Hospitalization For Anorexia Nervosa Research Articles

Abnormal Kidney Function in Anorexia Nervosa

Source: Gurevich E, Steiling S, Landau D. Incidence of impaired kidney function among adolescent patients hospitalized with anorexia nervosa. JAMA Netw Open. 2021;4(11):e2134908. doi:10.1001/jamanetworkopen.2021.34908Investigators from Schneider’s Children’s Medical Center of Israel, Petach Tikva, Israel, and Sackler School of Medicine, Tel Aviv, Israel, conducted a retrospective study to assess kidney function in children and adolescents hospitalized with anorexia nervosa (AN) and identify predictors of impaired kidney function (IKF) in these patients. For the study, discharge diagnoses were used to identify youths, 9-18 years old, hospitalized at Schneider’s Children’s Medical Center of Israel for AN between 2010 and 2019. Only youths with a first-time hospitalization for AN were included in the study. Patients with AN were age- and sex-matched to a random sample of control children with normal serum creatinine (SCr) levels, hospitalized for other reasons during the same period. The medical records of study participants were reviewed and data on demographics, BMI, and SCr abstracted. In patients with AN, data on free triiodothyronine (FT3) level and minimal heart rate (HR) also were collected. Kidney function was assessed in study participants using maximal SCr levels, minimal estimated glomerular filtration rate (eGFR) and SCr/BMI ratio during the hospitalizations. These parameters were compared in AN patients and controls using chi-square or Fisher exact tests. AN patients were classified as having IKF if their minimal eGFR during the hospitalization was <90 mL/min/1.73 m2. Stepwise regression was used to identify predictors of IKF in AN patients.A total of 395 youths with AN and 495 controls were included in the analyses. The mean age of AN patients was 14.6 ± 2.2 years, and 298 (81.6%) were female. The median BMI percentile in those with AN was 12.3, compared to 49 in controls (P <0.001). Parameters of kidney function were significantly different between AN patients and controls including maximal SCr (mean values, 0.68 ± 0.15 mg/dL and 0.54 ± 0.14 mg/dL, respectively; P <0.001), SCr/BMI (mean values, 4% ± 1.2% and 2.8% ± 1.1%, respectively; P <0.001), and minimal eGFR (mean values, 99.8 ± 22.0 mL/min/1.73 m2 and 124 ± 26.5 mL/min/1.73 m2, respectively; P <0.001). Among those with AN, 146 (37%) met criteria for IKF compared to 0 control patients. In the group of AN patients, those with IKF had a significantly lower minimal HR than those without IKF (mean, 44 vs 56 beats per minute; P = 0.001) and lower FT3 levels (mean, 3.5 vs 4.1 pmol/L; P = 0.001); there was no significant difference between groups for mean BMI. Independent predictors of IKF in AN patients included SCr/BMI ratio, minimal HR, and systolic and diastolic blood pressure.The authors conclude that IKF is common in youths hospitalized with AN.Dr Sanchez-Kazi has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.AN has a prevalence rate between 0.1% and 2.2%.1 As previously reported, IKF is a known complication of AN with multifactorial etiologies including chronic dehydration, electrolyte derangements, and abuse of certain medications.2 Chronic hypokalemia has been associated with acute kidney injury (AKI) and chronic kidney disease.2 Other electrolyte abnormalities reported with AN and during refeeding include hypophosphatemia, hypomagnesemia, and hyponatremia. (See AAP Grand Rounds. 2021;45(2):16.)2,3 Kidney biopsy has shown interstitial fibrosis, evidence of ischemic injury, and hypokalemic nephropathy.2The biggest limitation of the current study, and all studies of AN, is the inability to accurately determine eGFR. Using creatinine and correction of eGFR per body surface is likely inaccurate due to low muscle mass. The prevalence of IKF in AN may increase or decline depending on the accuracy of eGFR. Using nuclear GFR may be more precise, although cumbersome, or perhaps measurement of serum cystatin C.4,5 Cystatin C, a low molecular weight protein secreted by all nucleated cells, is independent of muscle mass.4,5 BMI was used to correct for low muscle mass in the current study, although this method has not been verified. It is interesting to note that admission BMI did not correlate with eGFR, but minimal heart rate did. Does this suggest that cardiac abnormalities may contribute to reduction in kidney perfusion in AN?Although the current study was performed in Israel, AN is universal. AKI has been associated with longer hospitalization and increased morbidity not only in AN but also in other non-AN conditions.6In adolescent patients hospitalized with recently diagnosed AN, kidney function often is impaired and needs to be followed closely.The global pandemic of COVID-19 has been associated with a marked increase incidence of eating disorders.7 Social distancing, changes in food access and habits, and social pressure exerted through the internet appear to be contributory. Recent AAP guidelines outline the pediatrician’s role in detection and management of children and adolescents with disordered eating.8

