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Bendall C, Taylor NF. The effect of oral refeeding compared with nasogastric refeeding on the quality of care for patients hospitalised with an eating disorder: A systematic review. Nutr Diet 2023; 80:44-54. [PMID: 36254572 PMCID: PMC10092690 DOI: 10.1111/1747-0080.12770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/27/2022] [Accepted: 08/09/2022] [Indexed: 11/30/2022]
Abstract
AIM The aim of this systematic review was to compare the benefits and harms of nasogastric and oral-based refeeding on the quality of care, including effectiveness, safety, and patient experience, for patients hospitalised with an eating disorder. METHODS A systematic search for studies measuring comparative data between nasogastric and oral refeeding methods was conducted in August 2021. Title and abstracts and remaining full texts were screened by both authors. Risk of bias was evaluated using the PEDro scale, and overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation narrative synthesis. RESULTS Seven studies (one randomised controlled trial, five non-randomised studies of interventions, and one qualitative study) with 917 participants were included. There was low certainty evidence that nasogastric refeeding resulted in no difference or a small increase in weekly weight gain, and moderate certainty of greater total weight gain, and very low certainty of increased length of stay compared to oral refeeding. There was no difference or a small increase in discharge weight and body mass index with nasogastric refeeding compared to oral refeeding. No serious adverse events were reported. CONCLUSION Patients selected for nasogastric refeeding have a longer duration of illness and lower admission weight, making it difficult to determine which refeeding approach is superior. However, the lack of clear difference in weekly weight gain and the lack of reported harms suggests that other factors such as the normalisation of eating behaviour may be taken into account when choosing the most appropriate refeeding method.
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Affiliation(s)
- Cassandra Bendall
- School of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
- Department of Nutrition and DieteticsEastern HealthBox HillVictoriaAustralia
| | - Nicholas F. Taylor
- School of Allied Health, Human Services and SportLa Trobe UniversityMelbourneVictoriaAustralia
- Allied Health Clinical Research OfficeEastern HealthBox HillVictoriaAustralia
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Kan C, Hawkings YR, Cribben H, Treasure J. Length of stay for anorexia nervosa: Systematic review and meta-analysis. EUROPEAN EATING DISORDERS REVIEW 2021; 29:371-392. [PMID: 33548148 DOI: 10.1002/erv.2820] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 11/23/2020] [Accepted: 12/22/2020] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Evidence regarding global trends in length of stay for patients with anorexia nervosa is limited. The aim of this study is to conduct a meta-analysis examining the length of stay for anorexia nervosa patients globally, and to investigate moderators of the variance. METHOD Medline, EMBASE and PsycINFO were searched for studies published up to January 2019. Two independent reviewers assessed the eligibility of each report based on predefined inclusion criteria. A meta-analysis was performed to calculate a pooled mean length of stay using the random-effects model. Subgroup analyses and meta-regression were conducted to explore potential sources of heterogeneity between studies. RESULTS Of 305 abstracts reviewed, 71 studies met the inclusion criteria, generating 111 datasets. The pooled mean length of stay (95% confidence interval) was 76.3 days (73.3, 79.4) using the random-effects model, with marked variation across countries and time. Heterogeneity between studies was explained by age and admission body mass index. CONCLUSIONS This meta-analysis found that although clinical features do contribute to length of admissions for anorexia nervosa, there are also global and temporal variations. Future research should provide an in-depth analysis of why and how this variation exists and what the impact is on the well-being of people with anorexia nervosa.
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Affiliation(s)
- Carol Kan
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Hannah Cribben
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Janet Treasure
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Jeffrey S, Heruc G. Balancing nutrition management and the role of dietitians in eating disorder treatment. J Eat Disord 2020; 8:64. [PMID: 33292567 PMCID: PMC7672860 DOI: 10.1186/s40337-020-00344-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
The symptoms of starvation and dietary restriction are often the subject of targeted intervention in evidence-based treatments across eating disorder diagnoses and treatment models. Despite the level of attention given to these symptoms of clinical malnutrition, they are often treated by health professionals with no nutritional qualifications and in a non-clinical manner in the outpatient setting, with dietitians having no defined role in manualised treatment models. Recently the Australia & New Zealand Academy for Eating Disorders (ANZAED) published practice and training standards for dietitians to help characterise their role in eating disorder treatment. Since malnutrition, secondary to dietary restriction, is a clinically significant nutritional diagnosis that co-occurs in eating disorder presentations, this commentary proposes that dietitians are ideally-positioned to assess and advise on the clinical aspects of malnutrition as a key member of the multidisciplinary team. Food is a central focus in eating disorder treatment, suggesting that nutritional care needs to be addressed by a dietitian alongside the psychological aspects of care that are addressed by a mental health professional.
