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Int J Eat Disord. 2016 Jan;49(1):50-8. doi: 10.1002/eat.22469. Epub 2015 Sep 29.

Comparison of standardized versus individualized caloric prescriptions in the nutritional rehabilitation of inpatients with anorexia nervosa.

Author information

1
Department of Psychiatry, University of Minnesota Medical Center, Minneapolis, Minnesota.
2
Department of Psychology, University of Nevada, Reno, Nevada.
3
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
4
Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York.

Abstract

OBJECTIVE:

Sparse research informs how caloric prescriptions should be advanced during nutritional rehabilitation of inpatients with anorexia nervosa (AN). This study compared the impact of a standardized caloric increase approach, in which increases occurred on a predetermined schedule, to an individualized approach, in which increases occurred only following insufficient weight gain, on rate, pattern, and cumulative amount of weight gain and other weight restoration outcomes.

METHOD:

This study followed a natural experiment design comparing AN inpatients consecutively admitted before (n = 35) and after (n = 35) an institutional change from individualized to standardized caloric prescriptions. Authors examined the impact of prescription plan on weekly weight gain in the first treatment month using multilevel modeling. Within a subsample remaining inpatient through weight restoration (n = 40), multiple regressions examined the impact of caloric prescription plan on time to weight restoration, length of hospitalization, maximum caloric prescription, discharge BMI, and incidence of activity restriction and edema.

RESULTS:

There were significant interactions between prescription plan and quadratic time on average weekly weight gain (p = .03) and linear time on cumulative weekly weight gain (p < .001). Under the standardized plan, patients gained in an accelerated curvilinear pattern (p = .04) and, therefore, gained cumulatively greater amounts of weight over time (p < .001). Additionally, 30% fewer patients required activity restriction under the standardized plan.

DISCUSSION:

Standardized caloric prescriptions may confer advantage by facilitating accelerated early weight gain and lower incidence of bedrest without increasing the incidence of refeeding syndrome.

KEYWORDS:

anorexia nervosa; inpatient treatment; nutritional rehabilitation; weight restoration

PMID:
26769581
PMCID:
PMC4717916
DOI:
10.1002/eat.22469
[Indexed for MEDLINE]
Free PMC Article

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