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Table 48 Meal support during inpatient treatment versus no meal support be used in the treatment of children and adolescents with eating disorders

From: Canadian practice guidelines for the treatment of children and adolescents with eating disorders

Certainty assessment

Impact

Certainty

Importance

№ of studies

Study design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other considerations

Rate of Weight Gain (assessed with: Measures of Weight Gain in Kg/Day), Need for NGT Feeds (assessed with: # of Patients Receiving NGT Feeds)

3

Case Control

serious a

serious b

not serious

serious c

all plausible residual confounding would reduce the demonstrated effect

Three studies examined the effect of meal support/supervision as part of inpatient treatment for a total number of patients receiving meal support of 88 patients. There were no significant differences between cohorts who received meal support and those who did not on the rate of weight gain per day or week,although there was a trend towards greater weight gain /day or week in the group who received meal support. Weight gain varied from 0.09 kg/day to 0.35 kg/day across studies.

VERY LOW

CRITICAL

serious d

not serious

not serious

not serious

strong association all plausible residual confounding would reduce the demonstrated effect

One study of these studies reported on difference in the rate of NGT feeds in cohort of patients treated on inpatient unit before the institution of consistent meal support vs after. 8/12 patients not receiving meal support (ie 66.7%) and 1/9 (11.1%) of those receiving meal support required NGT feeds as part of inpatient admission.

MODERATE

IMPORTANT

  1. Explanations
  2. aDifferences in LOS and age between those receiving meal support and those not receiving meal support may have affected outcomes
  3. bWide variation in # of meals/day supervised between various studies
  4. cWide confidence intervals in some studies/groups
  5. dCriteria for initiating NGT feeds somewhat vague (ie “consistent failure” to meet expected weight gain and/or acute refusal of food
  6. Bibliography:
  7. Case Control - Kells 2013 [239], Kells 2017 [240], Couturier 2009 [238]