Department of General Internal Medicine, Bern University Hospital, and University of Bern, Switzerland.
Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital, and University of Bern, Switzerland.
Nutrition. 2014 May;30(5):524-30. doi: 10.1016/j.nut.2013.09.019. Epub 2014 Jan 29.
Anorexia nervosa is associated with several serious medical complications related to malnutrition, severe weight loss, and low levels of micronutrients. The refeeding phase of these high-risk patients bears a further threat to health and potentially fatal complications. The objective of this study was to examine complications due to refeeding of patients with anorexia nervosa, as well as their mortality rate after the implementation of guidelines from the European Society of Clinical Nutrition and Metabolism.
We analyzed retrospective, observational data of a consecutive, unselected anorexia nervosa cohort during a 5-y period. The sample consisted of 65 inpatients, 14 were admitted more than once within the study period, resulting in 86 analyzed cases.
Minor complications associated with refeeding during the first 10 d (replenishing phase) were recorded in nine cases (10.5%), four with transient pretibial edemas and three with organ dysfunction. In two cases, a severe hypokalemia occurred. During the observational phase of 30 d, 16 minor complications occurred in 14 cases (16.3%). Six infectious and 10 non-infectious complications occurred. None of the patients with anorexia nervosa died within a follow-up period of 3 mo.
Our data demonstrate that the seriousness and rate of complications during the replenishment phase in this high-risk population can be kept to a minimum. The findings indicate that evidence-based refeeding regimens, such as our guidelines are able to reduce complications and prevent mortality. Despite anorexia nervosa, our sample were affected by serious comorbidities, no case met the full diagnostic criteria for refeeding syndrome.
神经性厌食症与多种与营养不良、严重体重减轻和微量营养素水平低相关的严重医学并发症有关。这些高风险患者的再喂养阶段对健康构成进一步威胁，并可能导致致命并发症。本研究的目的是检查神经性厌食症患者再喂养的并发症，以及在实施欧洲临床营养与代谢学会指南后的死亡率。
我们分析了连续、未选择的神经性厌食症队列在 5 年期间的回顾性观察数据。该样本包括 65 名住院患者，14 名患者在研究期间多次入院，因此分析了 86 例病例。
在最初 10 天的再喂养期间（补充阶段）记录了 9 例（10.5%）与再喂养相关的轻微并发症，其中 4 例出现短暂的胫前水肿，3 例出现器官功能障碍。在 2 例严重低钾血症的情况下。在 30 天的观察阶段，14 例中有 16 例发生了 16.3%的轻微并发症。发生了 6 例感染性和 10 例非感染性并发症。在 3 个月的随访期间，没有神经性厌食症患者死亡。
我们的数据表明，在这个高风险人群中，再喂养阶段的严重程度和并发症发生率可以降至最低。研究结果表明，基于证据的再喂养方案，如我们的指南，能够减少并发症并预防死亡。尽管存在神经性厌食症，但我们的样本存在严重的合并症，没有一个病例符合再喂养综合征的全部诊断标准。
