1
|
Robertson N, Davies L. The experiences of a therapeutic relationship between dietitians and patients in UK eating disorder treatment: A qualitative study. EUROPEAN EATING DISORDERS REVIEW 2024. [PMID: 38890773 DOI: 10.1002/erv.3117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/05/2024] [Accepted: 06/02/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE Dietitians have a central role in eating disorder (ED) treatment, however few studies exist investigating therapeutic aspects of dietetic care and factors influencing the dietitian-patient relationship. To address the gap, this study aimed to use a qualitative description approach to explore the experiences of delivering and receiving dietetic care in ED treatment in the UK. METHOD Semi-structured interviews were conducted with 6 specialist ED dietitians and focus groups with 11 recovered ED patients. Interviews were transcribed and inductive thematic analysis was performed to identify key themes describing the data. RESULTS Six key themes were generated: (1) Building trust, (2) Appropriate timing, (3) Adapting, (4) Dietitians as experts, (5) Boundaries, and (6) Difficult relationships. Participants highlighted the importance of building trust and considering nutritional risk and readiness in treatment approach. Patients expressed a desire for dietitians to have experience in EDs, facilitating understanding of their illness. However, dietitians identified the nature of EDs making their role challenging at times. DISCUSSION This study described various factors affecting dietetic care in EDs and provided a valuable insight into patients' perceptions of treatment. The findings support advancements in ED dietitians' knowledge and understanding, helping to enhance quality of care.
Collapse
Affiliation(s)
- Nicole Robertson
- Department of Clinical Sciences and Nutrition, University of Chester, Chester, UK
- Department of Nutrition and Dietetics, East Lancashire Hospitals NHS Trust, Blackburn, UK
| | - Luke Davies
- Department of Clinical Sciences and Nutrition, University of Chester, Chester, UK
| |
Collapse
|
2
|
Morgan K, Cutmore C, Matthews-Rensch K. Adding mini meals to a nasogastric refeeding protocol for patients with eating disorders can be achieved on general hospital wards. J Hum Nutr Diet 2023; 36:1207-1213. [PMID: 36945998 DOI: 10.1111/jhn.13170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 03/19/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Treatment of medically compromised patients with eating disorders is difficult in general hospital wards. There is currently no consensus on the best feeding method; however, previous research has demonstrated the safety of using enteral feeding. Because an oral diet has benefits on psychological and behavioural pathways, concurrent feeding requires further investigation. The present study aimed to examine acceptability and safety of implementing mini meals to a previously nil-by-mouth 7-day enteral feeding protocol. METHODS This was mixed methods research including a retrospective observational study and participant survey. Patients admitted to a tertiary hospital in Brisbane, Australia, between July 2020 and March 2021 were eligible. Eligible participants were provided mini meals from day 5. Type and quantity of meals consumed alongside clinical incident data were collected. The survey examined acceptability of mini meals. Descriptive statistics were used to interpret findings. Content analyses were conducted on survey responses. RESULTS Sixty-four participants (95%, n = 57/60 female, 25.2 ± 8.9 years; 75%, n = 45/60 diagnosed with anorexia nervosa) were included. At least half of the participants consumed some or all of the mini meals at each meal period. No clinical incidents were reported. Twenty-six (50%, n = 26/52) surveys were returned. Half (54%, n = 14/26) agreed-strongly agreed that mini meals improved their experience. Eleven participants desired more choice in menu items. CONCLUSIONS The present study found that introducing mini meals into an enteral feeding protocol is acceptable and safe for patients with eating disorders. Participants reported benefits in returning to eating; however, some items on the menu require reconsideration to enable increased consumption.
