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Comparison of standardized versus individualized caloric prescriptions in the nutritional rehabilitation of inpatients with anorexia nervosa.
Int J Eat Disord 2016; 49(1):50-8IJ

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.

Authors+Show Affiliations

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

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

26769581

Citation

Haynos, Ann F., et al. "Comparison of Standardized Versus Individualized Caloric Prescriptions in the Nutritional Rehabilitation of Inpatients With Anorexia Nervosa." The International Journal of Eating Disorders, vol. 49, no. 1, 2016, pp. 50-8.
Haynos AF, Snipes C, Guarda A, et al. Comparison of standardized versus individualized caloric prescriptions in the nutritional rehabilitation of inpatients with anorexia nervosa. Int J Eat Disord. 2016;49(1):50-8.
Haynos, A. F., Snipes, C., Guarda, A., Mayer, L. E., & Attia, E. (2016). Comparison of standardized versus individualized caloric prescriptions in the nutritional rehabilitation of inpatients with anorexia nervosa. The International Journal of Eating Disorders, 49(1), pp. 50-8. doi:10.1002/eat.22469.
Haynos AF, et al. Comparison of Standardized Versus Individualized Caloric Prescriptions in the Nutritional Rehabilitation of Inpatients With Anorexia Nervosa. Int J Eat Disord. 2016;49(1):50-8. PubMed PMID: 26769581.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of standardized versus individualized caloric prescriptions in the nutritional rehabilitation of inpatients with anorexia nervosa. AU - Haynos,Ann F, AU - Snipes,Cassandra, AU - Guarda,Angela, AU - Mayer,Laurel E, AU - Attia,Evelyn, Y1 - 2015/09/29/ PY - 2015/09/09/accepted PY - 2016/1/16/entrez PY - 2016/1/16/pubmed PY - 2016/9/7/medline KW - anorexia nervosa KW - inpatient treatment KW - nutritional rehabilitation KW - weight restoration SP - 50 EP - 8 JF - The International journal of eating disorders JO - Int J Eat Disord VL - 49 IS - 1 N2 - 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. SN - 1098-108X UR - https://www.unboundmedicine.com/medline/citation/26769581/Comparison_of_standardized_versus_individualized_caloric_prescriptions_in_the_nutritional_rehabilitation_of_inpatients_with_anorexia_nervosa_ L2 - https://doi.org/10.1002/eat.22469 DB - PRIME DP - Unbound Medicine ER -