基于医院的高卡路里喂养和青少年及年轻成人神经性厌食或非典型神经性厌食的进餐困扰。
Hospital-based higher calorie refeeding and mealtime distress in adolescents and young adults with anorexia nervosa or atypical anorexia nervosa.
机构信息
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.
Department of Preventive & Restorative Dental Sciences, University of California, San Francisco, California, USA.
出版信息
Int J Eat Disord. 2023 Jun;56(6):1219-1227. doi: 10.1002/eat.23931. Epub 2023 Mar 15.
OBJECTIVE
The StRONG study demonstrated that higher calorie refeeding (HCR) restored medical stability faster in patients hospitalized with anorexia nervosa (AN) and atypical AN (AAN), with no increased safety events compared with standard-of-care lower calorie refeeding (LCR). However, some clinicians have expressed concern about potential unintended consequences of HCR (e.g., greater mealtime distress). The purpose of this study was to examine patient treatment preference and compare mealtime distress, food refusal, and affective states between treatments.
METHOD
Participants (N = 111) in this multisite randomized clinical trial were ages 12-24 years, with AN or AAN, admitted to hospital with medical instability who received assigned study treatment (HCR or LCR). Treatment preference was assessed prior to randomization in the full sample. In a subset of participants (n = 45), linear mixed effect models were used to analyze momentary ratings of mealtime distress (pre, during, and post-meals) and daily affective state during the hospitalization.
RESULTS
About half (55%) of participants reported a preference for LCR. Treatment assignment was not associated with food refusal, mealtime distress, or affective states in the subsample. Food refusal increased significantly over the course of refeeding (p = .018). Individuals with greater depression experienced more negative affect (p = .033), with worsening negative affect over time for individuals with higher eating disorder psychopathology (p = .023).
DISCUSSION
Despite understandable concerns about potential unintended consequences of HCR, we found no evidence that treatment acceptability for HCR differed from LCR for adolescents and young adults with AN and AAN.
PUBLIC SIGNIFICANCE
The efficacy and safety of higher calorie refeeding in hospitalized patients with anorexia nervosa has been demonstrated. However, it is not known whether higher calorie refeeding (HCR) increases meal-time distress. This study demonstrated that HCR was not associated with increased mealtime distress, food refusal, or affective states, as compared with lower calorie refeeding. These data support HCR treatment acceptability for adolescents/young adults with anorexia nervosa and atypical anorexia nervosa.
目的
STRONG 研究表明，与标准低热量喂养（LCR）相比，高卡路里喂养（HCR）能更快地恢复神经性厌食症（AN）和非典型 AN（AAN）住院患者的医疗稳定性，且不会增加安全性事件。然而，一些临床医生对 HCR 的潜在意外后果表示担忧（例如，增加用餐时的不适）。本研究旨在检查患者的治疗偏好，并比较两种治疗方法的用餐时不适、拒食和情绪状态。
方法
这项多中心随机临床试验的参与者（N=111）年龄在 12-24 岁之间，患有 AN 或 AAN，因医疗不稳定而住院，接受指定的研究治疗（HCR 或 LCR）。在全样本中，在随机分组前评估了治疗偏好。在部分参与者（n=45）中，使用线性混合效应模型分析了住院期间用餐时的不适（餐前、餐中和餐后）和每日情绪状态的即时评分。
结果
约一半（55%）的参与者表示更喜欢 LCR。在亚组中，治疗分配与拒食、用餐时不适或情绪状态无关。随着喂养的进行，拒食显著增加（p=0.018）。抑郁程度较高的个体情绪较消极（p=0.033），且进食障碍心理病理程度较高的个体情绪随时间恶化（p=0.023）。
讨论
尽管对 HCR 的潜在意外后果存在担忧，但我们没有发现接受 HCR 治疗的可接受性与接受 LCR 治疗的可接受性在 AN 和 AAN 青少年和年轻人中存在差异的证据。
意义
在住院的神经性厌食症患者中，高卡路里喂养的疗效和安全性已经得到证实。然而，高卡路里喂养（HCR）是否会增加用餐时的不适尚不清楚。这项研究表明，与低卡路里喂养相比，HCR 并不会增加用餐时的不适、拒食或情绪状态。这些数据支持 HCR 治疗在患有神经性厌食症和非典型神经性厌食症的青少年/年轻人中的可接受性。
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