Diversité des prises en charge hospitalières de l’anorexie mentale en psychiatrie en France

BackgroundHospitalization is rare in anorexia nervosa (AN) and local application of indications is heterogeneous. However, no study has evaluated the effect of these different treatment modalities on the mean length of stay. Our objective was to describe the context and modalities of a wide range of hospital care programs offered to patients with anorexia nervosa in eleven specialized French psychiatric centers for patients from childhood to adulthood. This work was carried out within the framework of the EVHAN (Evaluation of Hospitalization for AN, Eudract number: 2007-A01110-53, registered in Clinical trials) research program. The EVHAN program comprises five main lines: weight objectives at discharge, the practice or not of a separation period, the use of clear nutritional dietary objectives (cognitive/behavioral), the intensity of family involvement in treatment, and the existence or absence of a stabilization phase before ending inpatient treatment. These main lines will make it possible to study the impact of treatment modalities on the future of patients in the short and medium term (at discharge and at 1-year follow-up). MethodsThe eleven centers are located in France (Bordeaux, Nantes, Paris and Ile-de-France, Rouen and Saint-Étienne). Various staff members (psychiatrists, somatic doctors, nurses, dieticians, psychologists) from each center were interviewed using a semi-structured questionnaire. Data on operating modalities and context of care were collected and analyzed. ResultsFour of the eleven centers were exclusively child/adolescent centers, and seven of 11 were adolescent (from 11, 13 or 16 years) and young adult centers. All centers offered a graduated approach from outpatient to full hospitalization. The majority had a number of beds allocated for patients with eating disorders. The criteria for hospitalization were homogeneous with respect to somatic and/or psychic severity prefiguring the consensus criteria defined by the French Health Authority (HAS) in 2010. Child/adolescent units used the weight curve to set weight objectives at discharge (between the 10th and 50th percentiles). Most adult units used weight objectives at discharge corresponding to a body mass index between 17 and 20kg/m2. Nine centers used a written or oral care contract. One unit did not separate the patient from her/his usual environment, the others had a practice gradient of partial separation and total separation times. These were either short, lasting a maximum of 3 weeks, or long, lasting more than 3 weeks. Conversely, patients were not isolated within the unit, and benefited from a rich social life, depending on her/his physical condition. The patient's family was in contact with the team and fully supported. The longest periods of separation involved adolescents and adults. Nutritional support varied from a group approach (meals in the dining room, standardized meals of the care center) to very individualized approaches within a specific framework. All the units reported meeting with families at least once during the hospitalization; with the patient's parents for child/adolescent patients and/or unmarried patients and with the husband/wife for married patients. The majority of the centers requested a phase of weight stabilization, whatever the age before hospital discharge. ConclusionThere is international and national consensus regarding the indications for hospitalization, and the main lines of multidisciplinary care to be developed within this framework. However, local application of these indications was heterogeneous resulting in diverse modalities of hospital care for anorexia nervosa in France. Specialized teams have developed management strategies arising from their “team culture”. The complexity of the anorexic pathology, due to the psyche-soma intrication and the diversity of age groups, highlights the complexity of care available. The impact of this diversity of hospital care on patient outcomes will be studied as a result of this work.

