The strategy, called "low early, advance slowly," often results in loss of weight or extra fluid in the first day or two of hospitalization. Now some researchers and health providers, both the United States and abroad, contest departure-low approach, suggesting that many patients may be fed more aggressively as long as they are closely monitored for medical complications.
Scientific evidence in support of the bass-start method have been rare. In a study published online in the Journal of Adolescent Health, in August, researchers at the University of California, San Francisco, sought to evaluate more closely, examining the weight gain of adolescents hospitalized on a recharge Protocol recommended in what they think, this is the first study of this kind.
The study, which involved 35 young people, found that 83 percent on the scheme of departure-bas, which have been fed 1,200 calories per day with increases of 200 calories every other day, have lost weight. On the whole, patients did not regain weight lost newly to the sixth day in hospital, an average of.
"It is very shocking to parents," said Andrea k. Garber, Associate Professor of Pediatrics at the University of California, San Francisco and the principal author of the study. "The irony is that the goal of hospitalization is to get the child renourished and we spend the first eight days without any weight gain."
While it is not uncommon for a patient with anorexia lose weight after hospitalization, most practitioners fluid loss, mostly water attribute.
"There is a body of evidence that our older, more careful feeding strategies are older and wiser that they must be," said Dr. David s. Rosen, Professor of Pediatrics, internal medicine and Psychiatry, school of Medicine of the University of Michigan, which leads to the American Academy of Pediatrics Committee on Adolescence.
Still, he and other doctors urge caution before making radical changes in the treatment, stating that research needs more to be done. Twenty percent of patients in the study U.C.S.F. had low blood phosphorus levels, indicating a high risk of developing a potentially fatal condition called refeeding syndrome and electrolyte imbalance, noted Dr. Rosen.
"We have shown that the regular approach, we do not make as much progress that we would like," he said. "But we know that the power of the people more aggressively is a safe thing to do." The answer is, not really. ?
Although medical practices are far from uniform and treatment is customized according to the circumstances of the patient, a typical schema starts young patients with meals and snacks totalling approximately 1,200 calories per day.
New schemas evaluated - and already brought in some hospitalized patients programs - start patients with 1,900 calories a day. In a week and a half, a patient may be consumed 3 000 or more calories per day. The danger is that these patients may experience a refeeding syndrome, which can cause many complications including heart arrhythmia and death, when you try to return to the normal diets too quickly. These patients may also have developed digestive disorders such as gastroesophageal reflux disease, diarrhea, and constipation. They can involuntarily vomit because the stomach and digestive capacity is decreased.
And there are psychological problems. Hunger affects capacity cognitive, experts say, and often of consultation cannot be effective until the weight is restored. Until then, patients with eating disorders are subject to continuing aversion to food.
"Think about the psychological trauma of being in a hospital and have to eat all the food," said Marjorie Nolan, a dietitian in Manhattan, specializing in eating disorders and a spokesman for the Academy of Nutrition and dietetics. "These young are young, they cannot process the information, and here they gained five pounds in a week and their greater fear is happening: they are in progress in bold.". Who knows is not true, but it is how they see. ?
Ms. Nolan said one of his patients, who is now 18, was fed aggressively at the age of 15 years and he put his back recovery in the long term.
"They had the weight back on it, which he medically stabilized to some extent, what was necessary, but it was so aggressive that now, a few years later, she is still traumatized by it,", said Ms. Nolan. "."
A woman of 27 years in the area of the city of New York who was hospitalized twice, at the age of 18 years and again at 20, said aggressive recharge can be psychologically overwhelming and even physically painful.
"Your stomach shrinks when you eat, so it feels like Thanksgiving, every day, when you are in the hospital getting large quantities of food," said the woman, who asked that his name retained to maintain his privacy. "It is physically difficult to walk around time after, and it is difficult to keep all." After consuming so little for so long, she said: "you eat a carrot and you feel it".
She said that she found much weight during his first hospitalization but was so upset by gain rapid that she lost quickly weight once she was released. Two years later, she was hospitalized again but remained in the hospital for a longer stay of six weeks.
The current guidelines of the American Academy of Pediatrics recommend slow Rehydrating children suffering from malnutrition and adolescents to avoid refeeding syndrome; Society of medicine and adolescent health also recommends "the gradual increase in caloric intake.
But in an editorial accompanying the new study of U.C.S.F., Dr. Debra Katzman, Chief of the division of Medicine of the adolescents to the hospital for sick children, said that overzealous application of the guidelines conservative recharge had resulted in death in some cases.
The United States pressure to keep the short hospital stays made rapid weight gain still more urgent, because the goal is to restore as much weight as possible before the release, she said in an interview.
Experts agree that much more research is needed to develop clear guidelines, based on evidence for treatment.
"We do not know how best to treat these children, even when they wind up in the hospital", said Dr. Rosen. "It's a balancing act number." You want to do is find place sweet between feeding people as aggressively as possible but are not of refeeding syndrome, which is a lethal, frightening, dangerous disease. ?
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