A Prospective Examination of Weight Gain in Hospitalized Adolescents With Anorexia Nervosa on a Recommended Refeeding Protocol
A Prospective Examination of Weight Gain in Hospitalized Adolescents With Anorexia Nervosa on a Recommended Refeeding Protocol
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DOI：
10.1016/j.jadohealth.2011.06.011
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发表时间：
2012-01-01
影响因子：
7.6
通讯作者：
Moscicki, Anna-Barbara
中科院分区：
文献类型：
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作者：
Garber, Andrea K.;Michihata, Nobuaki;Moscicki, Anna-Barbara
目的：目前对因神经性厌食症（AN）住院的青少年的再进食建议是保守的，从低热量开始，缓慢推进以避免再进食综合征。本研究的目的是检查AN住院青少年在推荐的再喂养方案下的体重变化和临床结果。方法：对13.1 ~ 20.5岁因AN住院的青少年进行随访。每天测量体重、生命体征、电解质和24小时体液平衡。百分比中位体重指数（%MBMI）计算为年龄和性别的第50百分位BMI。卡路里是入院时规定的，每隔一天增加一次。结果：35名受试者平均（SD）年龄16.2（1.9）岁，参与时间16.7（6.4）天。卡路里从1205（289）增加到2668（387）。没有受试者出现再进食综合征；20%血清磷含量低。MBMI百分比从80.1（11.5）增加到84.5 (9.6)；总体增重2.10 (1.98)kg，但83%的受试者最初体重减轻。平均MBMI %直到第8天才显著增加。在校正了MBMI %和入院时最低心率的多变量回归模型中，基线时较高的卡路里处方与更快的体重增加（p = 0.003）和更短的住院时间（p = 0.030）显著相关。结论：住院的AN青少年在推荐的再喂养方案下表现出最初的体重减轻和缓慢的体重增加。入院时制定的高热量饮食预示着体重增加更快，住院时间更短。这些发现支持在患有AN住院的青少年中制定更积极的喂养策略。需要进一步的研究来确定热量和补充方案，以最大限度地安全增加体重，同时避免再进食综合征。由爱思唯尔公司代表青少年健康和医学协会出版。
Purpose: Current refeeding recommendations for adolescents hospitalized with anorexia nervosa (AN) are conservative, starting with low calories and advancing slowly to avoid refeeding syndrome. The purpose of this study was to examine weight change and clinical outcomes in hospitalized adolescents with AN on a recommended refeeding protocol.Methods: Adolescents aged 13.1-20.5 years were followed during hospitalization for AN. Weight, vital signs, electrolytes, and 24-hour fluid balance were measured daily. Percent median body mass index (%MBMI) was calculated as 50th percentile BMI for age and gender. Calories were prescribed on admission and were increased every other day.Results: Thirty-five subjects with a mean (SD) age of 16.2 (1.9) years participated over 16.7 (6.4) days. Calories increased from 1,205 (289) to 2,668 (387). No subjects had refeeding syndrome; 20% had low serum phosphorus. Percent MBMI increased from 80.1 (11.5) to 84.5 (9.6); overall gain was 2.10 (1.98) kg. However, 83% of subjects initially lost weight. Mean %MBMI did not increase significantly until day 8. Higher calories prescribed at baseline were significantly associated with faster weight gain (p = .003) and shorter hospital stay (p = .030) in multivariate regression models adjusted for %MBMI and lowest heart rate on admission.Conclusions: Hospitalized adolescents with AN demonstrated initial weight loss and slow weight gain on a recommended refeeding protocol. Higher calorie diets instituted at admission predicted faster weight gain and shorter hospital stay. These findings support the development of more aggressive feeding strategies in adolescents hospitalized with AN. Further research is needed to identify caloric and supplementation regimens to maximize weight gain safely while avoiding refeeding syndrome. Published by Elsevier Inc. on behalf of Society for Adolescent Health and Medicine.