Volume 87 - 2024 - Fasc.2 - Reviews
High-calorie refeeding in adolescents with anorexia nervosa: a narrative review
Background and objectives: Recent studies about refeeding in
anorexia nervosa (AN) suggest starting with a high calorie diet.
This narrative review aims to understand the initial refeeding
management in hospitalized children and adolescents with AN and
to develop a practical protocol.
Methods: We performed a comprehensive database search
in June 2023 for abstracts published between January 2010 and
May 2023 in different databases: Pubmed, The Cochrane Library
and Embase with the terms refeeding syndrome, energy intake,
diet therapy, weight restoration, hypophosphatemia, nutritional
rehabilitation, anorexia nervosa, restrictive eating disorders, child,
adolescent and young adult.
Results: Fifteen papers were included in this review. Twelve
studies were retrospective or observational. Only 3 randomized
controlled trials were found. Initial energy intake varies within
a wide range between 500 and 2800 kcal per day but generally
begins with higher calories than current recommendations. Only
hypophosphatemia was often described without clinical refeeding
syndrome. Initial weight restoration was better with high calorie
refeeding (HCR). Length of stay was shorter with HCR in some
studies. Long term outcomes were unknown. Only two studied
severely malnourished patients (< 70 % mBMI).
Conclusion: In adolescents with AN and with a low risk of RS,
high calorie refeeding is possible under close medical monitoring
and with prompt electrolyte correction. Robust studies with a
unified protocol are needed to confirm the safety of high calorie
refeeding especially in severely malnourished adolescents with AN.
The role of psychotherapeutic approaches in treatment of functional dyspepsia, systematic review, and meta-analysis
Background: Functional dyspepsia is a common functional gastrointestinal disorder that is often challenging to treat. Psychotherapeutic interventions have been proposed as an alternative or adjunctive approach to conventional treatments, but their efficacy remains unclear.
Objective: This systematic review and meta-analysis aimed to evaluate the efficacy of psychotherapeutic interventions in the treatment of functional dyspepsia.
Methods: A comprehensive search of electronic databases was conducted, from inception to March 2023, for randomized controlled trials (RCTs) that evaluated the effects of psychotherapeutic interventions on patients with functional dyspepsia. The primary outcome measures were gastrointestinal symptoms, quality of life, depression, and anxiety. Data were extracted and analyzed using Review Manager 5.3 software. The risk of bias of the included studies was assessed using the Cochrane Risk of Bias tool.
Results: Sixteen RCTs comprising 1550 patients with functional dyspepsia were included in the meta-analysis. The types of psychotherapeutic interventions used in the included studies were cognitive-behavioral therapy (CBT), hypnotherapy, and mindfulness-based stress reduction (MBSR). The control groups were usual care, placebo, supportive therapy, or no treatment. The meta-analysis showed that psychotherapeutic interventions had a significant effect on reducing gastrointestinal symptoms,depression and anxiety in patients with functional dyspepsia. However, no significant improvement was observed in the quality-of-life scores of patients who received psychotherapeutic interventions compared to those in the control group.
Conclusion: Psychotherapeutic interventions, such as CBT, hypnotherapy, and MBSR, could be a useful adjunct to conventional treatments for functional dyspepsia, as they were found to significantly reduce gastrointestinal symptoms and anxiety in patients. However, further studies are needed to assess the long-term effects and generalizability of these interventions.
