Differences in Nutritional Outcome Measures between Preadolescents and Adolescents with Anorexia Nervosa who received a Nasogastric Feeding Tube versus Oral Diet upon Hospital Admission

DIFFERENCES IN NUTRITIONAL OUTCOME MEASURES BETWEEN PREADOLESCENTS AND ADOLECENTS WITH ANOREXIA NERVOSA WHO RECEIVED A NASOGASTRIC FEEDING TUBE VERSUS ORAL DIET UPON HOSPITAL ADMISSION by Paige E. Herring Background: Anorexia nervosa (AN) is a disease defined by an extreme weight loss due to an intense fear of gaining weight, and it is the third most chronic disease in adolescent females. Hospitalizations are common among patients with AN due to the major consequences that can arise from this disease. Most of the complications can be resolved with significant weight gain, so hospitals have an implemented feeding protocols to optimize weight gain. Studies have shown that nasogastric (NG) feedings have resulted in a greater weight gain and reduced length of stay without significant side effects. Objective: The purpose of this study is to examine the association between demographic and clinical characteristics and mode of nutrition therapy (oral feeding vs. NG tube feedings) in a population of pre-adolescents and adolescents with a hospital admission diagnosis of AN. The clinical outcome measures are length of stay (LOS), weight gain, and suspected refeeding syndrome. Participants/Setting: The study sample includes 64 patients between the ages 9 and 20 years who have been admitted to Children’s Healthcare of Atlanta between January 1, 2014 and December 31, 2015 for clinical treatment of AN. The demographic, anthropometric, mode of nutrition therapy and clinical characteristics of the patient population were obtained. Statistical Analysis: Frequency statistics were used to describe demographic, anthropometric, mode of nutrition therapy and clinical characteristics of the patient population. A Student’s t-test was used to examine differences in continuous variables by tube feeding status, while a MannWhitney U test was used for the non-normally distributed variables. A Chi-square test was used to examine differences in tube feeding status by categorical variables. Results: Data were collected and analyzed for 64 patients, with a mean age of 14.6 + 2.4 years, and the majority of the population being female (93.8%) and Caucasian (92.2%). Approximately half (n=30, 47%) of the population received an NG tube during the admission. Mean discharge BMI was significantly higher in those who received an oral diet vs. NG tube (16.67 vs. 17.08, respectively; p=0.042) while weight change was significantly lower (1.3 kg vs. 2.1 kg, respectively; p=0.012) and LOS shorter (8 days vs. 11 days, respectively; p=0.002) There were no significant differences in other characteristics by mode of nutrition therapy. Conclusion: NG tube feeding is an effective method for feeding hospitalize adolescent patients with AN to yield greater weight gain results. Future studies are necessary to determine the amount of time exclusively on the NG tube, reasons for choosing NG vs. oral feedings, and other variables associated with weight gain and length of stay. DIFFERENCES IN NUTRITIONAL OUTCOME MEASURES BETWEEN PREADOLESCENTS AND ADOLECENTS WITH ANOREXIA NERVOSA WHO RECEIVED A NASOGASTRIC FEEDING TUBE VERSUS ORAL DIET UPON HOSPITAL ADMISSION by Paige E. Herring A Thesis Presented in Partial Fulfillment of Requirements for the Degree of Master of Science in Health Sciences The Byrdine F. Lewis School of Nursing and Health Professions Department of Nutrition Georgia State University Atlanta, Georgia 2016