Refeeding Adolescent Eating Disorders

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Restrictive eating disorders are a serious problem for many adolescents. In some cases, inpatient monitoring is needed for these patients. These individuals are typically severely malnourished with BMIs of 14 or below. During their stay, nutritional support to gain weight back to a healthy range is essential. The current guidelines recommend that patients start at 10 kcal/kg/day. This exceptionally low kcal recommendation is to avoid refeeding syndrome. However, recent research suggests that, in the adolescent population, the starting kcal recommendations does not need to be so restrictive.
            A study performed by Parker, Faruquie, Anderson, et al. assessed the complications of feeding adolescents above the current recommendations. The study looked at 162 adolescents admitted to an inpatient eating disorder program with an average length of stay of 3.6 weeks. The average age was 16.7 years and average BMI on admittance was 80.1% of ideal. They began feeding at 58.4 kcal/kg/day which is much higher than the recommended levels. The average weekly gain was 2.1kg. During this time-frame, none of the patients developed cardiac symptoms indicative of refeeding syndrome or signs of delirium. They did, however, develop decreased levels of several electrolytes. No significant significance was found between the higher caloric intake and the decreased electrolyte balance. This study suggests that a more aggressive feeding schedule may be warranted in adolescents with severe eating disorders.
SG
Parker E K, Faruquie S S, Anderson G, et al. Higher caloric refeeding is safe in hospitalized        
adolescents patients with restrictive eating disorders. J Nutr Metab. 2016:2016;1-9. DOI: 5168978.

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