Evidence map›Paper›PMID 38179719›Full record

Trial reportThe International journal of eating disorders2024

Short-term outcomes of the study of refeeding to optimize inpatient gains for patients with atypical anorexia nervosa.

Andrea K Garber, Jing Cheng, Erin C Accurso, Sara M Buckelew, Amanda E Downey, Daniel Le Grange, Sasha Gorrell, Cynthia J Kapphahn, Anna Kreiter, Anna-Barbara Moscicki and 1 more

Open access · hybridAbstract readRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in The International journal of eating disorders, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
2.6field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it, 4 citations in OpenAlex.

  1. Guideline
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors at 3 institutions in 1 country.

Andrea K GarberDepartment of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA.ORCID 0000-0002-7563-0651
Jing ChengDepartment of Preventive and Restorative Dental Sciences, University of California, San Francisco, California, USA.ORCID 0000-0002-0417-3713
Erin C AccursoDepartment of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.ORCID 0000-0002-5521-6381
Sara M BuckelewDepartment of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA.
Amanda E DowneyDepartment of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, San Francisco, California, USA.ORCID 0000-0002-5206-7798
Daniel Le GrangeDepartment of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.ORCID 0000-0001-7293-9496
Sasha GorrellDepartment of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.ORCID 0000-0002-8861-8547
Cynthia J KapphahnDepartment of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, Los Angeles, California, USA.ORCID 0000-0002-5667-4157
Anna KreiterDepartment of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, Los Angeles, California, USA.
Anna-Barbara MoscickiDepartment of Pediatrics, Division of Adolescent and Young Adult Medicine, University of California, Los Angeles, California, USA.
Neville H GoldenDepartment of Pediatrics, Division of Adolescent Medicine, Stanford University, Stanford, California, USA.ORCID 0000-0003-2262-6955
University of California, San Francisco · USUniversity of California, Los Angeles · USStanford University · US

Funding

Multi-center Randomized Controlled Trial of Refeeding in Anorexia NervosaR01HD082166 · NICHD · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI GARBER, ANDREA K · 2015 to 2025
$5.7M
Neural Correlates of Reinforcement Learning Specific to Hyperactivityin Adolescent Anorexia NervosaK23MH126201 · NIMH · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI GORRELL, SASHA CATHERINE · 2021 to 2025
$848k
Adapting and Implementing Family-Based Treatment for Youth with Anorexia Nervosa in Publicly-Funded SettingsK23MH120347 · NIMH · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · PI ACCURSO, ERIN CECILIA · 2019 to 2023
$846k
Characterizing Acute Exercise Response in Restrictive Eating DisordersR21MH131787 · NIMH · UNIVERSITY OF WISCONSIN-MADISON · PI GORRELL, SASHA CATHERINE, SCHAUMBERG, KATHERINE · 2023 to 2023
$450k
NICHD NIH HHS R01 HD082166NIMH NIH HHS K23 MH120347NIMH NIH HHS K23MH120347NIMH NIH HHS K23 MH126201NIMH NIH HHS K23MH126201NIMH NIH HHS R21 MH131787NIMH NIH HHS R21MH131787
6 · The paper itself

Abstract

objectiveThe StRONG trial demonstrated the safety and efficacy of higher calorie refeeding (HCR) in hospitalized adolescents and young adults with malnutrition secondary to restrictive eating disorders. Here we compare refeeding outcomes in patients with atypical anorexia nervosa (atypical AN) versus anorexia nervosa (AN) and examine the impact of caloric dose.

methodPatients were enrolled upon admission and randomized to meal-based HCR, beginning 2000 kcal/day and advancing 200 kcal/day, or lower calorie refeeding (LCR), beginning 1400 kcal/day and advancing 200 kcal every other day. Atypical AN was defined as %median BMI (mBMI) > 85. Independent t-tests compared groups; multivariable linear and logistic regressions examined caloric dose (kcal/kg body weight).

resultsAmong n = 111, mean ± SD age was 16.5 ± 2.5 yrs; 43% had atypical AN. Compared to AN, atypical AN had slower heart rate restoration (8.7 ± 4.0 days vs. 6.5 ± 3.9 days, p = .008, Cohen's d = -.56), less weight gain (3.1 ± 5.9%mBMI vs. 5.4 ± 2.9%mBMI, p < .001, Cohen's d = .51) and greater hypomagnesemia (29% vs. 11%, p = .03, OR = 3.29). These suboptimal outcomes were predicted by insufficient caloric dose (32.4 ± 6.9 kcal/kg in atypical AN vs. 43.4 ± 9.8 kcal/kg in AN, p < .001, Cohen's d = 1.27). For every 10 kcal/kg increase, heart rate was restored 1.7 days (1.0, 2.5) faster (p < .001), weight gain was 1.6%mBMI (.8, 2.4) greater (p < .001), and hypomagnesemia odds were 70% (12, 128) lower (p = .02). DISCUSSION: Although HCR is more efficacious than LCR for refeeding in AN, it contributes to underfeeding in atypical AN by providing an insufficient caloric dose relative to the greater body weight in this diagnostic group. PUBLIC SIGNIFICANCE: The StRONG trial previously demonstrated the efficacy and safety of higher calorie refeeding in patients with malnutrition due to restrictive eating disorders. Here we show that higher calorie refeeding contributes to underfeeding in patients with atypical anorexia nervosa, including poor weight gain and longer time to restore medical stability. These findings indicate these patients need more calories to support nutritional rehabilitation in hospital.

Indexed as

Anorexia NervosaRefeeding SyndromeAdolescentBody WeightHumansInpatientsWeight Gainanorexia nervosaatypical anorexia nervosacaloric dosehigher calorie refeedinglower calorie refeedingmalnutritionmedical instabilitynutritional rehabilitationrefeeding

Identifiers

PMID38179719
PMCPMC11302985
OpenAlexW4390614208

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.