Skip to main content

Advertisement

SpringerLink
Log in

Comparison between enteral nutrition and intravenous hyperalimentation in patients with eating disorders: results from the Japanese diagnosis procedure combination database

  • Original Article
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Objective

Eating disorders (EDs) are some of the most common chronic disorders in adolescent girls, and have some of the worst prognoses among psychiatric diseases. However, reported data on mortality and morbidity of ED patients are scarce, and no previous studies have compared the short-term outcomes of enteral nutrition (EN) and intravenous hyperalimentation (IVH) in patients with EDs.

Method

Using the Diagnostic Procedure Combination database, a national inpatient database in Japan, we searched for ED patients who received EN or IVH. We investigated the backgrounds, complications, and in-hospital mortality for all ED patients. We compared the length of stay between the EN and IVH groups using the Cox regression model. In-hospital mortality was compared between the groups using propensity score matching and inverse probability weighting.

Results

We identified 3,611 patients with EDs from 540 hospitals. The mean body mass index was 13.1 ± 1.9 kg/m2; 41 (1.1 %) patients died. The mean length of stay was 61.7 days. Compared with the EN-alone group (n = 634), the IVH-alone group (n = 278) showed significantly higher proportions of sepsis (0.5 vs. 5.8 %; p < 0.001) and disseminated intravascular coagulation (0.5 vs. 2.9 %; p = 0.005). The Cox regression showed no significant difference in hospital discharge between the two groups. Propensity-matched analysis evidenced lower in-hospital mortality in the EN group than the IVH group (0.4 vs. 3.0 %; p = 0.019).

Discussion

ED patients treated with IVH were significantly more likely to have higher in-hospital mortality and morbidity than those receiving EN.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Smink FRE, van Hoeken D, Hoek HW (2012) Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 14:406–414. doi:10.1007/s11920-012-0282-y

    Article  PubMed Central  PubMed  Google Scholar 

  2. Ebeling H, Tapanainen P, Joutsenoja A, Koskinen M, Morin-Papunen L, Järvi L, Hassinen R, Keski-Rahkonen A, Rissanen A, Wahlbeck K (2003) A practice guideline for treatment of eating disorders in children and adolescents. Ann Med 35:488–501

    Article  PubMed  Google Scholar 

  3. Robb AS, Silber TJ, Orrell-Valente JK, Valadez-Meltzer A, Ellis N, Dadson MJ, Chatoor I (2002) Supplemental nocturnal nasogastric refeeding for better short-term outcome in hospitalized adolescent girls with anorexia nervosa. Am J Psychiatry 159:1347–1353

    Article  PubMed  Google Scholar 

  4. Arcelus J, Mitchell AJ, Wales J, Nielsen S (2011) Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry 68:724–731. doi:10.1001/archgenpsychiatry.2011.74

    Article  PubMed  Google Scholar 

  5. Rigaud D, Brondel L, Poupard AT, Talonneau I, Brun JM (2007) A randomized trial on the efficacy of a 2-month tube feeding regimen in anorexia nervosa: A 1-year follow-up study. Clin Nutr 26:421–429. doi:10.1016/j.clnu.2007.03.012

    Article  PubMed  Google Scholar 

  6. Diamanti A, Basso MS, Castro M, Bianco G, Ciacco E, Calce A, Caramadre AM, Noto C, Gambarara M (2008) Clinical efficacy and safety of parenteral nutrition in adolescent girls with anorexia nervosa. J Adolesc Health 42:111–118. doi:10.1016/j.jadohealth.2007.09.024

    Article  CAS  PubMed  Google Scholar 

  7. Mehler PS, Weiner KL (2007) Use of total parenteral nutrition in the refeeding of selected patients with severe anorexia nervosa. Int J Eat Disord 40:285–287. doi:10.1002/eat.20371

    Article  PubMed  Google Scholar 

  8. Holmes S (2012) Enteral nutrition: an overview. Nurs Stand 26:41–46. doi:10.7748/ns2012.05.26.39.41.c9133

    Article  PubMed  Google Scholar 

  9. Abunnaja S, Cuviello A, Sanchez JA (2013) Enteral and parenteral nutrition in the perioperative period: state of the art. Nutrients 5:608–623. doi:10.3390/nu5020608

    Article  PubMed Central  PubMed  Google Scholar 

  10. Sako K, Loré JM, Kaufman S, Razack MS, Bakamjian V, Reese P (1981) Parenteral hyperalimentation in surgical patients with head and neck cancer: a randomized study. J Surg Oncol 16:391–402

    Article  CAS  PubMed  Google Scholar 

  11. Nakamura M, Yasunaga H, Shimada T, Horiguchi H, Matsuda S, Fushimi K (2013) Body mass index and in-hospital mortality in anorexia nervosa: data from the Japanese Diagnosis Procedure Combination Database. Eat Weight Disord 18:437–439. doi:10.1007/s40519-013-0051-x

