BACKGROUND Patients with eating disorders (EDs) are often considered a high-risk population to refeed. Current research advises using "start low, go slow" refeeding methods (∼1,000 kcal/day, advancing ∼500 kcal/day every 3 to 4 days) in adult patients with severe EDs to prevent the development of refeeding syndrome (RFS), typically characterized by decreases in serum electrolyte levels and fluid shifts. OBJECTIVE To compare the incidence of RFS and related outcomes using a low-calorie protocol (LC) (1,000 kcal) or a higher-calorie protocol (HC) (1,500 kcal) in medically compromised adult patients with EDs. DESIGN This was a retrospective pre-test-post-test study. PARTICIPANTS/SETTING One hundred and nineteen participants with EDs, medically admitted to a tertiary hospital in Brisbane, Australia, between December 2010 and January 2017, were included (LC: n=26, HC: n=93). The HC refeeding protocol was implemented in September 2013. MAIN OUTCOME MEASURES Differences in prevalence of electrolyte disturbances, hypoglycemia, edema, and RFS diagnoses were examined. STATISTICAL ANALYSIS PERFORMED χ2 tests, Kruskal-Wallis H test, analysis of variance, and independent t tests were used to compare data between the two protocols. RESULTS Descriptors were similar between groups (LC: 28±9 years, 96% female, 85% with anorexia nervosa, 31% admitted primarily because of clinical symptoms of exacerbated ED vs HC: 27±9 years, 97% female, 84% with anorexia nervosa, 44% admitted primarily because of clinical symptoms of exacerbated ED, P>0.05). Participants refed using the LC protocol had higher incidence rates of hypoglycemia (LC: 31% vs HC: 10%, P=0.012), with no statistical or clinical differences in electrolyte disturbances (LC: 65% vs HC: 45%, P=0.079), edema (LC: 8% vs HC: 6%, P=0.722) or diagnosed RFS (LC: 4% vs HC: 1%, P=0.391). CONCLUSIONS A higher-calorie refeeding protocol appears to be safe, with no differences in rates of electrolyte disturbances or clinically diagnosed RFS and a lower incidence of hypoglycemia. Future research examining higher-calorie intakes, similar to those studied in adolescent patients, may be beneficial.

中文翻译：

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高热量再喂养方案不会增加成年进食障碍患者的不良结局

背景 患有饮食失调 (ED) 的患者通常被认为是重新进食的高危人群。目前的研究建议在患有严重 ED 的成年患者中使用“开始低，慢慢来”的再喂养方法（~1,000 kcal/天，每 3 至 4 天推进~500 kcal/天）以防止再喂养综合征 (RFS) 的发展，通常以血清电解质水平降低和体液转移为特征。目的 比较使用低热量方案 (LC) (1,000 kcal) 或高热量方案 (HC) (1,500 kcal) 在患有 ED 的医学上受损的成年患者中 RFS 的发生率和相关结果。设计 这是一项回顾性的前测后测研究。参与者/设置 119 名患有 ED 的参与者，在 2010 年 12 月至 2017 年 1 月期间在澳大利亚布里斯班的一家三级医院住院，包括在内（LC：n=26，HC：n=93）。HC 再喂养方案于 2013 年 9 月实施。 主要观察指标 检查电解质紊乱、低血糖、水肿和 RFS 诊断发生率的差异。统计分析 执行的 χ2 检验、Kruskal-Wallis H 检验、方差分析和独立 t 检验用于比较两种方案之间的数据。结果 各组之间的描述相似（LC：28±9 岁，96% 女性，85% 患有神经性厌食症，31% 主要因为加重 ED 与 HC 的临床症状而入院：27±9 岁，97% 女性，84% 患有神经性厌食症神经性厌食症，44% 主要因 ED 加重的临床症状入院，P>0.05）。使用 LC 方案的参与者具有更高的低血糖发生率（LC：31% vs HC：10%，P=0.012），电解质紊乱（LC：65% vs HC：45%，P=0.079）、水肿（LC：8% vs HC：6%，P=0.722）或诊断的 RFS（LC：4% vs 4%，P=0.722）没有统计学或临床差异HC：1%，P=0.391）。结论 高热量再喂养方案似乎是安全的，电解质紊乱或临床诊断的 RFS 发生率没有差异，低血糖发生率较低。类似于在青少年患者中进行的研究，未来对高热量摄入的研究可能是有益的。