Long-term impact of higher vs. lower calorie refeeding in anorexia nervosa

描述(由申请人提供)：项目摘要/摘要神经性厌食症(AN)患者可能会因营养不良而变得不稳定，需要住院重新喂养或营养补充。重新喂养的目标是体重增加，因为在医院体重增加是长期康复的关键预测因素。然而，自从20世纪50年代S首次描述再喂养综合征以来，在再喂养过程中一直非常谨慎。这种综合征是由于营养物质引起的液体和电解质的快速变化引起的，可能导致心力衰竭、精神错乱和死亡。自从它被记录在患有AN的患者中以来，基于保守共识的建议被制定并被广泛应用，以确保再次喂养期间的安全性。这些建议要求每天从大约1200卡路里开始，然后每隔一天缓慢增加200卡路里。我们最近证明，这种“从低开始，慢慢进行”的方法会导致患有AN的青少年体重增加不明显，住院时间延长。这些发现有助于对“喂养不足综合症”的认识，这种综合症的特征是长期患病，甚至因过度谨慎地重新喂养而死亡。在一项后续研究中，我们发现，在风险没有增加的情况下，1800卡路里饮食与1200卡路里饮食相比，体重增加了一倍。虽然这些短期结果看起来很有希望，但长期影响尚不清楚。总体目标：拟议的纵向观察性研究的目的是比较青少年的长期康复和在医院接受高卡路里和低卡路里重新喂养的情况。到目前为止，我们对患有神经性厌食症(Shaan)住院的青少年进行的研究已经招募了56名青少年。这是在儿科临床研究中心重新喂食高热量方案与低卡路里方案的参与者中最大的一组，并进行了前瞻性的跟踪。我们现在建议在他们出院后一年内对他们的康复情况进行回顾检查。这些发现将被用作初步数据，以计划一项比较重新喂养方法的大型多中心试验。具体目标：我们将比较体重和生命体征的恢复、月经恢复和出院后一年多的再住院率。我们的主要假设是，更高的卡路里和更快的体重增加将导致更早的身体和营养恢复，以及较少的再次住院频率。研究设计：这项回顾性图表回顾将从我们门诊的医疗记录中提取现有数据，我们在那里为Shaan队列提供随访护理。我们将比较在住院期间和住院后8个时间点重新喂食高卡路里和低卡路里的受试者的康复轨迹：WKS。1、2、3、4和mo。3、6、9、12.意义：在住院的AN患者中平衡再次喂养综合征的风险和体重增加的需要是临床实践中的一个基本悖论。虽然目前推荐的低卡路里饮食似乎可以将风险降至最低，但它们也会导致喂养不足综合征。需要长期的跟踪数据来确定高卡路里再喂养的影响。这项拟议的研究是建立以证据为基础的方法重新喂养的必要的下一步。

DESCRIPTION (provided by applicant): Project Summary/Abstract Patients with Anorexia Nervosa (AN) can become medically unstable due to malnutrition and require hospitalization for re-feeding, or nutritional repletion. The goal of re-feeding is weight gain, since weight gain in hospital is a key predictor of long-term recovery. However, extreme caution has been used during re-feeding since the re-feeding syndrome was first described in the 1950's. This syndrome is caused by rapid shifts in fluids and electrolytes in response to nutrients and can result in cardiac failure, delirium and death. Since it was documented in patients with AN, conservative consensus-based recommendations were developed and have been applied broadly to ensure safety during re-feeding. These recommendations call for starting around 1200 calories per day and advancing slowly by 200 calories every other day. We recently demonstrated this "start low and go slow" approach contributes to poor weight gain and prolonged hospital stay in adolescents with AN. These findings have contributed to recognition of the "underfeeding syndrome", characterized by prolonged illness and even death due to overly cautious re-feeding. In a follow-up study, we found double the weight gain on 1800 vs. 1200 calorie diets with no increase in risk. While these short-term results look promising, the long- term impact is unknown. Overall Objective: The purpose of the proposed longitudinal observational study is to compare long-term recovery in adolescents with AN re-fed on higher vs. lower calories in hospital. Our Study of Adolescents Hospitalized with Anorexia Nervosa (SHAAN) has enrolled 56 adolescents to date. This is the largest cohort of participants re-fed on higher vs. lower calorie protocols and prospectively followed in a Pediatric Clinical Research Center. We are now proposing to examine their recovery retrospectively for one- year after discharge from hospital. These findings will be used as preliminary data to plan a large multicenter trial comparing re-feeding approaches. Specific Aims: We will compare weight and vital sign recovery, return of menses and rates of rehospitalization over one year following discharge from hospital in adolescents re-fed on higher vs. lower calories. Our overarching hypothesis is that higher calories and faster weight gain will lead to earlier physical and nutritional recovery and less frequent rehospitalization. Study Design: This retrospective chart review will extract existing data from the medical records in our outpatient clinic, where we provided follow-up care to the SHAAN cohort. We will compare recovery trajectories between subjects re-fed on higher vs. lower calories during hospitalization and at 8 time points following hospitalization: wks. 1, 2, 3, 4, and mo. 3, 6, 9, 12. Significance: Balancing risk for the re-feeding syndrome with the need for weight gain in hospitalized patients with AN represents a fundamental paradox for clinical practice. While the current recommendations for lower calorie diets appear to minimize risk, they also contribute to the underfeeding syndrome. Long-term follow-up data are required to determine the impact of higher calorie re-feeding. The proposed study is an essential next step to building evidence-based approaches to re-feeding in AN.