Medical Nutrition Therapy and Nutritional Rehabilitation in Hospitalised Patients Affected by Eating Disorders

Eur Eat Disord Rev. 2025 Oct 18. doi: 10.1002/erv.70042. Online ahead of print.

ABSTRACT

OBJECTIVE: Hospitalised patients with eating disorders (EDs) often present with severe malnutrition, electrolyte imbalances, and metabolic complications that require specialised nutritional approaches. This consensus aimed to develop evidence-informed, expert-driven recommendations for the nutritional management of hospitalised patients with EDs, addressing risk stratification, caloric progression, refeeding protocols, formulation selection, supplementation and long-term monitoring.

METHODS: An eight-expert panel conducted a modified Delphi process in two online rating rounds. One hundred six statements were formulated across 12 thematic sections and evaluated on a 5-point Likert scale (≥ 85% accepted, 80%-84.9% revised, < 80% rejected). Revised statements were re-evaluated in Round 2 and, if necessary, finalised at an online meeting.

RESULTS: Of the 106 original statements, 89 (84.0%) reached immediate consensus, 14 (13.2%) required revision, and three (2.8%) were eliminated. Ten revised statements exceeded the ≥ 85% threshold in Round 2, one was rejected, and three ‘pending’ statements were approved in a conclusive online meeting. The final statements span key domains of inpatient care of EDs, including comprehensive nutritional assessment, stepwise refeeding regimens, careful electrolyte and biochemical monitoring, personalised approaches for those at high risk of refeeding syndrome and tailored considerations for paediatric and perinatal populations.

DISCUSSION: The final consensus statements provide a structured framework for the nutritional rehabilitation of hospitalised patients with EDs, emphasising balanced yet flexible refeeding protocols, vigilant metabolic monitoring, ethical considerations in limited-capacity cases, and continuity of care through discharge and relapse prevention. By aligning clinical practice with specialist insight and existing guidelines, these recommendations aim to standardise and enhance inpatient ED management.

PMID:41108537 | DOI:10.1002/erv.70042