Collapse
Affiliation(s)
- Kate Morgan
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Clare Cutmore
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Kylie Matthews-Rensch
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
- Eating disorders and Nutrition Research Group 'ENRG', Western Sydney University, Sydney, Australia
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Matthews-Rensch K, Young A, Cutmore C, Davis A, Jeffrey S, Patterson S. Acceptability of using a nasogastric refeeding protocol with adult patients with medically unstable eating disorders. J Eval Clin Pract 2023; 29:49-58. [PMID: 35700213 DOI: 10.1111/jep.13718] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 01/18/2023]
Abstract
RATIONALE, AIMS AND OBJECTIVES Nasogastric feeding is becoming commonly used to support patients with medically compromised eating disorders. Previous research has demonstrated the safety of this approach, however there is limited evidence as to how adult patients and staff perceive this feeding method. This study aimed to describe the acceptability of a nasogastric refeeding protocol with adult patients with medically unstable eating disorders and the staff involved in their treatment. METHOD This was a qualitative exploratory study using semi-structured interviews conducted in acute medical wards of a tertiary hospital where nasogastric nutrition is the sole source of nutrition for the first 7 days of the eating disorder admission. Data were analysed using the Framework method. RESULTS Eight patients (100% female, median: 22 years old, n = 6 diagnosed with anorexia nervosa) and 12 staff members (medical n = 5, nursing n = 5, dietitians n = 2; median: 8.5 years clinical experience) were interviewed. Patients reported that nasogastric feeding was tolerable, however concerns were raised regarding communication and the desire for concurrent oral feeding. Acceptability from staff was influenced by perceived competence, confidence, tensions around patient-centred care, and working with stigma and ambivalence. CONCLUSIONS Consideration needs to be given as to whether a 'nil by mouth' status during nasogastric feeding further impacts recommencing an oral diet to progress treatment. Improvements are required within the current service, including improved communication, additional educational resources for patients, and allowing patients to partake in decision-making as able.
Collapse
Affiliation(s)
- Kylie Matthews-Rensch
- Nutrition and Dietetics, Royal Brisbane Women's Hospital, Herston, Queensland, Australia
| | - Adrienne Young
- Nutrition and Dietetics, Royal Brisbane Women's Hospital, Herston, Queensland, Australia
| | - Clare Cutmore
- Nutrition and Dietetics, Royal Brisbane Women's Hospital, Herston, Queensland, Australia
| | - Amanda Davis
- Queensland Eating Disorder Service, Metro North, Queensland, Australia
| | - Shane Jeffrey
- Metro North Mental Health Metro North Hospital and Health Service, Herston, Queensland, Australia
| | - Susan Patterson
- Metro North Mental Health Metro North Hospital and Health Service, Herston, Queensland, Australia
| |
Collapse
|
5
|
Elran-Barak R, Lewis YD, Schifter T. Women's perspectives toward their nutritional counseling for eating disorders: a qualitative internet-based study in Israel. Health Care Women Int 2021; 43:219-238. [PMID: 34403324 DOI: 10.1080/07399332.2021.1917580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Nutritional counseling is a central part of eating disorder (ED) treatment. However, the nature of this treatment has not yet been described from women's perspectives. We conducted two studies exploring views of women regarding their ED nutritional counseling. In the first study, we used content analysis to reveal practices that registered dietitians (RDs) use in ED treatment. In the second study, we used phenomenological analysis to explore the nature of the client-dietitian collaboration. Data included 1,897 posts and 8,673 responses from 414 distinct female users, retrieved from a moderated ED Internet community website in Israel. Content analysis demonstrated six practices used by RDs: meal planning, weight monitoring, health assessment/consultation, establishing rapports, food logs, joint eating. Phenomenological analysis produced four positions demonstrating client-dietitian collaborations: "Silent dialogue," "Cancelation and deception," "Tough love," "Containment." Findings revealed women's efforts to continue treatment despite their ambivalence about goals and recovery, and RDs' efforts to help women, despite the women's ambivalence, to move forward toward recovery.
Collapse
Affiliation(s)
| | - Yael Doreen Lewis
- Shalvata Mental Health Center, Hod Hasharon, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tami Schifter
- Gertner Institute for Epidemiology and Health Policy Research, Ramat Gan, Israel
| |
Collapse
|
6
|
Medication in AN: A Multidisciplinary Overview of Meta-Analyses and Systematic Reviews. J Clin Med 2019; 8:jcm8020278. [PMID: 30823566 PMCID: PMC6406645 DOI: 10.3390/jcm8020278] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 12/12/2022] Open
Abstract
Drugs are widely prescribed for anorexia nervosa in the nutritional, somatic, and psychiatric fields. There is no systematic overview in the literature, which simultaneously covers all these types of medication. The main aims of this paper are (1) to offer clinicians an overview of the evidence-based data in the literature concerning the medication (psychotropic drugs and medication for somatic and nutritional complications) in the field of anorexia nervosa since the 1960s, (2) to draw practical conclusions for everyday practise and future research. Searches were performed on three online databases, namely MEDLINE, Epistemonikos and Web of Science. Papers published between September 2011 and January 2019 were considered. Evidence-based data were identified from meta-analyses, if there were none, from systematic reviews, and otherwise from trials (randomized or if not open-label studies). Evidence-based results are scarce. No psychotropic medication has proved efficacious in terms of weight gain, and there is only weak data suggesting it can alleviate certain psychiatric symptoms. Concerning nutritional and somatic conditions, while there is no specific, approved medication, it seems essential not to neglect the interest of innovative therapeutic strategies to treat multi-organic comorbidities. In the final section we discuss how to use these medications in the overall approach to the treatment of anorexia nervosa.
