness - etiology; Thinness - prevention & control; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Weight Gain; Inpatients; Children and adolescents; Anorexia nervosa; Nutrition therapy; Refeeding; Human; Diet therapy; Evidence-based practice; Adolescent; Metabolic diseases; Systematic review; Eating disorder; Child; Initiation; Evidence-based medicine
• ISSN: 2212-2672; 2212-2680
• DOI: 10.1016/j.jand.2013.11.022

Abstract Restoration of weight and nutritional rehabilitation are recognized as fundamental steps in the therapeutic treatment of children and adolescent inpatients with anorexia nervosa (AN). However, current recommendations on initial energy requirements for this population are inconsistent, with a clear lack of empirical evidence. Thus, the aim of our study was to systematically review, assess, and summarize the available evidence on the effect of differing nutrition therapies prescribed during refeeding on weight restoration in hospitalized children and adolescents (aged 19 years and younger) with diagnosed AN. Searches were conducted in Scopus, Web of Science, Global Health (CABI), PubMed, and the Cochrane database for articles published in English up to May 2012, and complemented by a search of the reference lists of key publications. Seven observational studies investigating a total of 403 inpatients satisfied the inclusion criteria. The range of prescribed energy intakes varied from 1,000 kcal to >1,900 kcal/day with a progressive increase during the course of hospitalization. It appeared that additional tube feeding increased the maximum energy intake and led to greater interim or discharge weight; however, this was also associated with a higher incidence of adverse effects. Overall, the level of available evidence was poor, and therefore consensus on the most effective and safe treatment for weight restoration in inpatient children and adolescents with AN is not currently feasible. Further research on refeeding methods is crucial to establish the best practice approach to treatment of this population.