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Affiliation(s)
- Shane Jeffrey
- Executive Committee, Australia & New Zealand Academy for Eating Disorders, Sydney, Australia
- River Oak Health, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Gabriella Heruc
- Executive Committee, Australia & New Zealand Academy for Eating Disorders, Sydney, Australia.
- School of Medicine, Western Sydney University, Campbelltown, Australia.
- Eating Disorder Service, Northern Sydney Local Health District, Sydney, Australia.
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Ante Z, Luu TM, Healy-Profitós J, He S, Taddeo D, Lo E, Auger N. Pregnancy outcomes in women with anorexia nervosa. Int J Eat Disord 2020; 53:403-412. [PMID: 32100355 DOI: 10.1002/eat.23251] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/10/2020] [Accepted: 02/11/2020] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Birth outcomes of women with anorexia nervosa are poorly understood. We hypothesized that hospitalization for anorexia nervosa before or during pregnancy is associated with an elevated risk of adverse maternal and infant birth outcomes. METHOD We performed a retrospective cohort study of 2,134,945 pregnancies in Quebec, Canada, from 1989 to 2016. The main exposure measure was anorexia nervosa requiring hospital treatment before or during pregnancy. Outcome measures included stillbirth, preterm birth, low birth weight, small-for-gestational age birth, preeclampsia, gestational diabetes, cesarean delivery, and other pregnancy disorders. We computed risk ratios and 95% confidence intervals (CI) for the association between anorexia nervosa and birth outcomes adjusted for maternal characteristics. RESULTS Compared with no hospitalization, anorexia nervosa hospitalization was associated with 1.99 times the risk of stillbirth (95% CI 1.20-3.30), 1.32 times the risk of preterm birth (95% CI 1.13-1.55), 1.69 times the risk of low birth weight (95% CI 1.44-1.99), and 1.52 times the risk of small-for-gestational age birth (95% CI 1.35-1.72). The associations with low birth weight and small-for-gestational age birth were more prominent in women hospitalized for anorexia nervosa during pregnancy or within 2 years of delivery. Hospitalization for anorexia nervosa was associated with certain maternal outcomes, including precipitate labor, acute liver failure, and admission to an intensive care unit. DISCUSSION Hospitalization for anorexia nervosa before or during pregnancy is associated with adverse infant and maternal outcomes. Infants are primarily at risk of stillbirth, preterm birth, low birth weight, and small-for-gestational age birth.
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Affiliation(s)
- Zharmaine Ante
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Thuy Mai Luu
- Department of Pediatrics, Sainte-Justine University Hospital Centre, University of Montreal, Montreal, Quebec, Canada
| | - Jessica Healy-Profitós
- Institut national de santé publique du Québec, Montreal, Quebec, Canada.,University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Siyi He
- Institut national de santé publique du Québec, Montreal, Quebec, Canada.,University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Danielle Taddeo
- Department of Adolescent Medicine - Eating Disorders, Sainte-Justine University Hospital Centre, University of Montreal, Montreal, Quebec, Canada
| | - Ernest Lo
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Nathalie Auger
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada.,Institut national de santé publique du Québec, Montreal, Quebec, Canada.,University of Montreal Hospital Research Centre, Montreal, Quebec, Canada.,School of Public Health, University of Montreal, Montreal, Quebec, Canada
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The use of enteral nutrition in the treatment of eating disorders: a systematic review. Eat Weight Disord 2019; 24:179-198. [PMID: 30196528 DOI: 10.1007/s40519-018-0572-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/27/2018] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Enteral nutrition (EN) is frequently used in the treatment of anorexia nervosa (AN), and less commonly, bulimia nervosa (BN); yet, no standardized guidelines for treatment exist at this time. The aim of this review is to investigate the efficacy of EN in the treatment of eating disorders and make recommendations for clinical practice and future research. METHODS An exhaustive literature search of 7 databases was completed. The search strategy combined key terms anorexia nervosa, bulimia, and eating disorders with terms associated with EN. There were no restrictions on publication date or language. Studies that assessed the effect of EN on weight restoration, refeeding syndrome, and binge/purge behaviors in the treatment of AN and BN were included. RESULTS Of 73 full-text articles reviewed, 22 met inclusion criteria. Nineteen studies reported that significant short-term weight gain was achieved when EN was used for refeeding malnourished AN patients; however, results varied for the six studies reporting on long-term weight gain, maintenance, and recovery. In studies with a comparator, no significant differences were found between the EN and oral refeeding cohorts regarding gastrointestinal disturbance, refeeding syndrome, or electrolyte abnormalities. Five studies examined the effect of EN on binge/purge behaviors, suggesting that temporary exclusive EN decreases the frequency and severity of binge/purge episodes. CONCLUSION Although EN is an essential life-saving treatment in severe cases of AN, it does not guarantee long-term success or recovery. The results of this systematic review highlight the need for prospective controlled trials with adequate sample sizes to make comparisons between specific feeding methods, formulations, and defined short and long-term outcomes. Evidence-based standards for clinical practice are needed with specific guidelines for best results for AN and BN treatment. LEVEL OF EVIDENCE I, systematic review.
