An Investigation of Effective Nutritional Rehabilitation for Adolescents and Young Adults with Restrictive Eating Disorders

Abstract

Patients hospitalised with restrictive eating disorders (EDs) require nutritional rehabilitation as a core component of inpatient treatment, to reverse malnutrition associated medical instabilities and complications, restore body weight and address disordered eating behaviours. Although conservative consensus-based guidelines have traditionally advocated a ‘start low, go slow’ approach to refeeding, recently, evidence has challenged these guidelines by providing a more assertive feeding approach without the increased development of refeeding complications. However, uncertainty continues around the optimal nutritional rehabilitation provided to patients, including macronutrient composition and prophylactic supplementation.

This thesis aims to contribute to the evidence base that guides dietetic management of adolescents and young adolescents (AYA’s) hospitalised with restrictive EDs by: (1) conducting an audit of thiamine levels during the nutritional rehabilitation of AYA’s hospitalised with restrictive EDs, (2) systematically reviewing evidence on macronutrient composition provided to malnourished patients with EDs and treatment outcomes, and (3) conducting a double blinded randomised controlled trial (RCT) iso-calorically comparing a low carbohydrate enteral formula against a standard formula in AYA’s hospitalised with anorexia nervosa. Given the supply constraints in Australia of the low carbohydrate formula studied, alternative implementation strategies are discussed.

Recommended directions for future research include: (1) the safety and efficacy of a lower carbohydrate enteral formula in severely malnourished patients at the highest risk for developing refeeding complications, including older patients with restrictive eating disorders, who may have a more severe and enduring course of illness, (2) prospective studies evaluating the optimal supplementation regimen to patients hospitalised with restrictive ED’s, including phosphate and thiamine.