title: The medical risks of severe anorexia nervosa during initial re-feeding and medical stabilisation.
abstract: OBJECTIVE
  Objective evidence about the risks associated with anorexia nervosa and how to manage them, is limited. The aim of this study is to describe the medical risk profile, management and outcomes of a cohort of patients with severe anorexia nervosa (sAN) during medical stabilisation treatment.
  
  
  METHODS
  Retrospective analysis of case records gathered medical risk data for a 90 day high risk period, on 65 patients with sAN admitted to two specialist services. Prospectively established definitions of medical risk variables and significant complications were applied to the data to describe the risk profiles and outcomes.
  
  
  RESULTS
  Amongst this population with an average initial BMI of 12.8 kg/m2, 74% developed no significant medical complications. Oral re-feeding over 60 days achieved an increase in mean BMI to 14.4 kg/m2and mean weight gain of 4 kg. No patients developed severe hypophosphatemia (<0.45 mmol/L) or any other indicators of a re-feeding syndrome. All the medical complications that arose were temporary.
  
  
  CONCLUSIONS
  Initial re-feeding and medical stabilisation of patients with severe AN can be managed safely in specialist inpatient and community settings with slow re-feeding. Although the prevalence of complications was shown to be low, slight worsening of medical risk markers and increased incidence of complications did occur during initial re-feeding. The limited comparable published data appears to support slower rates of re-feeding, showing fewer abnormal results and complications. There is however a need for a definitive prospective multi-centre observational cohort study to investigate risks factors, and the effects of treatment on medical outcomes, in a large sample with varied rates of re-feeding.
authors.affiliation: Anorexia Nervosa Intensive Treatment Team (ANITT), Royal Edinburgh Hospital, 6th Floor Kennedy Tower, Morningside Terrace, Edinburgh, EH10 5HF, UK.
authors.forename: Jennie E
authors.initials: JE
authors.lastname: Davies
authors.affiliation: Naomi Unit, The Retreat, Heslington Road, York, YO10 5BN, UK.
authors.forename: Annette
authors.initials: A
authors.lastname: Cockfield
authors.affiliation: Naomi Unit, The Retreat, Heslington Road, York, YO10 5BN, UK.
authors.forename: Andrea
authors.initials: A
authors.lastname: Brown
authors.affiliation: Anorexia Nervosa Intensive Treatment Team (ANITT), Royal Edinburgh Hospital, 6th Floor Kennedy Tower, Morningside Terrace, Edinburgh, EH10 5HF, UK.
authors.forename: Jean
authors.initials: J
authors.lastname: Corr
authors.affiliation: Naomi Unit, The Retreat, Heslington Road, York, YO10 5BN, UK.
authors.forename: Danielle
authors.initials: D
authors.lastname: Smith
authors.affiliation: Anorexia Nervosa Intensive Treatment Team (ANITT), Royal Edinburgh Hospital, 6th Floor Kennedy Tower, Morningside Terrace, Edinburgh, EH10 5HF, UK; Department of Psychiatry, University of Edinburgh, Kennedy Tower, Morningside Terrace, Edinburgh, EH10 5HF, UK. Electronic address: calum.munro@ed.ac.uk.
authors.forename: Calum
authors.initials: C
authors.lastname: Munro
mesh_terms: D000293:Adolescent; D000328:Adult; D000856:Anorexia Nervosa / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D015992:Body Mass Index; D002149:Energy Intake; D004739:England / Q000453:epidemiology; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D017674:Hypophosphatemia / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008499:Medical Records; D009752:Nutritional Status; D015995:Prevalence; D055677:Refeeding Syndrome / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D015430:Weight Gain; D055815:Young Adult
keywords: Hypophosphatemia; Medical risk; Re-feeding syndrome; Severe anorexia nervosa