Can higher calorie feeding protocols for eating disorder patients admitted to an adult hospital ward be safely implemented to reduce the length of stay? A scoping review
- 1Gold Coast University Hospital, Gold Coast Health, Queensland Health, Southport, QLD Australia
- 2Faculty of Health Sciences and Medicine, Bond University, Robina, QLD Australia
Abstract
Background: Hospital admissions for eating disorders are increasing, yet adult inpatient nutritional restoration often relies on conservative low-calorie refeeding to avoid refeeding syndrome (RFS). Evidence from younger populations suggests higher-calorie refeeding (HCR) may be safe and more efficient, but adult data is limited. This scoping review mapped the extent, characteristics and safety of HCR (≥ 1500 kcal/day) for people with eating disorders admitted to adult hospital wards.
Methods: Five electronic databases were searched in July 2025 for studies published January 2012–June 2025. Eligible studies included adults with a diagnosed eating disorder, or mixed-age samples treated on adult wards, who commenced HCR on admission. Primary outcomes were RFS markers, particularly refeeding hypophosphataemia; secondary outcomes were length of stay (LOS), weight gain and change in body mass index (BMI). Three reviewers independently screened records and charted data, and findings were synthesised descriptively.
Results: Of 778 records identified, 11 studies met inclusion criteria. Most were retrospective cohorts, with three quasi-experimental before–after designs, undertaken in adult specialist or general inpatient settings across several countries. Together they described 4874 patients exposed to HCR, usually starting at 1500–2000 kcal/day and advancing as tolerated. Definitions and monitoring of RFS varied widely. No study reported deaths or clinically defined RFS attributable to HCR. Biochemical hypophosphataemia affected up to around one-third of patients, was usually mild and managed with electrolyte supplementation. Four studies reported LOS; two found shorter admissions and faster weight gain with HCR compared with lower-calorie protocols.
Conclusions: Across observational studies, initiating HCR for people with eating disorders on adult hospital wards appears feasible and can be delivered without an obvious increase in clinical RFS, while potentially reducing LOS and enhancing weight restoration when combined with close monitoring and supplementation. Heterogeneity in RFS definitions, refeeding protocols and outcome reporting, and the absence of randomised trials, limit confidence in these findings. Prospective studies using standardised RFS criteria and clearly defined HCR and comparator protocols are needed to guide adult-focused practice and policy.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s40337-026-01669-9.
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BibTeX
@article{taylor2026higher,
title = {{Can higher calorie feeding protocols for eating disorder patients admitted to an adult hospital ward be safely implemented to reduce the length of stay? A scoping review}},
author = {Jackson Taylor and Michael Salmon and Caitlin Rogash and Grace Branjerdporn},
journal = {Journal of Eating Disorders},
year = {2026},
month = jul,
doi = {10.1186/s40337-026-01669-9},
url = {https://doi.org/10.1186/s40337-026-01669-9},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Can higher calorie feeding protocols for eating disorder patients admitted to an adult hospital ward be safely implemented to reduce the length of stay? A scoping review
AU - Jackson Taylor
AU - Michael Salmon
AU - Caitlin Rogash
AU - Grace Branjerdporn
PY - 2026
DA - 2026/07/30
JO - Journal of Eating Disorders
DO - 10.1186/s40337-026-01669-9
UR - https://doi.org/10.1186/s40337-026-01669-9
AB - Background: Hospital admissions for eating disorders are increasing, yet adult inpatient nutritional restoration often relies on conservative low-calorie refeeding to avoid refeeding syndrome (RFS). Evidence from younger populations suggests higher-calorie refeeding (HCR) may be safe and more efficient, but adult data is limited. This scoping review mapped the extent, characteristics and safety of HCR (≥ 1500 kcal/day) for people with eating disorders admitted to adult hospital wards. Methods: Five electronic databases were searched in July 2025 for studies published January 2012–June 2025. Eligible studies included adults with a diagnosed eating disorder, or mixed-age samples treated on adult wards, who commenced HCR on admission. Primary outcomes were RFS markers, particularly refeeding hypophosphataemia; secondary outcomes were length of stay (LOS), weight gain and change in body mass index (BMI). Three reviewers independently screened records and charted data, and findings were synthesised descriptively. Results: Of 778 records identified, 11 studies met inclusion criteria. Most were retrospective cohorts, with three quasi-experimental before–after designs, undertaken in adult specialist or general inpatient settings across several countries. Together they described 4874 patients exposed to HCR, usually starting at 1500–2000 kcal/day and advancing as tolerated. Definitions and monitoring of RFS varied widely. No study reported deaths or clinically defined RFS attributable to HCR. Biochemical hypophosphataemia affected up to around one-third of patients, was usually mild and managed with electrolyte supplementation. Four studies reported LOS; two found shorter admissions and faster weight gain with HCR compared with lower-calorie protocols. Conclusions: Across observational studies, initiating HCR for people with eating disorders on adult hospital wards appears feasible and can be delivered without an obvious increase in clinical RFS, while potentially reducing LOS and enhancing weight restoration when combined with close monitoring and supplementation. Heterogeneity in RFS definitions, refeeding protocols and outcome reporting, and the absence of randomised trials, limit confidence in these findings. Prospective studies using standardised RFS criteria and clearly defined HCR and comparator protocols are needed to guide adult-focused practice and policy. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s40337-026-01669-9.
SN - 2050-2974
ER -