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Open Access

Making the most of an admission: the safety and efficacy of higher caloric refeeding in hospitalised adolescents with restrictive eating disorders

  • Elizabeth Parker1Email author,
  • Sonia Faruquie2,
  • Gail Anderson2,
  • Linette Gomes2,
  • Danielle Hewitt2,
  • Andrew Kennedy2,
  • Christine Wearne3,
  • Michael Kohn3 and
  • Simon Clarke2
Journal of Eating Disorders20153(Suppl 1):O66

Published: 23 November 2015


Eating DisorderEating DisorderCaloric IntakeHypophosphatemiaNasogastric Feeding


This study examines weight gain and assesses complications associated with refeeding adolescent inpatients admitted with a restrictive eating disorder (ED) who were provided with caloric intakes above current recommendations.


Patients admitted to an adolescent ED program for >48 hours were included in a 3-year retrospective chart review. The structured ‘rapid’ refeeding program mostly utilised initial nasogastric feeding, with routine phosphate prescription.


The mean (SD) age of the 184 adolescents was 16.7 years (0.9). Mean (SD) admission BMI was 16.9kg/m2 (2.3) and discharge BMI was 19.5kg/m2 (1.5). The mean (SD) starting caloric intake was 2523.6kcal/day (383.5) equating to 56kcal/kg (12). Most patients (87.5%) were treated with nasogastric tube feeding. Mean (SD) length of stay was 3.5 weeks (1.9) with a weekly weight gain of 2.1kg (0.9). No patients developed cardiac signs of refeeding syndrome or delirium; complications included peripheral oedema (3.8%), hypophosphatemia (1.1%), hypomagnesaemia (6%), and hypokalaemia (1.6%). Caloric prescription on admission was not associated with developing hypophosphatemia (p=0.15), hypokalaemia (p=0.40) and hypomagnesaemia (p=0.96).


Results demonstrated the efficacy of treating adolescent inpatients with restrictive EDs safely with higher initial caloric intakes, resulting in rapid weight restoration without major refeeding complications; which challenges current conservative calorie prescriptions advocated in clinical guidelines.

Authors’ Affiliations

Department of Dietetics and Nutrition, Westmead Hospital, Sydney, Australia
Department of Adolescent Medicine, Westmead Hospital, Sydney, Australia
Department of Medical Psychology, Westmead Hospital, Sydney, Australia


© Parker et al. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.