• Phoebe Hoo, Romi Goldschlager, John Katsoulis, Evan Newnham, Nur-Shirin Harun, Karen Gwee, Carol Silberberg, Nick Russell, Simon Lam, Esti Adithama, Natasha Cook, and Andrew Weickhardt.
• Austin Clinical School, The University of Melbourne, Melbourne, Victoria, Australia.
• Intern Med J. 2023 Oct 1; 53 (10): 175217671752-1767.

BackgroundPatients with anorexia nervosa (AN) may experience life-threatening malnutrition-related complications requiring inpatient medical stabilisation. Several management guidelines have been developed but discrepancies exist because of limited high-level evidence.AimsTo review the evidence base for recommendations contained in Victorian health services guidelines for the nutritional management of inpatients with AN.MethodsMEDLINE and Embase databases were searched for published studies on the nutritional management of inpatients with AN, combined with a manual search through citations. Studies including patients with AN aged 16 years and older were included. Case reports, small case series of <10 patients, studies of nonmedical management and studies with an exclusive paediatric population were excluded. The search results were compared with AN inpatient medical management guidelines sourced from large tertiary health services across Victoria, Australia.ResultsThe search yielded 584 studies, subsequently reduced to nine studies using the inclusion and exclusion criteria. The results suggest that commencing refeeding at a higher caloric value allows faster weight gain and shorter hospitalisation. Enteral tube feeding is preferential to parenteral nutrition because of infrequent and milder complications. Zinc supplementation showed a doubled rate of body mass index increase compared with placebo. Comparison with Victorian health services guidelines revealed inconsistent recommendations for high-calorie refeeding and micronutrient supplementation.ConclusionThe evidence supports high-calorie refeeding of 2000 kcal/day in AN inpatient medical management and zinc supplementation in improving the rate of weight restoration. This is inconsistently reflected in different Victorian health services guidelines. Updated national consensus guidelines could assist in improving consistency of evidence-based health care.© 2022 The Authors. Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.

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