Mosuka Emmanuel M, Murugan Anushree, Thakral Abhinav, Ngomo Mbelle C, Budhiraja Sushil, St Victor Rosemarie
Pediatrics, Brookdale University Hospital Medical Center, New York, USA.
Medicine, Université de Yaoundé, Faculté de Médecine et des Sciences Biomédicales, Yaoundé, CMR.
Cureus. 2023 May 21;15(5):e39313. doi: 10.7759/cureus.39313. eCollection 2023 May.
Over the years, the standard of care for re-alimentation of patients admitted for the treatment of anorexia nervosa (AN) has been a conservative or cautious approach described as "start low and go slow." These traditional refeeding protocols advocate for a low-calorie diet that restricts carbohydrates, with the primary goal of hypothetically lowering the risk of refeeding syndrome (RFS) and its complication. However, no consensus exists for the optimal inpatient approach to refeeding children and adolescents with AN. There is still some disagreement about what constitutes an ideal pace for nutritional rehabilitation. Varying treatment protocols have emerged across the globe, often reflecting the preferences and biases of individual practitioners and contributing to the lack of a universally accepted protocol for refeeding in AN. Although it is widely accepted that low-caloric refeeding (LCR) is safe for inpatient treatment of AN, this strategy has been shown to have several significant drawbacks, leading to increased criticism of the LCR method. Research from the last decade has led to calls for a more aggressive refeeding protocol, one that suggests a higher caloric intake from the offset. As a result, this research aimed to conduct a systematic review of the existing literature on strategies for refeeding hospitalized pediatric/adolescent patients with AN and related eating disorders. We aimed to compare high-caloric refeeding (HCR) and LCR in terms of weight gain, length of stay, and risk of RFS. We conducted a thorough search of medical databases for abstracts published in English, including Google Scholar, PubMed, and MEDLINE, to find relevant studies published between 2010 and February 2023. Our focus was on articles that evaluated high versus low refeeding protocols in children and adolescents hospitalized for treating AN and related eating disorders. Only articles that reported on at least one of the outcome variables of interest, such as hypophosphatemia, weight gain, RFS, or length of hospital stay, were considered. This review included 20 full-text articles published in the last decade on the HCR protocol in children and adolescents, with a total sample size of 2191 participants. In only one of the 20 studies did researchers find evidence of a true clinical case of RFS. We, therefore, found no evidence that HCR increased the risk of RFS in adolescents, even in those with a very low body mass index (BMI). However, evidence suggests a lower BMI at the time of hospital admission is a better predictor of hypophosphatemia than total caloric intake. In conclusion, based on the evidence from this review, a high-caloric diet or rapid refeeding in children/adolescents suffering from AN may be both safe and effective, with serial laboratory investigations and phosphate supplementation as needed. Hence, more research, particularly, randomized controlled trials, is required to help shape an evidence-based refeeding guideline outlining target calorie intakes and rates of advancement to assist clinicians in the treatment of adolescents with AN and related eating disorders.
多年来，神经性厌食症（AN）住院患者重新进食的护理标准一直是一种保守或谨慎的方法，即“从低开始，慢慢来”。这些传统的重新进食方案提倡低热量饮食，限制碳水化合物摄入，其主要目标是理论上降低重新进食综合征（RFS）及其并发症的风险。然而，对于为患有AN的儿童和青少年进行重新进食的最佳住院治疗方法，目前尚无共识。对于什么构成营养康复的理想速度，仍然存在一些分歧。全球出现了各种不同的治疗方案，这往往反映了个体从业者的偏好和偏见，导致缺乏一种普遍接受的AN重新进食方案。尽管人们普遍认为低热量重新进食（LCR）对AN的住院治疗是安全的，但这种策略已被证明有几个重大缺点，导致对LCR方法的批评增加。过去十年的研究呼吁采用更积极的重新进食方案，即从一开始就建议摄入更高的热量。因此，本研究旨在对现有关于为患有AN和相关饮食失调的住院儿科/青少年患者重新进食策略的文献进行系统综述。我们旨在比较高热量重新进食（HCR）和LCR在体重增加、住院时间和RFS风险方面的差异。我们对医学数据库进行了全面搜索，以查找2010年至2023年2月期间发表的英文摘要，包括谷歌学术、PubMed和MEDLINE，以找到相关研究。我们关注的是评估为治疗AN和相关饮食失调而住院的儿童和青少年中高重新进食方案与低重新进食方案的文章。只有报告了至少一个感兴趣的结果变量（如低磷血症、体重增加、RFS或住院时间）的文章才被考虑。本综述包括过去十年发表的20篇关于儿童和青少年HCR方案的全文文章，总样本量为2191名参与者。在这20项研究中，只有一项研究发现了RFS真正临床病例的证据。因此，我们没有发现证据表明HCR会增加青少年患RFS的风险，即使是那些体重指数（BMI）非常低的青少年。然而，有证据表明，入院时较低的BMI比总热量摄入更能预测低磷血症。总之，基于本综述的证据，对于患有AN的儿童/青少年，高热量饮食或快速重新进食可能既安全又有效，并根据需要进行系列实验室检查和补充磷酸盐。因此，需要更多的研究，特别是随机对照试验，以帮助制定基于证据的重新进食指南，概述目标热量摄入量和进展速度，以协助临床医生治疗患有AN和相关饮食失调的青少年。
