Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California;
Department of Preventive and Restorative Dental Sciences, School of Dentistry, University of California, San Francisco, San Francisco, California.
Pediatrics. 2021 Apr;147(4). doi: 10.1542/peds.2020-037135. Epub 2021 Mar 22.
We recently reported the short-term results of this trial revealing that higher-calorie refeeding (HCR) restored medical stability earlier, with no increase in safety events and significant savings associated with shorter length of stay, in comparison with lower-calorie refeeding (LCR) in hospitalized adolescents with anorexia nervosa. Here, we report the 1-year outcomes, including rates of clinical remission and rehospitalizations.
In this multicenter, randomized controlled trial, eligible patients admitted for medical instability to 2 tertiary care eating disorder programs were randomly assigned to HCR (2000 kcals per day, increasing by 200 kcals per day) or LCR (1400 kcals per day, increasing by 200 kcals every other day) within 24 hours of admission and followed-up at 10 days and 1, 3, 6, and 12 months post discharge. Clinical remission at 12 months post discharge was defined as weight restoration (≥95% median BMI) plus psychological recovery. With generalized linear mixed effect models, we examined differences in clinical remission over time.
Of 120 enrollees, 111 were included in modified intent-to-treat analyses, 60 received HCR, and 51 received LCR. Clinical remission rates changed over time in both groups, with no evidence of significant group differences ( = .42). Medical rehospitalization rates within 1-year post discharge (32.8% [19 of 58] vs 35.4% [17 of 48], = .84), number of rehospitalizations (2.4 [SD: 2.2] vs 2.0 [SD: 1.6]; = .52), and total number of days rehospitalized (6.0 [SD: 14.8] vs 5.1 [SD: 10.3] days; = .81) did not differ by HCR versus LCR.
The finding that clinical remission and medical rehospitalization did not differ over 1-year, in conjunction with the end-of-treatment outcomes, support the superior efficacy of HCR as compared with LCR.
我们最近报告了这项试验的短期结果，结果显示，与低热量喂养（LCR）相比，高热量喂养（HCR）更早地恢复了医学稳定性，安全性事件没有增加，并且与较短的住院时间相关，住院的神经性厌食症青少年的住院时间显著缩短。在这里，我们报告了 1 年的结果，包括临床缓解率和再住院率。
在这项多中心、随机对照试验中，符合条件的患者因医学不稳定而被收入 2 家三级护理饮食失调症项目，在入院后 24 小时内被随机分配到 HCR（每天 2000 卡路里，每天增加 200 卡路里）或 LCR（每天 1400 卡路里，每隔一天增加 200 卡路里），并在出院后 10 天和 1、3、6 和 12 个月进行随访。出院后 12 个月的临床缓解定义为体重恢复（≥95%中位数 BMI）加上心理恢复。使用广义线性混合效应模型，我们检查了不同时间的临床缓解差异。
在 120 名入组患者中，有 111 名患者进行了改良意向治疗分析，其中 60 名患者接受了 HCR，51 名患者接受了 LCR。两组的临床缓解率随时间发生变化，但没有证据表明存在显著的组间差异（=.42）。出院后 1 年内的医疗再住院率（32.8%[58 例中的 19 例] vs 35.4%[48 例中的 17 例]，=.84）、再住院次数（2.4[SD：2.2] vs 2.0[SD：1.6]，=.52）和再住院总天数（6.0[SD：14.8] vs 5.1[SD：10.3]天，=.81）在 HCR 与 LCR 之间没有差异。
治疗结束时的结果表明，1 年内临床缓解和医疗再住院率没有差异，支持 HCR 优于 LCR。
