Short-term outcomes of the Study of Refeeding to Optimize Inpatient Gains¶
One-paragraph summary¶
Multicentre inpatient RCT of 120 adolescents and young adults aged 12–24 with AN or atypical AN and at least 60% median BMI. Higher-calorie refeeding began at 2,000 kcal/day and increased 200 kcal/day; lower-calorie refeeding began at 1,400 kcal/day and increased 200 kcal every other day. Higher-calorie refeeding restored medical stability sooner without more protocol-defined safety events under close monitoring (Garber 2021, PMID 33074282).
Key findings¶
- n=120 across two tertiary inpatient programs.
- Inclusion of atypical AN broadens relevance beyond low BMI.
- Higher-calorie arm: 2,000 kcal/day, +200 daily.
- Lower-calorie arm: 1,400 kcal/day, +200 every other day.
- Shorter time to medical stability and hospital stay in the higher-calorie arm.
What the trial did and did not establish (audit, 2026-09-02)¶
Two further papers from the same cohort complete the picture and were absent from the original note.
| Report | Question | Result |
|---|---|---|
| Garber 2021, PMID 33074282 | Short-term efficacy and safety | Medical stability restored earlier (HR 1.67, 95% CI 1.10–2.53; p=0.01); stay 4.0 days shorter (−6.1 to −1.9); $19,056 saved per participant; no excess electrolyte abnormalities or other adverse events |
| Golden 2021, PMID 33753542 | 1-year clinical remission and rehospitalization | No group difference in remission over 12 months (p=0.42); rehospitalization 32.8% (19/58) vs 35.4% (17/48), p=0.84; days rehospitalized 6.0 vs 5.1, p=0.81 |
| Garber 2024, PMID 38179719 | Atypical AN subgroup and caloric dose | Atypical AN (43% of 111) had slower heart-rate restoration (8.7±4.0 vs 6.5±3.9 days, p=0.008), less weight gain (3.1±5.9 vs 5.4±2.9 %mBMI, p<0.001) and more hypomagnesaemia (29% vs 11%, OR 3.29), explained by receiving 32.4±6.9 vs 43.4±9.8 kcal/kg |
The correct summary is therefore narrower than "higher-calorie refeeding works": it restores stability faster and costs less, with equal safety and equal one-year outcomes, and its fixed kcal/day design systematically underfeeds heavier patients.
Limitations¶
- Tertiary monitored settings with explicit electrolyte correction.
- Participants were ≥60% median BMI; extreme malnutrition remains less certain.
- A protocol package was compared, not calories isolated from monitoring.
- Short-term stabilization is not durable recovery.
Why it matters¶
The trial directly challenged overly conservative routine refeeding for monitored adolescents and young adults while preserving a clear boundary against unsupervised extrapolation.
Cited by wiki pages¶
- Refeeding and nutritional rehabilitation
- Service models and setting
- Red flags and safety concerns