J Acad Nutr Diet. 2018 Aug;118(8):1450-1463. doi: 10.1016/j.jand.2018.01.023. Epub 2018 Apr 12.
Patients with eating disorders (EDs) are often considered a high-risk population to refeed. Current research advises using "start low, go slow" refeeding methods (∼1,000 kcal/day, advancing ∼500 kcal/day every 3 to 4 days) in adult patients with severe EDs to prevent the development of refeeding syndrome (RFS), typically characterized by decreases in serum electrolyte levels and fluid shifts.
To compare the incidence of RFS and related outcomes using a low-calorie protocol (LC) (1,000 kcal) or a higher-calorie protocol (HC) (1,500 kcal) in medically compromised adult patients with EDs.
This was a retrospective pre-test-post-test study.
PARTICIPANTS/SETTING: One hundred and nineteen participants with EDs, medically admitted to a tertiary hospital in Brisbane, Australia, between December 2010 and January 2017, were included (LC: n=26, HC: n=93). The HC refeeding protocol was implemented in September 2013.
Differences in prevalence of electrolyte disturbances, hypoglycemia, edema, and RFS diagnoses were examined.
χ tests, Kruskal-Wallis H test, analysis of variance, and independent t tests were used to compare data between the two protocols.
Descriptors were similar between groups (LC: 28±9 years, 96% female, 85% with anorexia nervosa, 31% admitted primarily because of clinical symptoms of exacerbated ED vs HC: 27±9 years, 97% female, 84% with anorexia nervosa, 44% admitted primarily because of clinical symptoms of exacerbated ED, P>0.05). Participants refed using the LC protocol had higher incidence rates of hypoglycemia (LC: 31% vs HC: 10%, P=0.012), with no statistical or clinical differences in electrolyte disturbances (LC: 65% vs HC: 45%, P=0.079), edema (LC: 8% vs HC: 6%, P=0.722) or diagnosed RFS (LC: 4% vs HC: 1%, P=0.391).
A higher-calorie refeeding protocol appears to be safe, with no differences in rates of electrolyte disturbances or clinically diagnosed RFS and a lower incidence of hypoglycemia. Future research examining higher-calorie intakes, similar to those studied in adolescent patients, may be beneficial.
患有进食障碍（ED）的患者通常被认为是重新进食的高危人群。目前的研究建议在患有严重 ED 的成年患者中使用“低进量，慢增速”的喂养方法（每天约 1000 卡路里，每 3 至 4 天增加约 500 卡路里），以预防再喂养综合征（RFS）的发生，RFS 的典型特征是血清电解质水平降低和液体转移。
比较使用低热量方案（LC）（1000 卡路里）或高热量方案（HC）（1500 卡路里）在患有 ED 的医学上有并发症的成年患者中 RFS 的发生率和相关结果。
这是一项回顾性的预测试后测试研究。
参与者/设置：2010 年 12 月至 2017 年 1 月期间，119 名患有 ED 的患者被收入澳大利亚布里斯班的一家三级医院进行医学治疗，其中包括 26 名 LC 组和 93 名 HC 组。HC 喂养方案于 2013 年 9 月实施。
比较两种方案之间电解质紊乱、低血糖、水肿和 RFS 诊断的发生率差异。
使用 χ 检验、Kruskal-Wallis H 检验、方差分析和独立 t 检验比较两种方案的数据。
两组的描述符相似（LC：28±9 岁，96%为女性，85%为神经性厌食症，31%因 ED 临床症状加重入院；HC：27±9 岁，97%为女性，84%为神经性厌食症，44%因 ED 临床症状加重入院，P>0.05）。使用 LC 方案进行喂养的患者低血糖发生率更高（LC：31% vs HC：10%，P=0.012），电解质紊乱（LC：65% vs HC：45%，P=0.079）、水肿（LC：8% vs HC：6%，P=0.722）或诊断为 RFS（LC：4% vs HC：1%，P=0.391）的发生率没有统计学或临床差异。
高热量喂养方案似乎是安全的，没有电解质紊乱或临床诊断的 RFS 发生率差异，低血糖发生率更低。未来研究可以考虑更高的热量摄入，类似于对青少年患者的研究，可能会有所帮助。
