Guidelines for treating hospitalized  anorexia patients , needs a review confirms a study done recently by the The American Psychiatric Association.

Team@CMHF

According to researchers at UCSF, adolescents who are hospitalized with anorexia nervosa do not gain considerable weight during their initial week in hospital by receiving treatment based on current guidelines for refeeding. The study is published in the January issue of the Journal of Adolescent Health with an associated report. The study challenges the current guidelines to feeding adolescents with anorexia nervosa during hospitalization for malnutrition.

Patients should start with approximately 1,200 calories per day and advance slowly by 200 calories every other day, according to The American Psychiatric Association, American Dietetic Association and others. The aim of this “start low and go slow” method is to avoid refeeding syndrome – a potentially deadly condition as a result of rapid electrolyte shifts, a well-known risk when introducing nutrition therapy in a malnourished patient.

This study is the first to test these recommendations, which were established in 2000.
“Our findings show that the current recommendations are just not effective.
There were 35 teenage female participants in this study; most. They had been admitted to hospital with the following malnutrition signs:

• Low blood pressure
• Low body mass index (BMI)
• Low heart rate
• Low body temperature

A large proportion of the participants received low calorie diets based on the current guidelines. Participants received six small meals per day and were given high calorie liquid supplements when they refused food as a replacement. Even though those who received the low calorie diets did not develop refeeding syndrome, approximately 83% lost significant initial weight loss and no overall weight gain until their eighth day of hospitalization. Garber explained this discovery represents “a missed opportunity”

Garber continues:
“Studies show that weight gain during hospitalization is crucial for patients’ long-term recovery, we have to make the most out of their short time in the hospital.”

The team found that:

• Participants who started on lower calorie diets lost considerably more weight in the hospital
• Higher calorie diets resulted in less time in the hospital

In fact, “we showed that for every 100 calories higher, the hospital stay was almost one day shorter,” said Garber.

According to the researchers, the current guidelines are toO cautious and the study has raised other questions. For example, while insurances costs may be reduced as a result of shorter hospital stay, patients might not be ready to be discharged.

Garber explains:
“Shorter is not necessarily better. We have to consider the potential implications down the line, both psychological and emotional.

The team explain that results from the investigation are a promising start, because no adverse events were observed in those on the higher calorie diets.

Garber explains:
“If we can improve weight gain with higher calories,
then we’re on the right path.”

Ref; http://www.medicalnewstoday.com/articles/239033.php