Higher calorie diets for hospitalized adolescent patients with anorexia nervosa produced more weight gain when compared to the lower calorie diets currently recommended, says a study by researchers at the University of California San Francisco’s Beniott Children’s Hospital. The findings challenge the conservative diet approach hospitals use to feed anorexic adolescents for malnutrition.
The study findings were announced on September 20, 2013, and will be published in the November 2013 issue of the “Journal of Adolescent Health.” The journal article contains an editorial and two studies that support these findings.
“These findings are crucial to develop evidence-based guidelines for the treatment of young people suffering from malnutrition related to anorexia nervosa,” said Andrea Garber, PhD, RD, lead author of the study and associate professor of pediatrics, Division of Adolescent Medicine, UCSF Benioff Children’s Hospital. “This is the first study to follow patients in the hospital on a more aggressive feeding protocol, and it’s clear that we’re seeing better results as compared to the traditional approach.”
The American Dietetic Association, American Psychiatric Association, and other organizations currently recommend a diet of approximately 1,200 calories per day for anorexic patients that gradually increase by 200 calories every other day. This recommendation is intended to avoid a potentially fatal condition known as refeeding syndrome in a starving patient. The syndrome is caused by rapid electrolyte shifts in the body.
A previous study by Garber in 2011 was the first to demonstrate that adolescent hospital patients on the diets many hospitals use have poor outcomes such as initial weight loss, weight gain, and longer hospital stays.
“That study showed that the lower-calorie diets were contributing to the so-called ‘underfeeding syndrome’ and are just too conservative for most of the adolescents that we hospitalize,” said Garber. “Now we’ve compared a higher-calorie approach and found that it dramatically increases the rate of weight gain and shortens hospital stay.”
The current study participants were adolescents with anorexia who required hospitalization for malnutrition with characteristics such as low blood pressure, body temperature, heart rate, and body mass index.
Two types of diets were studied:
- 56 adolescent patients were put on higher calorie diets starting at 1800 calories per day, with 120 calories per day
- Other patients started at 1,100 calories a day and had an increase of 100 calories per day
The predominately white female adolescent patients were fed three snacks and three meals per day. Researchers constantly monitored their heart rates and checked their electrolytes twice a day.
When researchers compared the higher and lower calorie diets, they found:
- patients with more calories gained nearly twice the amount of weight gain as the lower calorie group
- Patients with more calories were hospitalized an average of seven fewer days than the lower calorie group
- patients on the higher calorie diet did not increase their risk of refeeding syndrome
“This higher calorie approach is a major shift in treatment that looks really promising – not only from a clinical perspective of better weight gain, but from the perspective of these young people who want to get better quickly and get back to their ‘real’ lives,” Garber said.