Quels facteurs expliquent la durée d’hospitalisation pour anorexie mentale: revue systématique de la littérature

ObjectivesThe cost of hospital treatment for anorexia nervosa (AN) is very high given its duration. Identifying factors related to length of hospital stay (LOS) would make it possible to consider targeted therapeutic strategies that, by optimizing care, would reduce their duration and costs. The objective of this work is to identify the factors related (predictive and associated) to LOS for AN. MethodsSystematic review of existing literature up to October 2020, based on Pubmed, according to PRISMA recommendations (Preferred Reported Items for Systematic reviews and Meta-Analysis). Factors related to LOS have been described in two categories: factors related to clinical aspects ; and factors related to therapeutic aspects and management modalities. We distinguished predictive factors (identified as pre-hospitalization or contemporaneous with hospital admission) and associated factors (observed during hospitalization) for each category. ResultsThirteen articles were selected. Samples from the selected studies ranged from 35 to 381 subjects, mostly women with restrictive type AN (R-AN), but some samples included all types of AN, or focused on purging-type forms. The mean age at admission ranged from 13.6 years (Standard Deviation–SD:±1.6) to 30.3 years (SD :±13.9), corresponding to adolescent, adult or mixed samples. Mean body mass indices at admission ranged from 12.3 (SD±1.4) to 16.6 (SD:±2.1). The duration of disease progression ranged from 11.7 months±2.2 to 9.7 years. Mean LOS are short for studies conducted in pediatrics or in medical services (ranging from 13.0 days [SD±7.3] to 22.1 days [SD±9.4]); they are more variable for studies conducted in psychiatry: from 15.6 days (SD±1.0) to 150.2 days (SD±80.8). Among the factors related to an increase in LOS, clinical predictors included: older age at onset or admission; longer duration of the disorder; low minimum body weight during AN; low BMI at admission; purgative form of anorexia nervosa; and high levels of dietary symptoms (asceticism and ineffectiveness dimensions on Eating Disorder Inventory-2). Therapeutic and management modality predictive factors were: a higher number of hospitalizations for AN; the use of enteral nutrition (nasogastric or percutaneous gastric tube) on admission or during hospitalization; the use of intravenous renutrition coupled with oral renutrition; hospitalization far from the patient's home; absence of hospital care in psychiatry after medical stabilization in a somatic unit; compulsory hospitalization. Associated factors were: the presence of psychiatric comorbidities; greater weight gain during hospitalization. Among the factors related to a decrease in LOS, the clinical predictive factor were: greater self-confidence at admission (measured by the Eating Disorder Recovery Self-Efficacy Questionnaire). Therapeutic and management modality predictors included: increased caloric intake of oral renutrition on admission; intake of oral nutritional supplements on admission; and hospitalization in urban areas. The associated factor was: compliance with the weight contract in the adolescent population. DiscussionFactors related to an increase in LOS are explained by: higher resistance to treatment, higher severity of the disease, the time required for weight gain in services using cognitive-behavioural therapy, complications associated with renutrition modalities such as parenteral renutrition, difficulties in organising outpatient follow-up which require better consolidation of inpatient treatment and the lack of multidisciplinary care in medical services. Factors related to a decrease in LOS are due to: faster weight gain, the presence of a greater number of outpatient follow-up structures close to the hospital and better adherence to treatment to complete the weight contract. ConclusionsTaking these factors into account during hospitalization for AN would help optimize care, duration and costs. This situation therefore requires the development of therapeutic trials targeting the identified factors in order to reduce LOS in the treatment of AN.

Sense of coherence in long-term follow-up of adolescents with anorexia nervosa

Background Sense of coherence (SOC) is a personal resource that allows people to stay healthy in spite of stressful situations. SOC is known to be low in eating disorders. We explored whether SOC correlated with anorexia nervosa (AN) symptoms several years after initial hospitalization for AN, to inform us whether AN treatment concepts could more specifically focus on increasing SOC. Methods Former patients were contacted 5–11 years after hospitalization for AN in a German integrative medicine hospital. Participants completed the Eating Disorder Inventory (EDI-2) and the SOC Questionnaire (SOC-13). Hospital records were reviewed. Correlations between EDI-2 subscales and SOC-13 were tested. A t-test was conducted to assess the difference between the SOC-13 and the norm. A median split was performed, dividing SOC scores into two groups and comparing these with EDI-2 subscales. Results Of 149 previously hospitalized female patients, 83 could be contacted and 68 agreed to participate (46%). 17.6% self-reported that they currently suffered from an eating disorder. The mean follow-up time was 7.2 years. All EDI-2 subscales correlated negatively with the SOC-13 score (p < .01). The mean SOC was significantly lower than the norm (p < .001). In the median split, the lower SOC group had significantly higher scores on all EDI-2 subscales. Conclusions Amongst previously hospitalized AN patients, the SOC was lower than a normative sample and correlated with on-going eating disorder symptoms in long-term follow-up. Strengthening SOC as a personal resource should be incorporated as a specific goal in AN treatment and its impact on long-term outcomes evaluated.