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Kells M, Kelly-Weeder S. Nasogastric Tube Feeding for Individuals With Anorexia Nervosa: An Integrative Review. J Am Psychiatr Nurses Assoc 2016; 22:449-468. [PMID: 27519612 DOI: 10.1177/1078390316657872] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The use of nasogastric (NG) feeding in individuals with anorexia nervosa (AN) is endorsed by national professional organizations; however, no guidelines currently exist. OBJECTIVES The objectives of this review were to identify and evaluate outcomes of NG feedings for individuals with AN and to develop recommendations for future research, policy, and practice. DESIGN An integrative review of the research literature was conducted. RESULTS Of the 19 studies reviewed, all indicated short-term weight gain following NG feeding. Four studies examined adherence; nearly 30% of subjects were nonadherent as evidenced by tube manipulation. Seven studies reported psychiatric outcomes, suggesting NG feeding reduces eating disorder behaviors but not overall symptomology. CONCLUSIONS NG feeding promotes short-term weight gain; however, long-term outcomes are poorly understood. Future research, using rigorous methods, is still needed to inform practice.
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Affiliation(s)
- Meredith Kells
- Meredith Kells, MSN, RN, CPNP, Boston College, Chestnut Hill, MA, USA; Boston Children's Hospital, Boston MA, USA
| | - Susan Kelly-Weeder
- Susan Kelly-Weeder, PhD, FNP-BC, FAANP, Boston College, Chestnut Hill, MA, USA
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Nutrition entérale à domicile en cas de troubles du comportement alimentaire. NUTR CLIN METAB 2013. [DOI: 10.1016/j.nupar.2013.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Hart S, Franklin RC, Russell J, Abraham S. A review of feeding methods used in the treatment of anorexia nervosa. J Eat Disord 2013; 1:36. [PMID: 24999415 PMCID: PMC4081821 DOI: 10.1186/2050-2974-1-36] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 07/26/2013] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Clear evidence based guidelines on the best and safest method of achieving and maintaining normal body weight during inpatient treatment of Anorexia Nervosa (AN) are currently not available. Oral feeding with food alone, high-energy liquid supplements, nasogastric feeding and parenteral nutrition all have the potential to achieve weight gain in the treatment of AN but the advantages and disadvantages of each method have not been comprehensively evaluated. A literature search was undertaken to identify papers describing feeding methods used during inpatient treatment of AN. The selection criteria searched for papers that described the feeding method; and reported weight change variables such as admission and discharge weight in kilograms, or Body Mass Index; or weight change over the course of inpatient treatment. RESULTS Twenty-six papers were identified, describing a total of 37 samples with a mean sample size of 58.9 participants, and a range from 6 to 318. The majority (84.6%) of papers were observational cohorts and retrospective chart reviews. The most common feeding method described was nasogastric feeding and food, then high-energy liquid supplements and food. CONCLUSIONS There is limited evidence on the efficacy of feeding methods used in the refeeding and nutritional rehabilitation of AN, therefore no conclusion can be made about the most effective method of achieving weight gain during inpatient treatment. While there are a number of papers exploring this issue there is no consistency in the way the information is reported to enable comparisons between the different methods. There is an urgent need for research in this area to guide decision-making in the inpatient management, refeeding and nutritional rehabilitation of AN.
