目的:StRONG试验证明了高卡路里再喂养(HCR)在住院青少年和青少年限制性饮食失调继发营养不良中的安全性和有效性。在这里,我们比较了非典型神经性厌食症(非典型AN)与神经性厌食症(AN)患者的再喂养结果,并检查了热量剂量的影响。
方法:患者在入院时被纳入,并随机分为基于膳食的HCR,开始2000千卡/天,推进200千卡/天,或更低的卡路里补充(LCR),从1400千卡/天开始,每隔一天推进200千卡。非典型AN定义为%中位数BMI(mBMI)>85。独立t检验比较组;多变量线性和逻辑回归检查了热量剂量(kcal/kg体重)。
结果:在n=111中,平均±SD年龄为16.5±2.5岁;43%患有非典型AN。与AN相比,非典型AN的心率恢复较慢(8.7±4.0天vs.6.5±3.9天,p=.008,科恩的d=-.56),体重增加较少(3.1±5.9%mBMI与5.4±2.9%mBMI,p<.001,科恩d=.51)和更高的低镁血症(29%与11%,p=.03,OR=3.29)。这些次优结果是通过热量剂量不足来预测的(非典型AN中的32.4±6.9kcal/kg与在AN中43.4±9.8kcal/kg,p<.001,科恩的d=1.27)。每增加10千卡/千克,心率恢复1.7天(1.0,2.5)快(p<.001),体重增加1.6%mBMI(.8,2.4)大(p<.001),低镁血症的几率降低了70%(12,128)(p=0.02)。
结论:尽管HCR比LCR更有效,它通过提供相对于该诊断组中较大体重的热量剂量不足,从而导致非典型AN的饮食不足。
■StRONG试验先前证明了由于限制性饮食失调而导致营养不良的患者接受高热量再喂养的有效性和安全性。在这里,我们表明,高卡路里的再喂养有助于非典型神经性厌食症患者的饮食不足,包括体重增加差和恢复医疗稳定性的时间更长。这些发现表明这些患者需要更多的卡路里来支持医院的营养康复。
OBJECTIVE: The StRONG trial demonstrated the safety and efficacy of higher calorie refeeding (HCR) in hospitalized adolescents and young adults with malnutrition secondary to restrictive eating disorders. Here we compare refeeding outcomes in patients with atypical anorexia nervosa (atypical AN) versus anorexia nervosa (AN) and examine the impact of caloric dose.
METHODS: Patients were enrolled upon admission and randomized to meal-based HCR, beginning 2000 kcal/day and advancing 200 kcal/day, or lower calorie refeeding (LCR), beginning 1400 kcal/day and advancing 200 kcal every other day. Atypical AN was defined as %median BMI (mBMI) > 85. Independent t-tests compared groups; multivariable linear and logistic regressions examined caloric dose (kcal/kg body weight).
RESULTS: Among n = 111, mean ± SD age was 16.5 ± 2.5 yrs; 43% had atypical AN. Compared to AN, atypical AN had slower heart rate restoration (8.7 ± 4.0 days vs. 6.5 ± 3.9 days, p = .008, Cohen\'s d = -.56), less weight gain (3.1 ± 5.9%mBMI vs. 5.4 ± 2.9%mBMI, p < .001, Cohen\'s d = .51) and greater hypomagnesemia (29% vs. 11%, p = .03, OR = 3.29). These suboptimal outcomes were predicted by insufficient caloric dose (32.4 ± 6.9 kcal/kg in atypical AN vs. 43.4 ± 9.8 kcal/kg in AN, p < .001, Cohen\'s d = 1.27). For every 10 kcal/kg increase, heart rate was restored 1.7 days (1.0, 2.5) faster (p < .001), weight gain was 1.6%mBMI (.8, 2.4) greater (p < .001), and hypomagnesemia odds were 70% (12, 128) lower (p = .02).
CONCLUSIONS: Although HCR is more efficacious than LCR for refeeding in AN, it contributes to underfeeding in atypical AN by providing an insufficient caloric dose relative to the greater body weight in this diagnostic group.
UNASSIGNED: The StRONG trial previously demonstrated the efficacy and safety of higher calorie refeeding in patients with malnutrition due to restrictive eating disorders. Here we show that higher calorie refeeding contributes to underfeeding in patients with atypical anorexia nervosa, including poor weight gain and longer time to restore medical stability. These findings indicate these patients need more calories to support nutritional rehabilitation in hospital.