Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Germany; Eating Disorder Treatment and Research Center, Faculty of Medicine, Technische Universität Dresden, Germany.
Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, Germany; Eating Disorder Treatment and Research Center, Faculty of Medicine, Technische Universität Dresden, Germany.
J Am Acad Child Adolesc Psychiatry. 2021 May;60(5):566-567. doi: 10.1016/j.jaac.2020.12.016. Epub 2020 Dec 21.
Refeeding is the cornerstone of treatment in anorexia nervosa (AN), a life-threatening eating disorder characterized by severe undernutrition. During refeeding, patients typically gain a large proportion of their body weight within a couple of weeks or months. The aims of this drastic nutritional intervention are mainly somatic stability and the improvement of the mental state of the patient, as a prerequisite for psychotherapy. There has been a recent trend away from the conventional low-calorie "start low, go slow" refeeding approach to higher calorie refeeding with a more rapid weight gain, shorter hospitalization time, and consequently, psychosocial and economic benefits. In favor of higher calorie refeeding, the rate of initial weight gain has been shown to predict weight recovery. Furthermore, recent neuroimaging studies suggest that the widespread reductions of gray matter volume and cortical thickness in acutely underweight AN patients abate rapidly after refeeding. Although the first studies provided evidence for the relative safety of higher calorie refeeding, particularly in the refeeding syndrome, a rare but possibly fatal complication, little is known about less acute side effects. However, relative to its significant clinical importance, the topic is understudied, and guidelines vary considerably across different countries. The clinical review at the focus of this editorial seeks to advance the medical literature by juxtaposing the details of refeeding protocols of 3 well-known specialized eating disorder centers.
重新喂养是神经性厌食症（AN）治疗的基石，这是一种危及生命的饮食失调症，其特征是严重营养不良。在重新喂养期间，患者通常在几周或几个月内体重会增加很大一部分。这种激进的营养干预的目的主要是躯体稳定和改善患者的精神状态，作为心理治疗的前提。最近出现了一种趋势，不再采用传统的低热量“低起点、慢进展”的重新喂养方法，而是采用更高热量的重新喂养方法，以更快地增加体重、缩短住院时间，从而带来心理社会和经济效益。支持更高热量的重新喂养，最初体重增加的速度被证明可以预测体重恢复。此外，最近的神经影像学研究表明，在急性体重不足的 AN 患者中，广泛的灰质体积和皮质厚度减少在重新喂养后迅速缓解。尽管最初的研究提供了证据证明更高热量的重新喂养相对安全，特别是在重新喂养综合征这一罕见但可能致命的并发症中，但对于不太急性的副作用知之甚少。然而，相对于其重要的临床意义，这个话题的研究还不够充分，不同国家的指南差异很大。本期社论的临床综述旨在通过并列 3 个著名的专门饮食失调症中心的重新喂养方案的细节来推进医学文献。