Absence of relationships between depression and anxiety and bone mineral density in patients hospitalized for severe anorexia nervosa.

Low BMD is frequent in anorexia nervosa (AN), depression, and during SSRI treatment but relation between these elements in AN is not established. The aims of this study were to assess the relationships between depression and anxiety, SSRI prescription, and (1) low BMD during inpatient treatment and (2) BMD change 1year after hospital discharge. From 2009 to 2011, 212 women with severe AN have been included in the EVHAN study (EValuation of Hospitalisation for AN). Depression, anxiety and obsessive-compulsive symptoms and comorbidity were evaluated using psychometric scales and CIDI-SF. BMD was measured by dual-energy X-ray absorptiometry. According to the CIDI-SF, 56% of participants (n = 70) had a lifetime major depressive disorder, 27.2% (n = 34) had a lifetime obsessive-compulsive disorder, 32.8% (n = 41) had a lifetime generalized anxiety disorder and 25.6% (n = 32) had a lifetime social phobia disorder. Half of the sample (50.7%; n = 72) had a low BMD (Z score ≤ -2). In multivariate analysis, lifetime lowest BMI was the only determinant significantly associated with low BMD (OR = 0.56, p = 0.0008) during hospitalization. A long duration of AN (OR = 1.40 (0.003-3.92), p = 0.03), the AN-R subtype (OR = 4.95 (1.11-26.82), p = 0.04), an increase of BMI between the admission and 1year (OR = 1.69 (1.21-2.60), p = 0.005) and a gain of BMD 1year after the discharge explained BMD change. We did not find any association between depression and anxiety or SSRI treatment and a low BMD or variation of BMD. Level III, cohort study.

Symptomatology long-term evolution after hospitalization for anorexia nervosa: Drive for thinness to explain effects of body dissatisfaction on type of outcome

Anorexia nervosa (AN) is a serious psychiatric disorder associated with the highest mortality rate. Body dissatisfaction (BD) is now considered as an important risk factor for AN onset and relapse. Recent results lead to the hypothesis according to which AN and drive for thinness (DT) are related to body dissatisfaction. The primary aim of this current study was to identify whether DT mediated the relationship between BD and AN symptoms several years after hospitalization. As a secondary aim, self-reported Body Shape Questionnaire, Eating Attitude Test, Eating Disorder Inventory and Beck Depression Inventory scores were compared between the 48 women with a history of severe AN and 73 matched controls. A mediation analysis didn't show evidence of a direct effect of BD on eating disorder symptomatology after controlling for DT suggesting a full mediation of DT on the association between BD and eating disorders symptomatology. Results also showed that patients with a bad outcome had a higher score of DT than controls, which was not the case of patients with a good outcome. These findings highlight the potential importance of DT and the usefulness of targeting this dimension in therapeutic interventions for AN patients if further research confirm these results.

Are lifetime affective disorders predictive of long-term outcome in severe adolescent anorexia nervosa?