    Article  PubMed  Google Scholar 

  12. D’Agostino RB Jr (1998) Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 17:2265–2281

    Article  PubMed  Google Scholar 

  13. Xu S, Ross C, Raebel MA, Shetterly S, Blanchette C, Smith D (2010) Use of stabilized inverse propensity scores as weights to directly estimate relative risk and its confidence intervals. Value Health 13:273–277. doi:10.1111/j.1524-4733.2009.00671.x

    Article  PubMed  Google Scholar 

  14. Rosling AM, Sparén P, Norring C, von Knorring A-L (2011) Mortality of eating disorders: a follow-up study of treatment in a specialist unit 1974-2000. Int J Eat Disord 44:304–310. doi:10.1002/eat.20827

    Article  PubMed  Google Scholar 

  15. Copeland PM, Herzog DB (1987) Hypoglycemia and death in anorexia nervosa. Psychother Psychosom 48:146–150

    Article  CAS  PubMed  Google Scholar 

  16. Jáuregui-Garrido B, Jáuregui-Lobera I (2012) Sudden death in eating disorders. Vasc Health Risk Manag 8:91–9891. doi:10.2147/VHRM.S28652

    Article  PubMed Central  PubMed  Google Scholar 

  17. Haruta I, Asakawa A, Ogiso K et al (2012) A case of anorexia nervosa with disseminated intravascular coagulation syndrome. Int J Eat Disord 45:453–455. doi:10.1002/eat.20954

    Article  PubMed  Google Scholar 

  18. Jeejeebhoy KN (2001) Total parenteral nutrition: potion or poison? Am J Clin Nutr 74:160–163

    CAS  PubMed  Google Scholar 

  19. Dresser RS, Boisaubin EV Jr (1986) Psychiatric patients who refuse nourishment. Gen Hosp Psychiatry 8:101–106

    Article  CAS  PubMed  Google Scholar 

  20. Gueguen J, Godart N, Chambry J, Brun-Eberentz A, Foulon C, Divac SM, Guelfi JD, Rouillon F, Falissard B, Huas C (2012) Severe anorexia nervosa in men: comparison with severe AN in women and analysis of mortality. Int J Eat Disord 45:537–545. doi:10.1002/eat.20987

    Article  PubMed  Google Scholar 

  21. Yasunaga H, Horiguchi H, Matsuda S, Fushimi K, Hashimoto H, Ayanian JZ (2013) Body mass index and outcomes following gastrointestinal cancer surgery in Japan. Br J Surg 100:1335–1343. doi:10.1002/bjs.9221

    Article  CAS  PubMed  Google Scholar 

  22. Calderon R, Vander Stoep A, Collett B, Garrison MM, Toth K (2007) Inpatients with eating disorders: demographic, diagnostic, and service characteristics from a nationwide pediatric sample. Int J Eat Disord 40:622–628. doi:10.1002/eat.20411

    Article  PubMed  Google Scholar 

  23. Chu ES, Gaudiani JL, Mascolo M, Statland B, Sabel A, Carroll K, Mehler PS (2012) ACUTE center for eating disorders. J Hosp Med 7:340–344. doi:10.1002/jhm.1906

    Article  PubMed  Google Scholar 

  24. Robergeau K, Joseph J, Silber TJ (2006) Hospitalization of children and adolescents for eating disorders in the State of New York. J Adolesc Health 39:806–810. doi:10.1016/j.jadohealth.2006.08.003

    Article  PubMed  Google Scholar 

  25. Agostino H, Erdstein J, Di Meglio G (2013) Shifting paradigms: continuous nasogastric feeding with high caloric intakes in anorexia nervosa. J Adolesc Health 53:590–594. doi:10.1016/j.jadohealth.2013.06.005

    Article  PubMed  Google Scholar 

  26. Morris J, Simpson AV, Voy SJ (2013) Length of stay of inpatients with eating disorders. Clin Psychol Psychother. doi:10.1002/cpp.1865

    Google Scholar 

  27. Strik Lievers L, Curt F, Wallier J, Perdereau F, Rein Z, Jeammet P, Godart N (2009) Predictive factors of length of inpatient treatment in anorexia nervosa. Eur Child Adolesc Psychiatry 18:75–84. doi:10.1007/s00787-008-0706-8

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This study was funded by grants from the Ministry of Health, Labour and Welfare, Japan (Research on Policy Planning and Evaluation Grant Number: H25-Policy-010), and the Council for Science and Technology Policy, Japan [Funding Program for World-Leading Innovative R&D on Science and Technology (FIRST) program Grant Number: 0301002001001].

Conflict of interest

No conflicts of interest are disclosed.

Author information

Authors and Affiliations

  1. Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan

    Nobuaki Michihata, Hiroki Matsui & Hideo Yasunaga

  2. Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan

    Kiyohide Fushimi

Authors
  1. Nobuaki Michihata
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hiroki Matsui
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kiyohide Fushimi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hideo Yasunaga
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hideo Yasunaga.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Michihata, N., Matsui, H., Fushimi, K. et al. Comparison between enteral nutrition and intravenous hyperalimentation in patients with eating disorders: results from the Japanese diagnosis procedure combination database. Eat Weight Disord 19, 473–478 (2014). https://doi.org/10.1007/s40519-014-0147-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-014-0147-y

Keywords

Search

Navigation