In our hospital, we have seen an exponential increase in inpatient admissions for patients with anorexia nervosa since the beginning of the COVID-19 pandemic; some of these patients as young as 8 years of age! The usual protocol is for them to begin refeeding very slowly, so that they do not develop the metabolic derangements that are seen in refeeding syndrome.
In 2020, Dr. Neville Golden, Dr. Andrea Garber, and colleagues at Stanford and UC-San Francisco reported on short-term results of a randomized controlled trial in which 12–24-year-old patients with anorexia nervosa were randomized to low-calorie refeeding (1400 kcal/day, increasing by 200 kcals every other day) or high-calorie refeeding (2000 kcal/day, increasing by 200 kcals every day) (10.1542/peds.2020-037135). They found that, short-term, patients who received higher-calorie refeeding gained weight more quickly and had shorter hospitalizations, without any increase in electrolyte disturbances or refeeding syndrome.
Now, the team is back with a new manuscript, one of the early releases in Pediatrics this week, which describes one-year outcomes from this study for 111 patients (of the 120 initially enrolled); 60 were in the higher-calorie group and 51 in the lower-calorie group. At one year, they found no differences in clinical remission, rehospitalization rates, number of rehospitalizations, or number of days of rehospitalization.
This is all great news and has important fiscal implications. In an accompanying commentary (10.1542/peds.2020-043737), Dr. Mark Norris and Dr. Jennifer Couturier from the University of Ottawa and McMaster University note that the shorter hospitalization stays added up to an average of $20,000 saved per patient! One important caveat is that the original study excluded the most severely affected patients, those whose body mass index (BMI) was <60% median BMI. The sample size is also fairly small, and it will be important to have these findings confirmed in additional studies and in patients with lower BMIs.
Check out the article and commentary, as it may change how you treat some of your patients who need hospitalization for treatment of anorexia nervosa.