Depression and anxiety are commonly associated with anorexia nervosa (AN) and contribute to difficulties in social integration, a negative factor for outcome in AN. The link between those disorders and AN has been poorly studied. Thus, our objective was to investigate (1) the link between outcome nine years after hospitalisation for AN and the occurrence of lifetime anxious or depressive comorbidities; (2) the prognostic value of these comorbidities on patient outcome; 181 female patients were hospitalised for AN (between 13 and 22years old), and were re-evaluated for their psychological, dietary, physical and social outcomes, from 6 to 12years after their hospitalisation. The link between anxious and depressive disorders (premorbid to AN and lifetime) and the outcome assessment criteria were tested through multivariate analyses; 63% of the participants had good or intermediate outcome, 83% had presented at least one anxiety or depression disorder in the course of their lives, half of them before the onset of AN. Premorbid obsessive compulsive disorders (OCD), BMI at admission, and premenarchal AN all contribute to poor prognosis. Social phobia and agoraphobia affect the subjects' quality of life and increase eating disorder symptoms. These results encourage a systematic assessment of, and care for, anxiety and depression comorbidities among female adolescent patients with a particular focus on premorbid OCD.

Impact of somatic severity on long-term mortality in anorexia nervosa.

Anorexia nervosa (AN) is a severe pathology on account of the high levels of associated morbidity and mortality. This study aimed to assess whether time in somatic intensive care unit, justified by a patient's somatic condition in the course of hospital care, has any relationship with patient outcome in terms of mortality in the long term. 195 patients were hospitalised for AN between April 1996 and May 2002, 97 were re-assessed 9years later on average. Out of 195 patients hospitalised for AN between April 1996 and May 2002, 29 had required transfer to intensive care. Mortality at 9years was 20 times higher in the group having been transferred to intensive care, irrespective of the duration of follow-up. The clinical seriousness of the somatic condition during hospitalisation for AN is a risk factor for excess mortality in the medium term.

Predictors of Positive Treatment Outcome in People With Anorexia Nervosa Treated in a Specialized Inpatient Unit: The Role of Early Response to Treatment.

To investigate factors which predict positive treatment outcome in inpatients with anorexia nervosa (AN), particularly the role of early treatment response. 102 patients entering specialist inpatient treatment were assessed for eating disorder history, psychopathology, and motivation to change. Predictive factors assessed were: early treatment response defined as weight increase of at least 0.5-1 kg/week during the first 6 weeks of treatment (n=87), admission body mass index (BMI), onset age, chronicity, motivation to change, diagnosis, and previous hospitalization for AN. Positive treatment outcome was defined as achieving a BMI of 17.5 kg/m(2) within an individual time frame. Logistic regression indicated that patients were 18 times more likely to reach positive treatment outcome if they met the National Institute for Health and Care Excellence weight guidelines within the first 6 weeks of hospitalization. Higher admission BMI was also found to predict positive treatment outcome. Higher entry BMI and early weight gain predict positive treatment outcome in individuals receiving specialist AN inpatient treatment. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Trends of hospitalization for anorexia nervosa in USA: A nationwide analysis

ObjectivesAnorexia Nervosa (AN) is an important cause of morbidity and mortality in hospitalized patients. While AN has been extensively studied in the past, the contemporary data for impact of AN on cost of hospitalization are largely lacking.MethodsWe queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample (HCUP-NIS) dataset between 1998-2011 using the ICD-9 codes for AN. Severity of co-morbid conditions was defined by Deyo modification of Charlson co-morbidity index. Primary outcome was in-hospital mortality and secondary outcome was total charges for hospitalization. Using SAS 9.2, chi-square test, t-test and Cochran-Armitage test were used to test significance.Results28,150 patients were analyzed. 93.94% were female and 6.06% were male (P &lt; 0.0001). 88.67% were white, 2.93% were black and 8.4% were of other race (P &lt; 0.0001). Rate of hospitalization decreased from 1530/million to 1349.5/million from 1998-2011. Overall mortality was 0.78% and mean cost of hospitalization was 25,829.82$. The in-hospital mortality reduced from 0.95% to 0.44% (P &lt; 0.0001) and mean cost of hospitalization increased from 11,956.55$ to 39,831.51$. Total yearly spending on AN related admissions increased from $145.33 million/year to $420.61 million/year.ConclusionsWhile mortality has slightly decreased from 1998 to 2011, the cost has significantly increased from $145.33 million/year to $420.61 million/year, which leads to an estimated $275.28 million additional burden to the US health care system. In the era of cost conscious care, preventing AN related Hospitalization could save billions of dollars every year. Focused efforts are needed to establish preventive measures for AN related hospitalization.Disclosure of interestThe authors have not supplied their declaration of competing interest.