Collapse
|
7
|
Lackner S, Mörkl S, Müller W, Fürhapter-Rieger A, Oberascher A, Lehofer M, Bieberger C, Wonisch W, Amouzadeh-Ghadikolai O, Moser M, Mangge H, Zelzer S, Holasek SJ. Novel approaches for the assessment of relative body weight and body fat in diagnosis and treatment of anorexia nervosa: A cross-sectional study. Clin Nutr 2019; 38:2913-2921. [PMID: 30670293 DOI: 10.1016/j.clnu.2018.12.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 10/26/2018] [Accepted: 12/21/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Anorexia nervosa (AN) is a severe psychosomatic disease that seriously affects nutritional status. Therapeutic approaches primarily aim for rapid weight restoration by high caloric diets and activity restriction. This often promotes abdominal body fat gain, which potentially negatively influences the patient's compliance and increases the risk of relapse. This study focused on the evaluation of body weight and subcutaneous adipose tissue (SAT) in AN patients by novel approaches. METHODS The SAT of AN patients (n = 18, body mass index (BMI) 15.3 ± 1.3 kg/m2) was determined by a highly accurate and reliable ultrasound method. The sum of SAT thicknesses of eight sites (DINCL) was calculated. Individual metabolic profiles were analyzed. The mass index (MI), which considers body proportions, was used in addition to BMI. Additional to the standard laboratory diagnostics, dermal carotenoids measured by resonance Raman spectroscopy, leptin, and oxidative stress indicators were determined. RESULTS The mean MI was 15.7 ± 1.4 kg/m2. The DINCL considerably differed between individuals with the same BMI. Half of the patients (Group 1) had low DINCL: 1.3-28.4 mm, and Group 2 showed values up to 58.2 mm (corresponding to approximately 6 kg SAT mass). The two group means differed by more than 300% (P < 0.001). Accordingly, leptin levels significantly differed (P < 0.001). Mean SAT thicknesses were significantly higher in Group 2 at all eight sites. The groups also significantly differed in two oxidative stress parameters: total antioxidative capacity, malondialdehyde-modified low density lipoprotein immunoglobulin M (MDA-LDL IgM), and in the carotenoid level. CONCLUSION Half of the patients had sufficiently high fat mass, despite very low BMI. Consequently, their muscle (and other organ) masses must have been extremely low. Diagnostic criteria and treatment protocols for AN should consider each patient's body composition. In addition to dietary treatments, muscle training at low energy turnover rates may be essential for avoiding unnecessary body fat gain, better treatment results, and long-term recovery.
Collapse
Affiliation(s)
- Sonja Lackner
- Department of Immunology and Pathophysiology, Medical University of Graz, Otto Loewi Research Center, Heinrichstraße, Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz, Graz, Austria
| | - Wolfram Müller
- Department of Biophysics, Medical University of Graz, Gottfried Schatz Research Center, Neue Stiftingtalstraße, Graz, Austria.
