title: Refeeding Low Weight Hospitalized Adolescents With Anorexia Nervosa: A Multicenter Randomized Controlled Trial.
abstract: BACKGROUND
  Refeeding patients with anorexia nervosa (AN) is associated with high morbidity and mortality. A lack of evidence from interventional studies has hindered refeeding practice and led to worldwide disparities in management recommendations. In the first randomized controlled trial in this area, we tested the hypothesis that refeeding adolescents with AN with a higher energy intake than what many guidelines recommend improved anthropometric outcomes without adversely affecting cardiac and biochemical markers associated with refeeding.
  
  
  METHODS
  Participants aged 10-16 years with a body mass index (BMI) <78% of the median (mBMI) for age and sex were recruited from 6 UK hospitals and randomly allocated to start refeeding at 1200 kcal/d (n = 18, intervention) or 500 kcal/d (n = 18, control).
  
  
  RESULTS
  Compared with controls, adolescents randomized to high energy intake had greater weight gain (mean difference between groups after 10 days of refeeding, -1.2% mBMI; 95% confidence interval, -2.4% to 0.0%; P = .05), but randomized groups did not differ statistically in QTc interval and other outcomes. The nadir in postrefeeding phosphate concentration was significantly related to percentage mBMI at the start of refeeding (baseline; P = .04) and baseline white blood cell count (P = .005) but not to baseline energy intake (P = .08).
  
  
  CONCLUSIONS
  Refeeding adolescents with AN with a higher energy intake was associated with greater weight gain but without an increase in complications associated with refeeding when compared with a more cautious refeeding protocol-thus challenging current refeeding recommendations.
authors: Great Ormond Street Children's Hospital Foundation Trust, London, UK Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK Graeme.oconnor@nhs.net.
authors: Graeme
authors: G
authors: O'Connor
authors: Great Ormond Street Children's Hospital Foundation Trust, London, UK Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK.
authors: Dasha
authors: D
authors: Nicholls
authors: Great Ormond Street Children's Hospital Foundation Trust, London, UK.
authors: Lee
authors: L
authors: Hudson
authors: Childhood Nutrition Research Centre, UCL Institute of Child Health, London, UK.
authors: Atul
authors: A
authors: Singhal
mesh_terms: D000293:Adolescent; D000856:Anorexia Nervosa / Q000178:diet therapy*; D002648:Child; D002149:Energy Intake; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D055677:Refeeding Syndrome / Q000517:prevention & control*; D006113:United Kingdom; D015430:Weight Gain
keywords: anorexia nervosa; eating disorders; pediatrics; refeeding syndrome