Table 1.

Summary of in-hospital refeeding studies, by refeeding approach

Reference	Study design	Na	Ageb	Admission BMIc (SD/SE)	Approach	Start Kcal/day	Caloric Advancement (Kcal/day)d	Weight Gain Rate (Kg/wk)e	IP LOSf, days (SD/SE)	Rate of RHg
Meal-based Refeeding
Solanto et al. 1994	Observational	22 L 31 H	16.0 L 16.2 H	15.0 (1.9) Ah 14.3 (1.6) B	Meals; behavioral contracts distinguish groups	1000-1200	67-100 (200 q 2-3 days)	0.64 (0.32) A 1.15 (0.48) B	≥28 days	NRi
Arii et al. 1996	Prospective	12	19.2	13.61	Meals for 1 wk, then one group to oral liquid only for 2-6 wks, then back to meals	1000	Variablej	NR	NR	NR
Ornstein et al. 2003	Retrospective	69	15.5	15.0 (1.5)k	Meals	1200-1400	100-200 (200 q 1-2 days)	NR	25.6 (11.6)	27.5%
Whitelaw et al. 2010	Retrospective	29	15.7	NRl	Target 2200 by day 3, 2700 by day 5	1900	100-300	1.3m	NR	38%
Garber et al. 2012	Observational	35	16.2	16.3 (2.3)n	Meals	1205	100	0.88	16.7 (16.4)	20%
Gaudiani et al. 2012	Retrospective	25	26.0	13.1o	Target 2000 kcal/day	990	NR	NR	19	45%
Garber et al. 2013	Observational	56	16.2	15.8 (0.5) Lp 16.6 (0.4) Hq	Meals	1093 L 1764 H	98(6) L 122(8) H	0.98 L 1.90 H	17.6 (1.2) L 11.9 (1.0) H	45%
Golden et al. 2013	Retrospective	310	16.1	15.9 (2.2) L 16.1 (1.7) Hr	Meals	1163 L 1557 H	100-200	1.52 L 1.56 H	16.6 (9.0) L 13.0 (7.3) H	18.2% L 14.9% H
Le Clerc et al. 2013	Retrospective	29	14.7	16.4 (1.7)s	Target weight gain 1 kg/week	1500	75-250 (250 q 2 days)	1.7	NR	3.5%
El Ghoch et al. 2014	Prospective	50	26.5	15.4 (1.6)	Target weight gain 1-1.5kg/week	1500	NR	NRt	91u	NR
Redgrave et al. 2015	Observational	361	28.5	16.2 (2.2)	Target 3500-4000kcals/day with IV glucose in BMI<14	1200-1500	250 (500 q 2-3 days)	1.98 (0.86)	27.68 (18.14)	18.5%
Combined nasogastric feeding with oral intake
Bufano et al. 1990	Retrospective	9	NR	NRv	Mean maximum of 2311 kcals/day	NG at 25% of REEw	25% of target kcals on Day 1, 50% on Day 2, 75% on Day 3	1.92	9-51x	33.3%
Robb et al. 2002	Retrospective	52 NG+Oy 48 O	14.8 NG+O 15.0 O	15.5 (1.7) NG+O 16.0 (1.8) O	Compare nocturnal NG + oral to oral; mean maximum kcals: 3255 (NG+O), 2508 (O)	NR	600, 1080, 1200 on first three days (NG), oral kcals NR	1.70 NG+O 0.76 O	22.3 NG+O 22.1 O	NR
Silber et al. 2004	Retrospective	6 NG+O 8 O	13.8 NG+O 14.9 O	15.3 (1.7) NG+O 17.4 (2.3) O	Compare nocturnal NG + oral to oral; maximum kcals were 4350 (NG+O) and 3400 (O)	NR	600, 1080, 1200 on first three days (NG), oral kcals NR	2.12 NG+O 0.53 O	36.0 NG+O 39.9 O	NRz
Riguad et al. 2007	RCT	41 NG+O 40 O	22.5 NG+O 24.2 O	12.1 (1.5) NG+O 12.8 (2.0) O	Compare 2-mo NG to NG + oral; target weight gain rate 1 kg/week	Based on REEaa	Variable, to target weight gain rate	1.36 NG+O 0.88 O	70 days	0%bb
Gentile et al. 2010	Retrospective	33	22.8	11.3 (0.7)	30 with NG+O; 3 with oral supplements and IV glucose	1402	1895 by Day 7; 2212 by Day 15; 2510 by Day 30; 2683 by Day 45; 3000 by Day 60	0.63	60	0%cc
Hatch et al. 2010	Prospective (test-retest)	37	15.1	16.1 (0.93)dd	24-72 hr continuous NG only, then nighttime NG + meals to target weight gain rate 1 kg/week	24-72 hr NG (100 ml/hr), then NG + 1200-1400 meals	Variable, to attain 2400-3000 kcal/day	NR	2.5 wks	NR
Gentile et al. 2012	Retrospective	10	23.9	11.2 (0.7)	Concentrated continuous NG feed with IV glucose for 24 hr and oral intake, started at 1199 kcal increase to 2871 by day 90	1199	2508 by day 15; 2784 by day 30; 2935 by day 60; 2871 by day 90	1.30	90	0%ee
Agostino et al. 2013	Retrospective	31 NG+O 134 O	14.9	16.6 (2.2) NG+O 16.7 (2.3) O	Compare continuous NG transitioning to oral alone to oral alone (historical controls)	1500-1800 NG+O 1000-1200 O	200	0.66 L 0.92 H	50.9 (24) L 33.8 (11) H	3.6%ff
Madden et al. 2015	Prospective cohort	78	14.8		24-72 hr continuous NG only, then nighttime NG + meals to target 2400-3000 kcals/day	72 hr NG (100 ml/hr), then NG + 1200-1400 meals	Variable, to attain 2400-3000 kcal/day	2.79 (wk 1) 1.34 (over 2.5 wk)	28.6	0%gg
Combined total parenteral nutrition with oral intake
Diamanti et al. 2008	Retrospective	104 PNhh+O 94 O	14.9 PN+O 15.2 O	14.3 (0.2) PN+O 16.0 (0.2) O	Compare oral to oral+TPN; both groups start 40 kcal/kg/d for 5 d then increase to 60 kcal/kg/d over 1 week	40 kcal/kg/day	Target 60 kcal/kg/day at day 7	0.71 PN+O 0.53 O	30.7 (2.2) PN+O 15.6 (1.0) O	3.8% (PN+O only)
Altered nutrient content
Rigaud et al. 2010	Retrospective	42 Nii 176 L	22.1 N 23.3 L	13.8 (1.7) N  13.2 (1.2) L	Compare normal (4000-4800mg) vs. low (1600-2000 mg) Na diet. Both groups got NG+O feeding.	Ad lib except for Na	Ad lib except for Na	1.09 L; N was NR	2 months	NR

