Gastroenterology and Nutritional Rehabilitation Unit.
the Department of Neuroscience, Anorexia Nervosa and Eating Disorder Unit, Child Neuropsychiatry.
J Pediatr Gastroenterol Nutr. 2022 May 1;74(5):674-680. doi: 10.1097/MPG.0000000000003410.
In patients with Anorexia Nervosa (AN) malnutrition can lead to life-long nutritional treatments. The refeeding process can combine natural feeding (NF) with specific nutritional strategies, including oral nutritional supplements (ONS) and nasogastric feeding (NGF). Aims of the present study were to assess the efficacy of hospital protocol and identify the most effective inpatient nutritional strategies for weight restoration.
All patients hospitalized from April 2015 to April 2020 were enrolled. According to hospital protocol, NF was proposed to all patients; ONS were combined with NF if caloric intake was <70% of the requirements and NGF was added if caloric intake did not reach 30% in the first week from admission.
Overall, 186 patients [M = 20; median age 14 (interquartile range 1316)] were included. Nutritional issues were the main indication to admission (56.6%). A significant effect of combination treatment, with a shorter duration of hospitalization when using ONS with NGF in addition to NF was found (ß: -20.28 [95% confidence interval -34.92:-5.65], P < 0.001). Only one patient showed a significant but limited increase of liver enzymes.
We provide a safe and effective standardized protocol to treat the malnutrition of teenagers with AN in an inpatient setting. Malnutrition was the most important cause of admission, and more than half of the patients admitted were severely malnourished. The combination of NF, ONS, and NGF was the most effective strategy to achieve the weight restoration; however, this result should be validated on larger series of patients treated with NGF and NF.
在神经性厌食症（AN）患者中，营养不良可能导致终身营养治疗。再喂养过程可以将自然喂养（NF）与特定的营养策略相结合，包括口服营养补充（ONS）和鼻胃管喂养（NGF）。本研究的目的是评估医院方案的疗效，并确定恢复体重最有效的住院营养策略。
纳入 2015 年 4 月至 2020 年 4 月住院的所有患者。根据医院方案，向所有患者提出 NF；如果热量摄入低于需求的 70%，则将 ONS 与 NF 联合使用，如果入院后第一周热量摄入未达到 30%，则添加 NGF。
共纳入 186 例患者[M=20；中位数年龄 14 岁（四分位距 1316）]。营养问题是入院的主要指征（56.6%）。发现联合治疗有显著效果，与单独使用 NF 相比，同时使用 ONS 和 NGF 可缩短住院时间（β：-20.28[95%置信区间-34.92:-5.65]，P < 0.001）。只有 1 例患者出现肝酶显著但有限的升高。
我们提供了一种安全有效的标准化方案，用于在住院环境中治疗青少年 AN 的营养不良。营养不良是入院的最重要原因，超过一半的入院患者严重营养不良。NF、ONS 和 NGF 的联合是实现体重恢复的最有效策略；然而，这一结果需要在接受 NGF 和 NF 治疗的更大系列患者中进行验证。