19. Adolescents With Higher Historical Weights Present With Greater Weight Loss and Lower Heart Rate Upon Hospitalization for Anorexia Nervosa

19. Adolescents With Higher Historical Weights Present With Greater Weight Loss and Lower Heart Rate Upon Hospitalization for Anorexia Nervosa

Hospitalisation pour anorexie mentale à l’adolescence : quel devenir 10 ans plus tard pour ces jeunes femmes ?

ObjectivesRecent studies in Sweden have shown that the mortality observed in recent years following hospitalisation for anorexia nervosa (AN) is falling. A study carried out by our team in 1991 showed a fairly high mortality rate of 7%, 11 years after hospitalisation for AN. What is the situation in 2011? What is the outcome of patients who have followed a care programme that has undergone changes? Patients and methodsThe study reconstituted a cohort of 180 patients hospitalised for AN between the age of 13 and 22 years. It was possible to evaluate 180 young women with regard to vital status, on average 9.7 ± 1.6 years after their hospitalisation. Ninety-seven young women (51%) were also evaluated with respect to their outcomes – psychological, eating habits, physical and social conditions. This was done using a self-assessment (clinical questionnaire, the Eating Disorder Inventory [EDI-2], the Social Adjustment Scale, Self-Report [SAS-SR] and the World Health Organization Questionnaire Quality of Life [WHOQOL short-form]) and a face-to-face interview looking for clinical data using questionnaires and structured instruments (Mini International Neuropsychiatric Interview [MINI], Morgan and Russell outcome scale). ResultsAmong the 180 subjects in the initial sample, four young women had died, i.e. 2.1% of the sample. The 97 subjects who were re-assessed were not different from the others at the time of hospitalisation. In the follow-up evaluation, the overall outcome of the patients was good or intermediate for 62.9% of the subjects. Their actual BMI was variable, ranging from underweight (10.94kg/m) to overweight (27.01kg/m), with a mean of 19.38±2.71kg/m. BMI was above the AN threshold for 85.3% of cases, and menstruation was present in about the same proportion. The mean score on the EDI-2 was fairly good, although it was 10 points above the mean score for the general population (54.94±40.05) compared to 44 in the general population; this is nevertheless well above the mean for an anorexic population, which is 106. Only 15.5% of the subjects (n=15) were still suffering from AN or bulimia (BN) according to complete DSM-IV criteria. Four were AN-R, and 11 were alternating from AN to BN. Social adjustment was good on average (mean score of 1.74±0.43 on SAS-SR scale) as was their quality of life (mean score 67.05±18.37 on the WHOQOL short form). The mortality of our sample was six times over the rate observed in general population. ConclusionAN that requires hospitalization during adolescence is a high morbi-mortality pathology.

Increased Physical Activity Not Decreased Energy Intake Is Associated with Inpatient Medical Treatment for Anorexia Nervosa in Adolescent Females

There is a dearth of data regarding changes in dietary intake and physical activity over time that lead to inpatient medical treatment for anorexia nervosa (AN). Without such data, more effective nutritional therapies for patients cannot be devised. This study was undertaken to describe changes in diet and physical activity that precede inpatient medical hospitalization for AN in female adolescents. This data can be used to understand factors contributing to medical instability in AN, and may advance rodent models of AN to investigate novel weight restoration strategies. It was hypothesized that hospitalization for AN would be associated with progressive energy restriction and increased physical activity over time. 20 females, 11–19 years (14.3±1.8 years), with restricting type AN, completed retrospective, self-report questionnaires to assess dietary intake and physical activity over the 6 month period prior to inpatient admission (food frequency questionnaire, Pediatric physical activity recall) and 1 week prior (24 hour food recall, modifiable activity questionnaire). Physical activity increased acutely prior to inpatient admission without any change in energy or macronutrient intake. However, there were significant changes in reported micronutrient intake causing inadequate intake of Vitamin A, Vitamin D, and pantothenic acid at 1 week versus high, potentially harmful, intake of Vitamin A over 6 months prior to admission. Subject report of significantly increased physical activity, not decreased energy intake, were associated with medical hospitalization for AN. Physical activity and Vitamin A and D intake should be carefully monitored following initial AN diagnosis, as markers of disease progression as to potentially minimize the risk of medical instability.

