Featured Research

from universities, journals, and other organizations

Decades-old treatment guidelines for anorexia challenged

Date:
December 13, 2011
Source:
University of California - San Francisco
Summary:
Adolescents hospitalized with anorexia nervosa who receive treatment based on current recommendations for refeeding fail to gain significant weight during their first week in the hospital, according to a new study.

Adolescents hospitalized with anorexia nervosa who receive treatment based on current recommendations for refeeding fail to gain significant weight during their first week in the hospital, according to a new study by UCSF researchers.

Related Articles


The findings, published in the January issue of the Journal of Adolescent Health with an accompanying editorial, challenge the current conservative approach to feeding adolescents with anorexia nervosa during hospitalization for malnutrition.

The American Psychiatric Association, American Dietetic Association and others recommend starting with about 1,200 calories per day and advancing slowly by 200 calories every other day. This "start low and go slow" approach is intended to avoid refeeding syndrome -- a potentially fatal condition resulting from rapid electrolyte shifts, a well-known risk when starting nutrition therapy in a starving patient.

The UCSF study is the first to test these recommendations, which have been in place since 2000. "Our findings show that the current recommendations are just not effective," said Andrea Garber, PhD, RD, associate professor of pediatrics in the Division of Adolescent Medicine at UCSF, who led the research with colleagues in the UCSF Adolescent Eating Disorders Program.

Study participants were hospitalized due to signs of malnutrition, including low body temperature, blood pressure, heart rate and body mass index. The vast majority of the 35 primarily white, female adolescent patients received low calorie diets based on the current recommendations. Patients were fed six small meals per day, and when they refused food, they were given high calorie liquid supplements as a replacement. The patients' vital signs were monitored closely, with their heart rates measured continuously and electrolytes checked twice a day.

While the low calorie diets did prevent refeeding syndrome for those patients, about 83 percent of them also experienced significant initial weight loss and no overall weight gain until their eighth day in the hospital. This finding represents "a missed opportunity," according to Garber.

"Studies show that weight gain during hospitalization is crucial for patients' long-term recovery," she said, "we have to make the most out of their short time in the hospital."

Although 94 percent of patients in the study started on fewer than 1,400 calories a day, it included a range of diets from 800 to 2,200 calories. This range allowed the researchers to examine the effect of increasing calories. According to Garber, two important findings emerged:

  • The calorie level of the starting diet predicted the amount of weight that would be lost in the hospital. In other words, those on lower calorie diets lost significantly more weight.
  • Higher calorie diets led to less time in the hospital. In fact, Garber said, "we showed that for every 100 calories higher, the hospital stay was almost one day shorter."

While the study finds that current recommendations are too cautious, it raises other questions, according to the research team. For example, while a shorter hospital stay may reduce insurance costs, patients may not be ready to go home yet.

"Shorter is not necessarily better" said Garber. "We have to consider the potential implications down the line, both psychological and emotional."

Another unanswered question relates to refeeding syndrome, which remains "a very real fear," according to Barbara Moscicki, MD, a professor of pediatrics in the Division of Adolescent Medicine at UCSF and senior author on the paper. Moscicki says that the team is proceeding cautiously since more aggressive approaches to feeding and supplementation have not yet been well studied.

Nevertheless, the researchers say that the study results are a promising start because no adverse events were seen in the study subjects on the higher calorie diets. "If we can improve weight gain with higher calories," Garber said, "then we're on the right path."

Other co-authors are Nobuaki Michihata, MD, Katherine Hetnal, and Mary-Ann Shafer, MD, all of UCSF. The study was conducted in the Pediatric Clinical Research Center through UCSF's NIH-funded Clinical and Translational Science Institute (CTSI).


Story Source:

The above story is based on materials provided by University of California - San Francisco. Note: Materials may be edited for content and length.


Journal Reference:

  1. Andrea K. Garber, Nobuaki Michihata, Katherine Hetnal, Mary-Ann Shafer, Anna-Barbara Moscicki. A Prospective Examination of Weight Gain in Hospitalized Adolescents With Anorexia Nervosa on a Recommended Refeeding Protocol. Journal of Adolescent Health, 2011; DOI: 10.1016/j.jadohealth.2011.06.011

Cite This Page:

University of California - San Francisco. "Decades-old treatment guidelines for anorexia challenged." ScienceDaily. ScienceDaily, 13 December 2011. <www.sciencedaily.com/releases/2011/12/111209105754.htm>.
University of California - San Francisco. (2011, December 13). Decades-old treatment guidelines for anorexia challenged. ScienceDaily. Retrieved November 23, 2014 from www.sciencedaily.com/releases/2011/12/111209105754.htm
University of California - San Francisco. "Decades-old treatment guidelines for anorexia challenged." ScienceDaily. www.sciencedaily.com/releases/2011/12/111209105754.htm (accessed November 23, 2014).

Share This


More From ScienceDaily



More Health & Medicine News

Sunday, November 23, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Ebola-Hit Sierra Leone's Late Cocoa Leaves Bitter Taste

Ebola-Hit Sierra Leone's Late Cocoa Leaves Bitter Taste

AFP (Nov. 23, 2014) The arable district of Kenema in Sierra Leone -- at the centre of the Ebola outbreak in May -- has been under quarantine for three months as the cocoa harvest comes in. Duration: 01:32 Video provided by AFP
Powered by NewsLook.com
Don't Fall For Flu Shot Myths

Don't Fall For Flu Shot Myths

Newsy (Nov. 23, 2014) Misconceptions abound when it comes to your annual flu shot. Medical experts say most people older than 6 months should get the shot. Video provided by Newsy
Powered by NewsLook.com
WFP: Ebola Risks Heightened Among Women Throughout Africa

WFP: Ebola Risks Heightened Among Women Throughout Africa

AFP (Nov. 21, 2014) Having children has always been a frightening prospect in Sierra Leone, the world's most dangerous place to give birth, but Ebola has presented an alarming new threat for expectant mothers. Duration: 00:37 Video provided by AFP
Powered by NewsLook.com
Could Your Genes Be The Reason You're Single?

Could Your Genes Be The Reason You're Single?

Newsy (Nov. 21, 2014) Researchers in Beijing discovered a gene called 5-HTA1, and carriers are reportedly 20 percent more likely to be single. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins