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Here we compare refeeding outcomes in patients with atypical anorexia nervosa (atypical AN) versus anorexia nervosa (AN) and examine the impact of caloric dose.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Patients were enrolled upon admission and randomized to meal\u2010based HCR, beginning 2000\u2009kcal\/day and advancing 200\u2009kcal\/day, or lower calorie refeeding (LCR), beginning 1400\u2009kcal\/day and advancing 200\u2009kcal every other day. Atypical AN was defined as %median BMI (mBMI)\u2009&gt;\u200985. Independent <jats:italic>t<\/jats:italic>\u2010tests compared groups; multivariable linear and logistic regressions examined caloric dose (kcal\/kg body weight).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among <jats:italic>n<\/jats:italic>\u2009=\u2009111, mean\u2009\u00b1\u2009SD age was 16.5\u2009\u00b1\u20092.5\u2009yrs; 43% had atypical AN. Compared to AN, atypical AN had slower heart rate restoration (8.7\u2009\u00b1\u20094.0\u2009days vs. 6.5\u2009\u00b1\u20093.9\u2009days, <jats:italic>p<\/jats:italic>\u2009=\u2009.008, Cohen's <jats:italic>d<\/jats:italic>\u2009=\u2009\u2212.56), less weight gain (3.1\u2009\u00b1\u20095.9%mBMI vs. 5.4\u2009\u00b1\u20092.9%mBMI, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001, Cohen's <jats:italic>d<\/jats:italic>\u2009=\u2009.51) and greater hypomagnesemia (29% vs. 11%, <jats:italic>p<\/jats:italic>\u2009=\u2009.03, OR\u2009=\u20093.29). These suboptimal outcomes were predicted by insufficient caloric dose (32.4\u2009\u00b1\u20096.9\u2009kcal\/kg in atypical AN vs. 43.4\u2009\u00b1\u20099.8\u2009kcal\/kg in AN, <jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001, Cohen's <jats:italic>d<\/jats:italic>\u2009=\u20091.27). For every 10\u2009kcal\/kg increase, heart rate was restored 1.7\u2009days (1.0, 2.5) faster (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001), weight gain was 1.6%mBMI (.8, 2.4) greater (<jats:italic>p<\/jats:italic>\u2009&lt;\u2009.001), and hypomagnesemia odds were 70% (12, 128) lower (<jats:italic>p<\/jats:italic>\u2009=\u2009.02).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Although HCR is more efficacious than LCR for refeeding in AN, it contributes to underfeeding in atypical AN by providing an insufficient caloric dose relative to the greater body weight in this diagnostic group.<\/jats:p><\/jats:sec><jats:sec><jats:title>Public significance<\/jats:title><jats:p>The StRONG trial previously demonstrated the efficacy and safety of higher calorie refeeding in patients with malnutrition due to restrictive eating disorders. Here we show that higher calorie refeeding contributes to underfeeding in patients with atypical anorexia nervosa, including poor weight gain and longer time to restore medical stability. These findings indicate these patients need more calories to support nutritional rehabilitation in hospital.<\/jats:p><\/jats:sec>","DOI":"10.1002\/eat.24115","type":"journal-article","created":{"date-parts":[[2024,1,5]],"date-time":"2024-01-05T10:01:00Z","timestamp":1704448860000},"page":"859-868","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Short\u2010term outcomes of the study of refeeding to optimize inpatient gains for patients with atypical anorexia nervosa"],"prefix":"10.1002","volume":"57","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7563-0651","authenticated-orcid":false,"given":"Andrea K.","family":"Garber","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Adolescent and Young Adult Medicine University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0417-3713","authenticated-orcid":false,"given":"Jing","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Preventive and Restorative Dental Sciences University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5521-6381","authenticated-orcid":false,"given":"Erin C.","family":"Accurso","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara M.","family":"Buckelew","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Adolescent and Young Adult Medicine University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5206-7798","authenticated-orcid":false,"given":"Amanda E.","family":"Downey","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Adolescent and Young Adult Medicine University of California  San Francisco California USA"},{"name":"Department of Psychiatry and Behavioral Sciences University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7293-9496","authenticated-orcid":false,"given":"Daniel","family":"Le Grange","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of California  San Francisco California USA"},{"name":"Department of Psychiatry and Behavioral Neuroscience The University of Chicago (Emeritus)  Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8861-8547","authenticated-orcid":false,"given":"Sasha","family":"Gorrell","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences University of California  San Francisco California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5667-4157","authenticated-orcid":false,"given":"Cynthia J.","family":"Kapphahn","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Adolescent and Young Adult Medicine University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Kreiter","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Adolescent and Young Adult Medicine University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna\u2010Barbara","family":"Moscicki","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Adolescent and Young Adult Medicine University of California  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2262-6955","authenticated-orcid":false,"given":"Neville H.","family":"Golden","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Adolescent Medicine Stanford University  Stanford California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,1,5]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/eat.23931"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jada.2006.09.007"},{"key":"e_1_2_10_4_1","volume-title":"Diagnostic and statistical manual of mental disorders: DSM\u2010IV\u2010TR","author":"American Psychiatric Association","year":"2000"},{"issue":"7","key":"e_1_2_10_5_1","first-page":"4","article-title":"Treatment of patients with eating disorders, third edition. 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