| | - Alfred Fürhapter-Rieger
- Department of Biophysics, Medical University of Graz, Gottfried Schatz Research Center, Neue Stiftingtalstraße, Graz, Austria
| | - Andreas Oberascher
- Department of Immunology and Pathophysiology, Medical University of Graz, Otto Loewi Research Center, Heinrichstraße, Graz, Austria
| | - Michael Lehofer
- State Hospital Graz South-West, Location South, Wagner Jauregg Platz, Graz, Austria
| | - Claudia Bieberger
- State Hospital Graz South-West, Location South, Wagner Jauregg Platz, Graz, Austria
| | - Willibald Wonisch
- Department of Physiological Chemistry, Medical University of Graz, Otto Loewi Research Center, Neue Stiftingtalstraße, Graz, Austria
| | | | - Maximilian Moser
- Department of Physiology, Medical University of Graz, Otto Loewi Research Center, Neue Stiftingtalstraße, Graz, Austria; Human Research Institute, Franz-Pichler-Straße, Weiz, Austria
| | - Harald Mangge
- Clinical Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Auenbruggerplatz, Graz, Austria
| | - Sieglinde Zelzer
- Clinical Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Auenbruggerplatz, Graz, Austria
| | - Sandra Johanna Holasek
- Department of Immunology and Pathophysiology, Medical University of Graz, Otto Loewi Research Center, Heinrichstraße, Graz, Austria
| |
Collapse
|
8
|
Hart S, Marnane C, McMaster C, Thomas A. Development of the "Recovery from Eating Disorders for Life" Food Guide (REAL Food Guide) - a food pyramid for adults with an eating disorder. J Eat Disord 2018; 6:6. [PMID: 29619220 PMCID: PMC5878939 DOI: 10.1186/s40337-018-0192-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 03/08/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND There is limited evidence to inform nutrition and dietetic interventions for individuals with eating disorders even though it is recommended as an essential part of multidisciplinary management. There is minimal guidance, an absence of standardised nutrition educational material, and no research on how best to educate patients on healthy eating and how to achieve nutrition adequacy. Therefore the REAL Food Guide was developed. METHODS The REAL Food Guide is a pyramid with four layers and key nutrition messages beside each layer that was conceived to address gaps in nutrition education and intervention for individuals with eating disorders. Written and verbal consumer feedback was obtained from consumers receiving treatment regarding the acceptability and usefulness of the REAL Food Guide. A unique database was developed to reflect the types of foods and realistic portion sizes that patients are likely to select. This database was used for nutrition modelling to assess the nutrition adequacy of three meal patterns (meat containing, vegetarian and semi-vegan) for both weight maintenance and weight regain. Each meal pattern was compared to the Nutrient Reference Values for Australia and New Zealand. RESULTS Nutritional analysis demonstrated nutritional adequacy of meal patterns for energy, macronutrients and most micronutrients when the recommended number of serves from the REAL Food Guide were assessed. All meal patterns were adequate in micronutrients except for the semi-vegan meal pattern that was inadequate in vitamin D. Feedback from individuals with eating disorders demonstrates the nutrition education tool was acceptable to them as they felt it was more helpful for their recovery than general nutrition guidelines. CONCLUSION The REAL Food Guide is a comprehensive and user-friendly guide that clinicians can use to educate patients about components of a balanced and healthy diet. The guide can educate all eating disorder clinicians, including those who are new to the field, about the basics of nutrition. Clinicians using the guide can be confident that, if followed, patient's energy and nutritional requirements will be met and important nutrition education messages are reinforced, that are tailored to the beliefs and concerns of individuals with eating disorders.
Collapse
Affiliation(s)
- Susan Hart
- Nutrition Services, St Vincent's Health Network, Darlinghurst, 2010 Australia.,2The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Camperdown, 2006 Australia
| | - Claire Marnane
- Newtown Nutrition, Suite 1, 33 King St, Newtown, 2042 Australia.,4Nutrition and Dietetics Program, The University of Sydney, Camperdown, 2006 Australia
| | - Caitlin McMaster
- 2The Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, University of Sydney, Camperdown, 2006 Australia.,5Weight Management Service, The Children's Hospital at Westmead, Westmead, 2145 Australia
| | - Angela Thomas
- Central Coast Eating Disorders Outpatient Service, Toukley, 2263 Australia
| |
Collapse
|
9
|
Mittnacht AM, Bulik CM. Best nutrition counseling practices for the treatment of anorexia nervosa: a Delphi study. Int J Eat Disord 2015; 48:111-22. [PMID: 24976176 DOI: 10.1002/eat.22319] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 05/27/2014] [Accepted: 05/30/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To use Delphi methodology to evaluate the extent to which a panel of registered dietitians (RDs) who treat anorexia nervosa (AN) concur on parameters related to nutrition counseling for AN. METHOD The twenty-one panelists who participated in this study: (i) were RDs (ii) had specialized in nutritional counseling for eating disorders for 5 years or more, and (iii) had Internet access at home or work. Over a 10-week period (between 8/2013 and 11/2013), panelists completed three iterative questionnaires. Questionnaire 1 included 12 open-ended questions regarding nutrition counseling for patients with AN. Subsequent questionnaires were developed based on a content analysis of responses to the first questionnaire, and panelists were asked to rank their level of agreement with these items. RESULTS Consensus was defined as 85% agreement and was achieved for 47 (35.3%) of the 133 items included in the third questionnaire. Items achieving consensus described nutrition counseling approaches that are applicable to all patients with AN, and their wording typically allowed for consideration of individual needs. Some items that did not achieve consensus reflected approaches for which individual tailoring may be necessary depending on age, stage of illness, and other patient factors. Consensus was also not shown for approaches for which there is little evidence. DISCUSSION Nutritional counseling intervention for AN has some consensus features, but the need for individualization was apparent. A stronger evidence-base for nutritional counseling interventions for AN would provide guidance and facilitate greater consistency among RDs regarding how to best care for this patient population.
