Health-Medical-Fitness-Diet-zk: Anorexia

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luni, 12 decembrie 2011

Anorexia Recommendations Challenged

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Main Category: Eating Disorders
Article Date: 12 Dec 2011 - 7:00 PST

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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. Andrea Garber, PhD, RD, associate professor of pediatrics in the Division of Adolescent Medicine at UCSF, who led the study with colleagues in the UCSF Adolescent Eating Disorders Program, explained:

"Our findings show that the current recommendations are
just not effective."

There were 35 teenage female participants in this study; most of them were Caucasian. 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. The researchers measured their heart rates continuously and checked electrolyte twice per day.

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."

Even though 94% of study participants started on less than 1,400 calories per day, the study included diets that ranged from 800 to 2,200 calories in order for the investigators to analyze the effect of increasing calories.

The team found that: Participants who started on lower calorie diets lost considerably more weight in the hospitalHigher calorie diets resulted in less time in the hospitalIn 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 to 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.

According to Barbara Moscicki, MD, a professor of pediatrics in the Division of Adolescent Medicine at UCSF and senior author on the report, another unanswered question relates to refeeding syndrome, which remains "a very real fear." Moscicki explains that the researchers are proceeding cautiously, as more aggressive strategies to feeding and supplementation have not yet been well investigated.

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."

Other co-authors are Nobuaki Michihata, MD, Katherine Hetnal, and Mary-Ann Shafer, MD, all of UCSF. The study was conducted in the Pediatric Clinical Research Center through UCSF's NIH-funded Clinical and Translational Science Institute (CTSI).?About UCSF Benioff Children's Hospital

Written by: Petra Rattue

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duminică, 11 decembrie 2011

Study Challenges Decades-Old Treatment Guidelines For Anorexia

Main Category: Anxiety / Stress
Article Date: 10 Dec 2011 - 1:00 PST

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Adolescents hospitalized with anorexia nervosa who receive treatment based on current recommendations for refeeding fail to gain significant weight during their first week in the hospital, according to a new study by UCSF researchers.

The findings, published in the January issue of the Journal of Adolescent Health with an accompanying editorial, challenge the current conservative approach to feeding adolescents with anorexia nervosa during hospitalization for malnutrition.

The American Psychiatric Association, American Dietetic Association and others recommend starting with about 1,200 calories per day and advancing slowly by 200 calories every other day. This "start low and go slow" approach is intended to avoid refeeding syndrome a potentially fatal condition resulting from rapid electrolyte shifts, a well-known risk when starting nutrition therapy in a starving patient.

The UCSF study is the first to test these recommendations, which have been in place since 2000. "Our findings show that the current recommendations are just not effective", said Andrea Garber, PhD, RD, associate professor of pediatrics in the Division of Adolescent Medicine at UCSF, who led the research with colleagues in the UCSF Adolescent Eating Disorders Program.

Study participants were hospitalized due to signs of malnutrition, including low body temperature, blood pressure, heart rate and body mass index. The vast majority of the 35 primarily white, female adolescent patients received low calorie diets based on the current recommendations. Patients were fed six small meals per day, and when they refused food, they were given high calorie liquid supplements as a replacement. The patients' vital signs were monitored closely, with their heart rates measured continuously and electrolytes checked twice a day.

While the low calorie diets did prevent refeeding syndrome for those patients, about 83 percent of them also experienced significant initial weight loss and no overall weight gain until their eighth day in the hospital. This finding represents "a missed opportunity," according to Garber.

"Studies show that weight gain during hospitalization is crucial for patients' long-term recovery," she said, "we have to make the most out of their short time in the hospital."

Although 94 percent of patients in the study started on fewer than 1,400 calories a day, it included a range of diets from 800 to 2,200 calories. This range allowed the researchers to examine the effect of increasing calories. According to Garber, two important findings emerged:

The calorie level of the starting diet predicted the amount of weight that would be lost in the hospital. In other words, those on lower calorie diets lost significantly more weight.

Higher calorie diets led to less time in the hospital. In fact, Garber said, "we showed that for every 100 calories higher, the hospital stay was almost one day shorter."

While the study finds that current recommendations are too cautious, it raises other questions, according to the research team. For example, while a shorter hospital stay may reduce insurance costs, patients may not be ready to go home yet.

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

Another unanswered question relates to refeeding syndrome, which remains "a very real fear", according to Barbara Moscicki, MD, a professor of pediatrics in the Division of Adolescent Medicine at UCSF and senior author on the paper. Moscicki says that the team is proceeding cautiously since more aggressive approaches to feeding and supplementation have not yet been well studied.

Nevertheless, the researchers say that the study results are a promising start because no adverse events were seen in the study subjects on the higher calorie diets. "If we can improve weight gain with higher calories," Garber said, "then we're on the right path."

Article adapted by Medical News Today from original press release. Source: UCSF
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