Long-term impact of higher vs. lower calorie refeeding in anorexia nervosa

高热量与低热量重新喂养对神经性厌食症的长期影响

• 批准号: 8568924
• 负责人: Andrea K Garber
• 金额: $ 7.82万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-18 至 2015-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8568924
• 关键词: Adolescent; Age; Ambulatory Care Facilities; Amenorrhea; Anorexia Nervosa; Behavior; Blood Pressure; Body Weight decreased; Body mass index; Caloric Restriction; Calories; Cardiac Death; Caring; Centers for Disease Control and Prevention (U.S.); Cessation of life; Childhood; Clinical; Clinical Research; Consensus; Data; Delirium; Development; Diet; Electrolytes; Enrollment; Ensure; Equilibrium; Fluid Shifts; Gender; Goals; Heart Arrest; Heart Rate; Heart failure; Hospitalization; Hospitalized Adolescent; Hospitals; Hypophosphatemia; Institution; Lead; Length of Stay; Link; Liquid substance; Malnutrition; Medical; Medical Records; Menstruation; Metabolic; Multicenter Studies; Multicenter Trials; Nutrient; Nutritional; Observational Study; Outcome; Outpatients; Participant; Patients; Process; Protocols documentation; Public Health; Publishing; Recommendation; Recovery; Research Design; Risk; Safety; Study models; Syndrome; Temperature; Time; Weight; Weight Gain; Weight maintenance regimen; Woman; abstracting; base; clinical care; clinical practice; cohort; evidence base; feeding; follow-up; girls; high risk; prospective; public health relevance; purge; response; trial comparing

DESCRIPTION (provided by applicant): Project Summary/Abstract Patients with Anorexia Nervosa (AN) can become medically unstable due to malnutrition and require hospitalization for re-feeding, or nutritional repletion. The goal of re-feeding is weight gain, since weight gain in hospital is a key predictor of long-term recovery. However, extreme caution has been used during re-feeding since the re-feeding syndrome was first described in the 1950's. This syndrome is caused by rapid shifts in fluids and electrolytes in response to nutrients and can result in cardiac failure, delirium and death. Since it was documented in patients with AN, conservative consensus-based recommendations were developed and have been applied broadly to ensure safety during re-feeding. These recommendations call for starting around 1200 calories per day and advancing slowly by 200 calories every other day. We recently demonstrated this "start low and go slow" approach contributes to poor weight gain and prolonged hospital stay in adolescents with AN. These findings have contributed to recognition of the "underfeeding syndrome", characterized by prolonged illness and even death due to overly cautious re-feeding. In a follow-up study, we found double the weight gain on 1800 vs. 1200 calorie diets with no increase in risk. While these short-term results look promising, the long- term impact is unknown. Overall Objective: The purpose of the proposed longitudinal observational study is to compare long-term recovery in adolescents with AN re-fed on higher vs. lower calories in hospital. Our Study of Adolescents Hospitalized with Anorexia Nervosa (SHAAN) has enrolled 56 adolescents to date. This is the largest cohort of participants re-fed on higher vs. lower calorie protocols and prospectively followed in a Pediatric Clinical Research Center. We are now proposing to examine their recovery retrospectively for one- year after discharge from hospital. These findings will be used as preliminary data to plan a large multicenter trial comparing re-feeding approaches. Specific Aims: We will compare weight and vital sign recovery, return of menses and rates of rehospitalization over one year following discharge from hospital in adolescents re-fed on higher vs. lower calories. Our overarching hypothesis is that higher calories and faster weight gain will lead to earlier physical and nutritional recovery and less frequent rehospitalization. Study Design: This retrospective chart review will extract existing data from the medical records in our outpatient clinic, where we provided follow-up care to the SHAAN cohort. We will compare recovery trajectories between subjects re-fed on higher vs. lower calories during hospitalization and at 8 time points following hospitalization: wks. 1, 2, 3, 4, and mo. 3, 6, 9, 12. Significance: Balancing risk for the re-feeding syndrome with the need for weight gain in hospitalized patients with AN represents a fundamental paradox for clinical practice. While the current recommendations for lower calorie diets appear to minimize risk, they also contribute to the underfeeding syndrome. Long-term follow-up data are required to determine the impact of higher calorie re-feeding. The proposed study is an essential next step to building evidence-based approaches to re-feeding in AN.

描述（由申请人提供）：神经性厌食症（AN）的项目摘要/抽象患者由于营养不良而在医学上变得不稳定，需要住院以重新喂养或营养补充。重新喂养的目的是体重增加，因为医院体重增加是长期恢复的关键预测指标。但是，自1950年代首次描述了重新喂养综合征以来，在重新喂食期间一直使用了极端谨慎。该综合征是由响应营养的流体和电解质的快速变化引起的，可能导致心脏衰竭，del妄和死亡。由于它是在具有保守共识建议的患者中进行的，因此已开发出来，并已广泛应用以确保在重新进食期间的安全性。这些建议要求每天开始1200卡路里的热量，并每隔一天缓慢升级200卡路里。我们最近证明了这种“低速和缓慢”的方法有助于体重增加不足，并且在AN的青少年中长期住院。这些发现有助于认识到“喂养不足综合征”，其特征是由于过度谨慎的重新进食而导致长期疾病甚至死亡。在一项后续研究中，我们发现体重增加了1800，而1200卡路里饮食的体重增加是不增加风险的1200次卡路里饮食。尽管这些短期结果看起来很有希望，但长期影响尚不清楚。总体目标：拟议的纵向观察研究的目的是比较青少年的长期恢复，并在医院中重新喂养较高的卡路里和较低的卡路里。我们对神经性厌食症（Shaan）住院的青少年的研究已招募了56名青少年。这是在更高卡路里方案中重新养成的最大参与者队列，并在儿科临床研究中心进行了前瞻性遵循。我们现在建议在出院后一年回顾性检查他们的恢复。这些发现将用作初步数据，以计划比较重新喂养方法的大型多中心试验。具体目的：我们将比较重量和生命体征的恢复，月经的恢复和重新住院的率一年后，在青少年出院后一年，以更高的卡路里和较低的卡路里重新喂养。我们的总体假设是，更高的卡路里和更快的体重增加将导致较早的物理和营养恢复且重新寄养较少。研究设计：此回顾性图表审查将从我们的门诊诊所中的病历中提取现有数据，在那里我们向Shaan Cohort提供后续护理。我们将比较住院期间在住院期间与较低卡路里和较低卡路里的受试者之间的恢复轨迹，住院后的8个时间点：WKS。 1、2、3、4和mo。 3、6、9、12。显着性：平衡重新喂养综合征的风险与住院患者的体重增加的需求是临床实践的基本悖论。虽然目前对低卡路里饮食的建议似乎可以最大程度地降低风险，但它们也有助于喂养不足的综合征。需要长期的随访数据来确定更高卡路里重新进食的影响。拟议的研究是建立基于证据的方法以重新喂养AN的重要下一步。