Collapse
Affiliation(s)
- Anne M Mittnacht
- Department of Nutrition at the University of North Carolina at Chapel Hill, North Carolina
| | | |
Collapse
|
10
|
Blumenstein I, Shastri YM, Stein J. Gastroenteric tube feeding: Techniques, problems and solutions. World J Gastroenterol 2014; 20:8505-8524. [PMID: 25024606 PMCID: PMC4093701 DOI: 10.3748/wjg.v20.i26.8505] [Citation(s) in RCA: 231] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Revised: 02/10/2014] [Accepted: 04/16/2014] [Indexed: 02/06/2023] Open
Abstract
Gastroenteric tube feeding plays a major role in the management of patients with poor voluntary intake, chronic neurological or mechanical dysphagia or gut dysfunction, and patients who are critically ill. However, despite the benefits and widespread use of enteral tube feeding, some patients experience complications. This review aims to discuss and compare current knowledge regarding the clinical application of enteral tube feeding, together with associated complications and special aspects. We conducted an extensive literature search on PubMed, Embase and Medline using index terms relating to enteral access, enteral feeding/nutrition, tube feeding, percutaneous endoscopic gastrostomy/jejunostomy, endoscopic nasoenteric tube, nasogastric tube, and refeeding syndrome. The literature showed common routes of enteral access to include nasoenteral tube, gastrostomy and jejunostomy, while complications fall into four major categories: mechanical, e.g., tube blockage or removal; gastrointestinal, e.g., diarrhea; infectious e.g., aspiration pneumonia, tube site infection; and metabolic, e.g., refeeding syndrome, hyperglycemia. Although the type and frequency of complications arising from tube feeding vary considerably according to the chosen access route, gastrointestinal complications are without doubt the most common. Complications associated with enteral tube feeding can be reduced by careful observance of guidelines, including those related to food composition, administration rate, portion size, food temperature and patient supervision.
Collapse
|
11
|
Rocks T, Pelly F, Wilkinson P. Nutrition therapy during initiation of refeeding in underweight children and adolescent inpatients with anorexia nervosa: a systematic review of the evidence. J Acad Nutr Diet 2014; 114:897-907. [PMID: 24512952 DOI: 10.1016/j.jand.2013.11.022] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 11/20/2013] [Indexed: 01/08/2023]
Abstract
Restoration of weight and nutritional rehabilitation are recognized as fundamental steps in the therapeutic treatment of children and adolescent inpatients with anorexia nervosa (AN). However, current recommendations on initial energy requirements for this population are inconsistent, with a clear lack of empirical evidence. Thus, the aim of our study was to systematically review, assess, and summarize the available evidence on the effect of differing nutrition therapies prescribed during refeeding on weight restoration in hospitalized children and adolescents (aged 19 years and younger) with diagnosed AN. Searches were conducted in Scopus, Web of Science, Global Health (CABI), PubMed, and the Cochrane database for articles published in English up to May 2012, and complemented by a search of the reference lists of key publications. Seven observational studies investigating a total of 403 inpatients satisfied the inclusion criteria. The range of prescribed energy intakes varied from 1,000 kcal to >1,900 kcal/day with a progressive increase during the course of hospitalization. It appeared that additional tube feeding increased the maximum energy intake and led to greater interim or discharge weight; however, this was also associated with a higher incidence of adverse effects. Overall, the level of available evidence was poor, and therefore consensus on the most effective and safe treatment for weight restoration in inpatient children and adolescents with AN is not currently feasible. Further research on refeeding methods is crucial to establish the best practice approach to treatment of this population.
