Background Routine supplementation of thiamine in patients with restrictive eating disorders prior to initiation of nutritional rehabilitation, is an example of a clinical guideline based on expert opinion rather than evidence-based recommendations. This study investigates whether adolescents hospitalised with a restrictive eating disorder commenced on a higher caloric refeeding regimen, present with or develop thiamine deficiency during their admission. Methods An eighteen month retrospective audit of 119 consecutive admissions for nutritional rehabilitation was conducted on patients admitted with an eating disorder in a large tertiary teaching hospital in Western Sydney. Data from paper-based and electronic medical records were collected. Baseline and weekly blood thiamine levels were documented, as well as patient demographic information including admission weight, age, length of stay, percentage median body mass index, weight change throughout admission and caloric prescription. Results Sixty admissions met inclusion criteria, mean age 17.2 years (SD 1.2); 88% female; BMI 16.8 kg/m 2 (SD 1.8) on admission. A linear mixed effects model identified that median thiamine levels increased by 9.2 nmol/L per week ( p < 0.001). No patient developed thiamine deficiency during their admission, one patient was admitted with thiamine levels below the normal range at 62 nmol (normal range 67 – 200 nmol/L) which resolved by the second week of admission. In 15 out of 60 patients (25%), thiamine levels were observed to rise above the upper limit. Conclusions Nutritional management of 60 malnourished adolescents hospitalised with an eating disorder was conducted safely with the provision of only 10 mg thiamine in a multivitamin daily, and no additional thiamine supplementation. The high caloric refeeding protocol, inclusive of a daily multivitamin, provided adequate thiamine to prevent thiamine deficiency. Further research should examine thiamine requirements in an exclusive severely malnourished population to assess the need for thiamine replacement in the most vulnerable group.

中文翻译：

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对因限制性饮食失调住院的青少年患者进行高热量营养康复期间硫胺素水平变化的审计

背景 限制性饮食失调患者在开始营养康复之前常规补充硫胺素是基于专家意见而非基于证据的建议的临床指南的一个例子。本研究调查了因限制性饮食失调而住院的青少年是否开始接受更高热量的再喂养方案，在入院期间是否存在或发展为硫胺素缺乏症。方法对在西悉尼一家大型三级教学医院收治的饮食失调患者进行了为期 18 个月的回顾性审计，该研究对 119 名连续入院进行营养康复治疗的患者进行了回顾。收集了来自纸质和电子病历的数据。记录基线和每周血硫胺素水平，以及患者的人口统计信息，包括入院体重、年龄、住院时间、体重指数中位数百分比、入院期间的体重变化和热量处方。结果 60 名入院符合纳入标准，平均年龄 17.2 岁（SD 1.2）；88% 女性；入院时 BMI 16.8 kg/m 2 (SD 1.8)。线性混合效应模型确定硫胺素水平中位数每周增加 9.2 nmol/L (p < 0.001)。没有患者在入院期间出现硫胺素缺乏症，一名患者入院时硫胺素水平低于正常范围 62 nmol（正常范围 67 – 200 nmol/L），在入院第二周解决。在 60 名患者中的 15 名 (25%) 中，观察到硫胺素水平上升到上限以上。结论 60 名因进食障碍住院的营养不良青少年的营养管理是安全的，每天仅提供 10 mg 硫胺素的复合维生素，并且没有额外的硫胺素补充剂。包括每日复合维生素在内的高热量再喂养方案提供了足够的硫胺素以防止硫胺素缺乏症。进一步的研究应检查严重营养不良人群对硫胺素的需求，以评估最脆弱群体对硫胺素替代品的需求。