Project 3: Outcome 6 to 12 years after hospitalisation for anorexia nervosa in adolescence

Project 3: Outcome 6 to 12 years after hospitalisation for anorexia nervosa in adolescence

A Prospective Examination of Weight Gain in Hospitalized Adolescents With Anorexia Nervosa on a Recommended Refeeding Protocol

Current refeeding recommendations for adolescents hospitalized with anorexia nervosa (AN) are conservative, starting with low calories and advancing slowly to avoid refeeding syndrome. The purpose of this study was to examine weight change and clinical outcomes in hospitalized adolescents with AN on a recommended refeeding protocol. Adolescents aged 13.1-20.5 years were followed during hospitalization for AN. Weight, vital signs, electrolytes, and 24-hour fluid balance were measured daily. Percent median body mass index (%MBMI) was calculated as 50th percentile BMI for age and gender. Calories were prescribed on admission and were increased every other day. Thirty-five subjects with a mean (SD) age of 16.2 (1.9) years participated over 16.7 (6.4) days. Calories increased from 1,205 (289) to 2,668 (387). No subjects had refeeding syndrome; 20% had low serum phosphorus. Percent MBMI increased from 80.1 (11.5) to 84.5 (9.6); overall gain was 2.10 (1.98) kg. However, 83% of subjects initially lost weight. Mean %MBMI did not increase significantly until day 8. Higher calories prescribed at baseline were significantly associated with faster weight gain (p = .003) and shorter hospital stay (p = .030) in multivariate regression models adjusted for %MBMI and lowest heart rate on admission. Hospitalized adolescents with AN demonstrated initial weight loss and slow weight gain on a recommended refeeding protocol. Higher calorie diets instituted at admission predicted faster weight gain and shorter hospital stay. These findings support the development of more aggressive feeding strategies in adolescents hospitalized with AN. Further research is needed to identify caloric and supplementation regimens to maximize weight gain safely while avoiding refeeding syndrome.

Psychosocial determinants and family background in anorexia nervosa—results from the Stockholm birth cohort study

The aim of this study was to examine the associations between psychosocial factors and family background and incidence of anorexia nervosa (AN) in a Swedish cohort. The Stockholm Birth Cohort, SBC (N = 14,294) contains information on social background and general health in males and females, born in Stockholm 1953. Hospitalizations for AN, based on diagnoses from the ICD-8 through ICD-10, were recorded from 1969 to 2002. Cox proportional hazard regression was used to measure the association between psychosocial characteristics and family background and the risk of AN. Higher maternal education was associated with a higher risk for hospitalization for AN. An increased risk for AN was also found among females who stated that they "often compare their future prospects with others." Although the study is based on a low number of cases, it confirms earlier findings of higher maternal education among individuals with eating disorders in similar cohorts.

Adolescents with Anorexia Nervosa: Multiple Perspectives of Discharge Readiness

Little is known about the conditions that must be in place to help adolescent patients and their families gain the confidence needed to continue recovery at home, following the adolescents' hospitalization for anorexia nervosa. Beliefs about discharge readiness were obtained through an open-ended questionnaire following the patients' first weekend pass home from an in-patient unit. The perceptions of patients, parents, and registered nurses were obtained using parallel versions of a questionnaire. An examination of the responses revealed four themes; medical stability, education, psychological changes, and community resource planning, that were common to all respondents, as well as themes specific to adolescents and to nurses. The findings suggest that each group of respondents has unique discharge readiness needs and that registered nurses have an important role to play in helping patients and families make the transition home as successful as possible. Implications for nursing practice are highlighted.

Long-term prognosis in anorexia nervosa: lessons from a 21-year follow-up study

In a prospective long-term follow-up of 84 patients 21 years after first hospitalisation for anorexia nervosa, we found that 50.6% had achieved a full recovery, 10.4% still met full diagnostic criteria for anorexia nervosa, and 15.6% had died from causes related to anorexia nervosa. Predictors of outcome included physical, social, and psychological variables.