Pediatric Nutrition in Practice

Nutrition Rehabilitation in Eating Disorders 263

3

Choice of Refeeding Methods

Hart et al. [5] reviewed the literature to identify
which of the different feeding methods is most ef-
fective and advantageous in AN. An analysis of the
published information revealed that the most
common method of refeeding was by nasogastric
feeding and food, followed by high-energy density
oral nutritional supplements and food [5]. How-
ever, due to the limited evidence available, no con-
clusion could be drawn on the most effective meth-
od of nutritional rehabilitation in AN. However,
the authors compiled benefits and disadvantages
of the different feeding methods for AN patients
( table 3 ). Similarly, Rocks et al. [6] concluded from
their review of the available literature that a con-
sensus on the most effective and safe treatment for
weight restoration in inpatient children and ado-
lescents with AN is not currently feasible. None-
theless, these authors concluded that the use of
tube feeding in addition to normal food intake in-
creased energy intake and body weight, although it
was associated with more frequent adverse effects.

A particular concern related to the use of na-

sogastric tube feeding in malnourished patients

is the risk of inducing refeeding syndrome with

hypophosphataemia. Adaption to starvation in

malnourished children and adolescents is associ-

ated with a reduced metabolic turnover, cellular

activity and organ function, low insulin secre-

tion, and deficiencies in a variety of micronutri-

ents, minerals and electrolytes [7]. Catabolic pa-

tients use substrates from adipose tissue and

muscle as sources of energy, and the total body

stores of nitrogen, phosphate, magnesium and

potassium become depleted. The sudden provi-

sion of energy and nutrients reverses catabolism

and leads to a surge of insulin secretion, which in

turn leads to massive intracellular shifts of phos-

phate, magnesium and potassium with a subse-

quent fall in their serum concentrations. The

clinical consequences of the resulting electrolyte

disturbances with hypophosphataemia include

haemolytic anaemia, muscle weakness and im-

paired cardiac function, with the risks of f luid

overload, cardiac failure, arrhythmia and death.

Table 3 (continued)

Benefits Disadvantages

Parenteral nutrition

• It requires minimal patient cooperation – It may reinforce a tendency to focus only on physical
  symptoms rather than the psychiatric implications of
  AN


• Sabotage occurs by pouring solutions into the sink and
  removing the device


• It cannot teach patients anything about eating, food
  choice or portion size, or about perceiving their bodies
  more accurately


• Medical complications [i.e. infections; arterial injury;
  cardiac arrhythmias (from placement); changes in
  vascular endothelium; hyperosmolarity and
  hyperglycaemia; hypophosphataemia and
  hypokalaemia]


• More medically intensive, incurring high costs

Modified from Hart et al. [5].

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 259–265
DOI: 10.1159/000375192