O'Connor, G; (2014) Refeeding low weight hospitalised Adolescents with Anorexia Nervosa. Doctoral thesis , UCL (University College London).

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Abstract

Refeeding adolescents with anorexia nervosa (AN) carries risks, the extent of which have been much debated but subject to little research. As such, the optimal nutritional management of such patients is unknown, and the lack of evidence from interventional studies has led to worldwide disparities in clinical management recommendations. In this first randomised controlled trial in this area, we tested the hypothesis that refeeding with a higher energy intake than that currently recommended in Europe, improves outcomes in low weight adolescents with AN. The aim of this study was to investigate the association between total energy intake on QTc interval, heart rate and hypophosphataemia. The primary outcome was QTc interval (ms). Secondary outcomes were heart rate, electrolytes (phosphate, magnesium and potassium) and anthropometry (weight [kg] and %BMI). Participants were 38 adolescents’ aged 10-16years with a DSM IV diagnosis of AN recruited from six acute paediatric services around the UK and were randomly allocated to commence refeeding at 1200kcal/ day (intervention) or at 500kcal/ day (control). Energy intake was incrementally increased by 200kcal day up to 80% of estimated energy requirements. The results showed that compared to controls, adolescents randomised to the higher calorie group had a greater weight gain. However, randomised groups did not differ statistically in QTc interval or heart rate. Refeeding hypophosphataemia (serum phosphate <0.9mmol/l) developed in a proportion of patients. However, there was no statistical difference in the incidence or severity of refeeding hypophosphataemia between the two groups. Participants that were below 68%BMI and those with low WBC’s (WBC <3.8 x 109/l) had a greater reduction in post refeeding phosphate. Together, these findings suggest that oral refeeding at 1200kcal/ day (38kcal/ kg/ day) which increases incrementally to 1900kcal/ day (58kcal/ kg/ day) is more beneficial for the majority of patients than commencing refeeding at 500kcal/ day in low weight adolescents with AN. The findings from this study challenge current European and UK recommendations.

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