A systematic review of approaches to refeeding in patients with anorexia nervosa
Open accessAbstract
OBJECTIVE: Given the importance of weight restoration for recovery in patients with anorexia nervosa (AN), we examined approaches to refeeding in adolescents and adults across treatment settings. METHODS: Systematic review of PubMed, PsycINFO, Scopus, and Clinical Trials databases (1960-2015) using terms refeeding, weight restoration, hypophosphatemia, anorexia nervosa, anorexia, and anorexic. RESULTS: Of 948 screened abstracts, 27 met these inclusion criteria: participants had AN; reproducible refeeding approach; weight gain, hypophosphatemia or cognitive/behavioral outcomes. Twenty-six studies (96%) were observational/prospective or retrospective and performed in hospital. Twelve studies published since 2010 examined approaches starting with higher calories than currently recommended (≥1400 kcal/d). The evidence supports 8 conclusions: 1) In mildly and moderately malnourished patients, lower calorie refeeding is too conservative; 2) Both meal-based approaches or combined nasogastric+meals can administer higher calories; 3) Higher calorie refeeding has not been associated with increased risk for the refeeding syndrome under close medical monitoring with electrolyte correction; 4) In severely malnourished inpatients, there is insufficient evidence to change the current standard of care; 5) Parenteral nutrition is not recommended; 6) Nutrient compositions within recommended ranges are appropriate; 7) More research is needed in non-hospital settings; 8) The long-term impact of different approaches is unknown; DISCUSSION: Findings support higher calorie approaches to refeeding in mildly and moderately malnourished patients under close medical monitoring, however the safety, long-term outcomes, and feasibility outside of hospital have not been established. Further research is also needed on refeeding approaches in severely malnourished patients, methods of delivery, nutrient compositions and treatment settings.
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Efficient attainment of a healthy body weight has been shown to predict recovery, and aggressive approaches including high caloric meals and/or enteral feeding are common, especially in institutionalized patients.
“Efficient attainment of a healthy body weight has been shown to predict recovery and thus aggressive approaches including high caloric meals and/or enteral feeding are common, especially in institutionalized patients [83].”
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“Efficient attainment of a healthy body weight has been shown to predict recovery and thus aggressive approaches including high caloric meals and/or enteral feeding are common, especially in institutionalized patients [83].”
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- Authors
- Garber, A. K., Sawyer, S. M., Golden, N. H., Guarda, A. S., Katzman, D. K., Kohn, M. R., Le Grange, D., Madden, S., Whitelaw, M., & Redgrave, G. W.
- Affiliations
- University of California, San Francisco (US)
- Royal Children's Hospital (AU)
- Stanford Medicine (US)
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine
- University of Toronto (CA)
- The University of Sydney (AU)
- Department of Pediatrics, Division of Adolescent and Young Adult Medicine University of California, San Francisco, Benioff Children's Hospital
- Johns Hopkins University (US)
- Corresponding author
- Garber, Andrea K.
- ORCID
- Venue
- International Journal of Eating Disorders
- Publisher
- Wiley
- Published
- 2015-12-12
- Volume
- 49
- Issue
- 3
- Pages
- 293-310
- ISSN
- 0276-3478 (ISSN-L)
- 1098-108X
- PMC
- PMC6193754
- OpenAlex
- W2189922945
- Cited by
- 226
- References
- 86
- Citations by year
- 2026: 13 · 2025: 25 · 2024: 27 · 2023: 23 · 2022: 22 · 2021: 28 · 2020: 31 · 2019: 20 · 2018: 16 · 2017: 16 · 2016: 5
- FWCI
- 1.78
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- International Journal of Eating Disorders (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD082166)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Keywords
- anorexia nervosa, refeeding syndrome, weight restoration, refeeding, hypophosphatemia, severe malnutrition, parenteral nutrition, nasogastric tube feeding, energy intake, electrolyte correction, inpatient care, adolescents, adults
- MeSH terms
- Anorexia Nervosa, Female, Humans, Male, Parenteral Nutrition, Prospective Studies, Retrospective Studies, Refeeding Syndrome
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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