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Affiliation(s)
- Susan Hart
- Department of Psychiatry, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Richard C Franklin
- School of Public Health, Tropical Medicine and Rehabilitation Sciences, James Cook University, Townsville, QLD 4811, Australia
| | - Janice Russell
- Department of Psychiatry, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, The University of Sydney, Camperdown, NSW 2006, Australia
- Northside Clinic Eating Disorder Program, Greenwich, NSW 2065, Australia
| | - Suzanne Abraham
- Northside Clinic Eating Disorder Program, Greenwich, NSW 2065, Australia
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards 2065, NSW, Australia
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Simon W, Lambert MJ, Busath G, Vazquez A, Berkeljon A, Hyer K, Granley M, Berrett M. Effects of providing patient progress feedback and clinical support tools to psychotherapists in an inpatient eating disorders treatment program: A randomized controlled study. Psychother Res 2013; 23:287-300. [DOI: 10.1080/10503307.2013.787497] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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10
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Higgins J, Hagman J, Pan Z, MacLean P. Increased physical activity not decreased energy intake is associated with inpatient medical treatment for anorexia nervosa in adolescent females. PLoS One 2013; 8:e61559. [PMID: 23637854 PMCID: PMC3630220 DOI: 10.1371/journal.pone.0061559] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 03/11/2013] [Indexed: 11/18/2022] Open
Abstract
There is a dearth of data regarding changes in dietary intake and physical activity over time that lead to inpatient medical treatment for anorexia nervosa (AN). Without such data, more effective nutritional therapies for patients cannot be devised. This study was undertaken to describe changes in diet and physical activity that precede inpatient medical hospitalization for AN in female adolescents. This data can be used to understand factors contributing to medical instability in AN, and may advance rodent models of AN to investigate novel weight restoration strategies. It was hypothesized that hospitalization for AN would be associated with progressive energy restriction and increased physical activity over time. 20 females, 11–19 years (14.3±1.8 years), with restricting type AN, completed retrospective, self-report questionnaires to assess dietary intake and physical activity over the 6 month period prior to inpatient admission (food frequency questionnaire, Pediatric physical activity recall) and 1 week prior (24 hour food recall, modifiable activity questionnaire). Physical activity increased acutely prior to inpatient admission without any change in energy or macronutrient intake. However, there were significant changes in reported micronutrient intake causing inadequate intake of Vitamin A, Vitamin D, and pantothenic acid at 1 week versus high, potentially harmful, intake of Vitamin A over 6 months prior to admission. Subject report of significantly increased physical activity, not decreased energy intake, were associated with medical hospitalization for AN. Physical activity and Vitamin A and D intake should be carefully monitored following initial AN diagnosis, as markers of disease progression as to potentially minimize the risk of medical instability.
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Affiliation(s)
- Janine Higgins
- School of Medicine, Department of Pediatrics, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA.
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Holm JS, Brixen K, Andries A, Hørder K, Støving RK. Reflections on involuntary treatment in the prevention of fatal anorexia nervosa: a review of five cases. Int J Eat Disord 2012; 45:93-100. [PMID: 21344467 DOI: 10.1002/eat.20915] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/26/2010] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Involuntary treatment in the prevention of fatal anorexia nervosa (AN) is still controversial. METHOD Five fatal cases of AN were identified out of 1,160 patients who attended a specialized eating disorder unit between 1994 and 2006. Information on inpatient, ambulatory, and emergency room treatment was extracted from a population-based registration system. RESULTS Personality disorders were diagnosed in all five patients and substance abuse in three patients. In all cases, illness duration was more than 10 years and late onset was seen in two cases. None of the deaths were due to suicide. Involuntary hospital admission was instituted for three patients, but only one patient was compulsory detained more than once. Four patients died after having discontinued treatment. DISCUSSION Compulsory treatment may be of crucial importance in the prevention of fatalities in patients with long-standing AN and psychiatric comorbidity who discontinue treatment.
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Affiliation(s)
- Janni Schmidt Holm
- Department of Endocrinology, Center for Eating Disorders, Odense University Hospital, Denmark
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Specialized refeeding treatment for anorexia nervosa patients suffering from extreme undernutrition. Clin Nutr 2010; 29:627-32. [DOI: 10.1016/j.clnu.2010.03.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Revised: 03/16/2010] [Accepted: 03/17/2010] [Indexed: 01/15/2023]
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