Collapse
|
12
|
Long-term effects of enteral feeding on growth and mental health in adolescents with anorexia nervosa—results of a retrospective German cohort study. Eur J Clin Nutr 2013; 68:171-7. [DOI: 10.1038/ejcn.2013.244] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 09/10/2013] [Accepted: 10/18/2013] [Indexed: 11/08/2022]
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Rocks T, Pelly F, Wilkinson P. Nutritional management of anorexia nervosa in children and adolescent inpatients: The current practice of Australian dietitians. Nutr Diet 2013. [DOI: 10.1111/1747-0080.12058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Tetyana Rocks
- School of Health and Sport Sciences; University of the Sunshine Coast; Sippy Downs Queensland Australia
| | - Fiona Pelly
- School of Health and Sport Sciences; University of the Sunshine Coast; Sippy Downs Queensland Australia
| | - Paul Wilkinson
- Accreditation, Recognition and Education Services; Dietitians Association of Australia; Canberra Australian Capital Territory Australia
| |
Collapse
|
15
|
Tholking MM, Mellowspring AC, Eberle SG, Lamb RP, Myers ES, Scribner C, Sloan RF, Wetherall KB. American Dietetic Association: Standards of Practice and Standards of Professional Performance for Registered Dietitians (Competent, Proficient, and Expert) in Disordered Eating and Eating Disorders (DE and ED). ACTA ACUST UNITED AC 2011; 111:1242-1249.e37. [DOI: 10.1016/j.jada.2011.05.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Indexed: 10/17/2022]
|
16
|
Hart S, Russell J, Abraham S. Nutrition and dietetic practice in eating disorder management. J Hum Nutr Diet 2011; 24:144-53. [DOI: 10.1111/j.1365-277x.2010.01140.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
17
|
Setnick J. Micronutrient deficiencies and supplementation in anorexia and bulimia nervosa: a review of literature. Nutr Clin Pract 2010; 25:137-42. [PMID: 20413694 DOI: 10.1177/0884533610361478] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Anorexia and bulimia nervosa are characterized by unbalanced eating patterns that include inadequate dietary intake of various nutrients. Conservation mechanisms resulting from starvation and/or self-prescribed nutrient supplements can result in laboratory values that appear within normal limits. These artificially inflated values drop to dangerous levels in some patients once rehydration and refeeding begin. Electrolyte status must be closely monitored during this time to prevent complications. Other micronutrient deficiencies can be corrected with adequate dietary intake, but patients with eating disorders are unlikely to consume such an adequate diet immediately upon entering treatment, so they may benefit from supplementation. Depleted nutrient stores require longer supplementation than acute inadequacies in nutrient intake. This review compiles the findings reported to date regarding micronutrient deficiencies and supplementation for patients with anorexia and bulimia. Because of the widely varying eating practices from patient to patient and the current lack of data controlling for nutrient self-supplementation, nutrition assessment performed by a nutrition professional via food intake history may be more practical than laboratory tests and more accurate than current food intake for determining potential micronutrient deficiencies.
Collapse
|
18
|
Affiliation(s)
| | - Leah Graves
- Laureate Eating Disorders Program, Tulsa, Oklahoma
| |
Collapse
|
19
|
Joint BAPEN and Nutrition Society Symposium on 'Feeding size 0: the science of starvation'. Severe malnutrition: therapeutic challenges and treatment of hypovolaemic shock. Proc Nutr Soc 2009; 68:274-80. [PMID: 19490738 DOI: 10.1017/s0029665109001359] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The systematic failure to recognise and appropriately treat children with severe malnutrition has been attributed to the elevated case-fatality rates, often as high as 50%, that still prevail in many hospitals in Africa. Children admitted to Kilifi District Hospital, on the coast of Kenya, with severe malnutrition frequently have life-threatening features and complications, many of which are not adequately identified or treated by WHO guidelines. Four main areas have been identified for research: early identification and better supportive care of sepsis; evidence-based fluid management strategies; improved antimicrobial treatment; rational use of nutritional strategies. The present paper focuses on the identification of children with sepsis and on fluid management strategies.
Collapse
|