Nagata Jason M, Nguyen Anthony, Vargas Ruben, Downey Amanda E, Chaphekar Anita V, Ganson Kyle T, Buckelew Sara M, Garber Andrea K
Department of Pediatrics, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA.
Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 550 16th Street, 4th Floor, Box 0503, San Francisco, CA, 94143, USA.
J Eat Disord. 2024 May 24;12(1):67. doi: 10.1186/s40337-024-01012-0.
Refeeding syndrome is the gravest possible medical complication in malnourished patients undergoing refeeding in the hospital. We previously reported that males with malnutrition secondary to eating disorders required more calories and had longer hospital stays than females; however, sex differences in electrolyte abnormalities indicating refeeding syndrome risk remain unknown. The objective of this study was to assess differences in electrolyte abnormalities indicating refeeding syndrome risk among male and female adolescents and young adults with eating disorders hospitalized for medical instability.
We retrospectively reviewed the electronic medical records of 558 patients aged 9-25 years admitted to the University of California, San Francisco Eating Disorders Program for medical instability between May 2012 and August 2020. Serum was drawn per standard of care between 5 and 7 am each morning and electrolyte abnormalities indicating refeeding syndrome risk were defined as: hypophosphatemia (< 3.0 mg/dL), hypokalemia (< 3.5 mEq/L), and hypomagnesemia (< 1.8 mg/dL). Logistic regression was used to assess factors associated with electrolyte abnormalities indicating refeeding syndrome risk.
Participants included 86 (15.4%) males and 472 (84.6%) females, mean (SD) age 15.5 (2.8) years. Rates of refeeding hypophosphatemia (3.5%), hypokalemia (8.1%), and hypomagnesemia (11.6%) in males hospitalized with eating disorders were low, with no statistically significant differences from females. Older age was associated with higher odds of refeeding hypophosphatemia and hypomagnesemia. Lower percent median body mass index and greater weight suppression at admission were associated with higher odds of refeeding hypophosphatemia.
Rates of electrolyte abnormalities indicating refeeding syndrome risk were low in males hospitalized for eating disorders and rates did not significantly differ from females. Together with our finding that males have higher caloric requirements and longer hospital length of stay, the finding that electrolyte abnormalities indicating refeeding syndrome risk were not greater in males than females supports future research to evaluate the safety and efficacy of higher calorie and/or faster advancing refeeding protocols for males.
再喂养综合征是医院中接受再喂养的营养不良患者可能出现的最严重的医学并发症。我们之前报道过，因饮食失调导致营养不良的男性比女性需要更多热量，住院时间也更长；然而，提示再喂养综合征风险的电解质异常方面的性别差异仍不清楚。本研究的目的是评估因医疗不稳定而住院的患有饮食失调的青少年和年轻成年人中，提示再喂养综合征风险的电解质异常在男性和女性之间的差异。
我们回顾性分析了2012年5月至2020年8月期间因医疗不稳定入住加利福尼亚大学旧金山分校饮食失调项目的558例9至25岁患者的电子病历。每天早上5点至7点按照标准护理程序采集血清，提示再喂养综合征风险的电解质异常定义为：低磷血症（<3.0mg/dL）、低钾血症（<3.5mEq/L）和低镁血症（<1.8mg/dL）。采用逻辑回归分析评估与提示再喂养综合征风险的电解质异常相关的因素。
参与者包括86名（15.4%）男性和472名（84.6%）女性，平均（标准差）年龄15.5（2.8）岁。因饮食失调住院的男性中，再喂养低磷血症（3.5%）、低钾血症（8.1%）和低镁血症（11.6%）的发生率较低，与女性相比无统计学显著差异。年龄较大与再喂养低磷血症和低镁血症的较高几率相关。入院时较低的中位体重指数百分比和更大程度的体重抑制与再喂养低磷血症的较高几率相关。
因饮食失调住院的男性中提示再喂养综合征风险的电解质异常发生率较低，且与女性无显著差异。连同我们发现男性有更高的热量需求和更长的住院时间这一结果，提示再喂养综合征风险的电解质异常在男性中并不高于女性这一发现支持未来开展研究以评估针对男性的更高热量和/或更快推进的再喂养方案的安全性和有效性。
