title: Comparison of standardized versus individualized caloric prescriptions in the nutritional rehabilitation of inpatients with anorexia nervosa.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Psychiatry, University of Minnesota Medical Center, Minneapolis, Minnesota.
authors.forename: Ann F
authors.initials: AF
authors.lastname: Haynos
authors.affiliation: Department of Psychology, University of Nevada, Reno, Nevada.
authors.forename: Cassandra
authors.initials: C
authors.lastname: Snipes
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Angela
authors.initials: A
authors.lastname: Guarda
authors.affiliation: Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York.
authors.forename: Laurel E
authors.initials: LE
authors.lastname: Mayer
authors.affiliation: Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Attia
mesh_terms: D000328:Adult; D000856:Anorexia Nervosa / Q000523:psychology / Q000628:therapy*; D002149:Energy Intake; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D008297:Male; D018529:Nutritional Support; D055677:Refeeding Syndrome / Q000209:etiology*; D016896:Treatment Outcome; D015430:Weight Gain
keywords: anorexia nervosa; inpatient treatment; nutritional rehabilitation; weight restoration