目的:StRONG研究表明,在神经性厌食症(AN)和非典型AN(AAN)住院的患者中,更高的卡路里再喂养(HCR)更快地恢复了医疗稳定性。与标准护理低卡路里再喂养(LCR)相比,安全事件没有增加。然而,一些临床医生对HCR的潜在意外后果表示担忧(例如,更大的进餐时间困扰)。这项研究的目的是检查患者的治疗偏好并比较用餐时的困扰,拒绝食物,和治疗之间的情感状态。
方法:这项多中心随机临床试验的参与者(N=111)年龄为12-24岁,与AN或AAN,因医疗不稳定而入院,接受指定的研究治疗(HCR或LCR)。在全部样品中随机化之前评估治疗偏好。在参与者的子集(n=45)中,线性混合效应模型用于分析进餐时间困扰的瞬时评级(预,during,和餐后)和住院期间的每日情感状态。
结果:大约一半(55%)的参与者报告了对LCR的偏好。治疗分配与拒绝进食无关,进餐时间的痛苦,或子样本中的情感状态。在重新喂养的过程中,拒绝食物的数量显着增加(p=.018)。抑郁症患者经历了更多的负面影响(p=.033),随着时间的推移,进食障碍精神病理学较高的个体的负面影响不断恶化(p=.023)。
结论:尽管对HCR的潜在意外后果的担忧是可以理解的,我们发现,对于患有AN和AAN的青少年和年轻成人,没有证据表明HCR的治疗可接受性不同于LCR.
UNASSIGNED:已证明在神经性厌食症住院患者中使用高热量再饲喂的有效性和安全性。然而,尚不清楚更高的卡路里再喂养(HCR)是否会增加进餐时间困扰。这项研究表明,HCR与进餐时间窘迫增加无关,拒绝食物,或情感状态,与低卡路里的再饲喂相比。这些数据支持HCR治疗对于患有神经性厌食症和非典型神经性厌食症的青少年/年轻人的可接受性。
The StRONG study demonstrated that higher calorie refeeding (HCR) restored medical stability faster in patients hospitalized with anorexia nervosa (AN) and atypical AN (AAN), with no increased safety events compared with standard-of-care lower calorie refeeding (LCR). However, some clinicians have expressed concern about potential unintended consequences of HCR (e.g., greater mealtime distress). The purpose of this study was to examine patient treatment preference and compare mealtime distress, food refusal, and affective states between treatments.
Participants (N = 111) in this multisite randomized clinical trial were ages 12-24 years, with AN or AAN, admitted to hospital with medical instability who received assigned study treatment (HCR or LCR). Treatment preference was assessed prior to randomization in the full sample. In a subset of participants (n = 45), linear mixed effect models were used to analyze momentary ratings of mealtime distress (pre, during, and post-meals) and daily affective state during the hospitalization.
About half (55%) of participants reported a preference for LCR. Treatment assignment was not associated with food refusal, mealtime distress, or affective states in the subsample. Food refusal increased significantly over the course of refeeding (p = .018). Individuals with greater depression experienced more negative affect (p = .033), with worsening negative affect over time for individuals with higher eating disorder psychopathology (p = .023).
Despite understandable concerns about potential unintended consequences of HCR, we found no evidence that treatment acceptability for HCR differed from LCR for adolescents and young adults with AN and AAN.
The efficacy and safety of higher calorie refeeding in hospitalized patients with anorexia nervosa has been demonstrated. However, it is not known whether higher calorie refeeding (HCR) increases meal-time distress. This study demonstrated that HCR was not associated with increased mealtime distress, food refusal, or affective states, as compared with lower calorie refeeding. These data support HCR treatment acceptability for adolescents/young adults with anorexia nervosa and atypical anorexia nervosa.