^aFor studies that included comparison groups, we report Ns separately for low-weight-gain (L) and high-weight-gain (H) interventions.

^bAge is presented as mean

^cBMI=body mass index (kg/m²).

^dRates of caloric advancement are calculated for some programs, who may not advance calories every day.

^eIn some cases these rates are calculated rather than derived directly from the published reports, and not all patients stayed at least a week in all studies.

^fIP LOS=inpatient length of stay.

^gRH=refeeding hypophosphatemia.

^hA and B refer to differing behavioral contracts (all participants started on same range of calories).

ⁱNR=not reported.

^jPer text, “daily calorie intake was increased only following agreement between the therapist and the patient.” (p 56)

^kMean (SD) percent of ideal body weight was 72.7% (7.1).

^lMean (SD) percent of ideal body weight was 72.9% (9.1).

^mOver the first two weeks of admission.

ⁿMean (SD) percent median BMI was 80.1 (11.5).

^oMean (SD) percent ideal body weight was 62% (10).

^pFor studies that included comparison groups, Ns are reported separately for low-calorie (L) and high-calorie (H) interventions.

^qMean (SD) percent median BMI was 77.6 (2.6) in the lower calorie group, 81.9 (1.8) in the higher calorie group.

^rMean (SD) percent median BMI was 77.9 (9.6) in the lower calorie group, 78.7 (7.8) in the higher calorie group.

^sMean (SD) percent ideal body weight was 75.8% (5.4).

^tWeight gain goal was 0.45-0.68 kg/wk

^uProgram included 13 weeks inpatient treatment plus 7 weeks partial hospitalization.

^vMean (SD) body weight was 34.51 (4.48) kg.

^wREE=resting energy expenditure.

^xPatients were discharged from the program to outpatient follow-up when they requested to switch back from enteral to meal-based refeeding and could demonstrate they had “food intake exceeding the basal metabolic rate” (p 405).

^yNG=nasogastric refeeding; O=oral refeeding.

^z“There were no cases of refeeding syndrome.” (p 417)

^aaREE=resting energy expenditure.

^bbPatients with BMI < 12 received prophylactic phosphorous supplementation.

^ccMost patients received prophylactic phosphorous supplementation.

^ddMean (SD) percent ideal body weight was 79.1% (5.8).

^eePatients received prophylactic phosphorous supplementation.

^ffAll 6 patients with hypophosphatemia were in the oral-only group; however, 90.3% of patients in the enteral feeding group were on prophylactic phosphorous supplementation.

^ggPatients received prophylactic phosphorous supplementation.

^hhPN=parenteral nutrition; O=oral.

ⁱⁱN=Normal sodium diet; L=low sodium diet.