ONE-YEAR OUTCOMES FROM A MULTI-CENTER RANDOMIZED CONTROLLED TRIAL (RCT) OF REFEEDING IN ANOREXIA NERVOSA: THE STUDY OF REFEEDING TO OPTIMIZE INPATIENT GAINS (STRONG)

• Published in: Journal of adolescent health 2021-02, Vol.68 (2S), p.S8
• Main Authors: Golden, Neville H, Cheng, Jing, Kapphahn, Cynthia, Buckelew, Sara M, Machen, Vanessa I, Kreiter, Anna A, Accurso, Erin C, Adams, Sally H, Grange, Daniel Le, Moscicki, AnnaBarbara, Sy, Allyson, Wilson, Leslie S, Garber, Andrea K
• Format: Article
• Language: English
• Subjects: Anorexia; Body mass index; Bulimia; Cattle; Clinical outcomes; Clinical trials; College admissions; Eating disorders; Food refusal; Hospitalization; Inpatient care; Length of stay; Malnutrition; Meals; Medical diagnosis; Patient admissions; Refusal; Remission (Medicine); Young adults
• ISSN: 1054-139X; 1879-1972

Purpose: We recently reported the short-term results of this RCT, demonstrating that higher calorie refeeding (HCR) restored medical stability earlier with no increase in safety events, and significant savings associated with shorter length of stay as compared to lower calorie refeeding (LCR) in hospitalized adolescents and young adults with anorexia nervosa (AN). Here we report the one-year outcomes including rates of clinical remission, rehospitalization rate, number of readmissions, and total number of hospital days following the initial admission. Methods: This RCT compared HCR and LCR in patients admitted to two large tertiary care eating disorder programs for medical instability. Inclusion criteria included age 12-24 y and diagnosis of AN or atypical AN. Exclusion criteria included diagnosis of ARFID or bulimia nervosa, extreme malnutrition (< 60% median BMI (mBMI)). Within 24 h of admission, participants were randomly assigned to HCR (2,000 kcals/d, increasing by 200 kcals/d) or LCR (1,400 kcals/d, increasing by 200 kcals every other day). Calories were provided by meals, with oral liquid replacement for food refusal. Data were collected prospectively by study personnel daily in hospital, and at day 10, month 1, 3, 6 and 12 after discharge. Clinical remission was defined as achieving weight restoration (> 95 % mBMI) plus an EDE-Q global score within 1 SD of community norms. Generalized linear mixed effect models examined differences in clinical remission over time. Fisher's exact tests and Wilcoxon rank sum test compared categorical and continuous variables respectively. Data are presented as mean (SD). Results: Of 120 participants enrolled, 111 were included in modified intention-to-treat analyses, 60 received HCR and 51 LCR. Participants were 91% female, 81% white, 78% non-Hispanic, 16.4 (2.5) yrs old and 84.9 (11.7) % mBMI at admission. Although clinical remission changed over time in both groups (P=0.0001), there was no evidence of significant group difference in change of remission over time (HCR 20%, 16.7%, 26.7%, and 30%, and LCR 15.7%, 25.5%, 19.6%, and 25.5% at 1, 3, 6, and 12 months after discharge, P=0.56). Rehospitalization rates within 12 months after the initial admission [31.7% (19/60) vs. 33.3% (17/51, p=.80], number of rehospitalizations [0.79 (1.7) vs. 0.71 (1.3), p = .86], and total number of days rehospitalized after initial stay [6.0 (14.8) vs. 5.1 (10.3) days, p= .81] did not differ by HCR vs. LCR . Conclusions: In the first RC