Cited by 226Eating Disorders and BehaviorsChild Nutrition and Feeding IssuesNutrition, Health and Food Behavior

A systematic review of approaches to refeeding in patients with anorexia nervosa

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Garber, Andrea K., Sawyer, Susan M., Golden, Neville H., Guarda, Angela S., Katzman, Debra K., Kohn, Michael R., Le Grange, Daniel, Madden, Sloane +2 more·2016·International Journal of Eating Disorders

Abstract

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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  1. [13]NICE. Eating Disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa, and related eating disorders 2004 [cited 2012 Sep 12]. Available from: http://www.nice.org.uk/nicemedia/pdf/CG9FullGuideline.pdf. 23346610

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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.
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
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
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

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