Eating disorders in male populations are underrecognized and undertreated, leading to delays in identification, diagnosis, and treatment. Although male adolescents and young adults generally have greater energy requirements than females due to greater body weights, metabolic response, and exercise, current inpatient nutritional refeeding protocols support a single caloric prescription regardless of sex. The objective of this study was to determine sex differences in nutritional refeeding outcomes among adolescents and young adults hospitalized for eating disorders.
We retrospectively reviewed electronic medical records of 601 patients aged 9-25 years admitted to a tertiary care center for medical and nutritional management, between May 2012 and August 2020. We collected demographic, clinical, and nutritional characteristics (including initial calorie prescription, discharge kilocalories [kcals], weight change, and length of stay) from the electronic medical record. Descriptive statistics, unadjusted, and adjusted linear regression models were used to assess the association between sex and nutritional outcomes, as well as length of stay.
A total of 588 adolescents and young adults met eligibility criteria, [16% male, mean (SD) age 15.96±2.75, 71.6% anorexia nervosa, admission percent median body mass index (%mBMI) 87.1±14.1]. In unadjusted comparisons, there were no significant sex differences in prescribed kilocalories (kcal) per day at admission (2013 vs. 1980 kcal, P=0.188); however, males had higher Estimated Energy Requirements (EER) (3694 vs. 2925 kcal, P<0.001). In linear regression models adjusting for potential confounders including age, race/ethnicity, and diagnosis, male sex was associated with higher prescribed kcals at discharge (B=855 kcal, p<0.001), greater weight change (B=0.50 kg, p=0.016), and longer length of stay (B=1.83 days, p=0.001) than females. Older age, lower admission weight, lower prescribed kcal at admission, higher EER, and lower heart rate at admission were factors associated with longer length of stay in linear regression models. In these adjusted models, every 1000 lower kcal prescribed at admission was associated with a 3.99 day longer length of stay while every 1000 greater kcal in the EER was associated with a 1.61 day longer length of stay.
We report for the first time that males hospitalized for eating disorders require higher kcal/day at discharge than females despite clinical protocols that standardize the beginning kcal/day regardless of sex. This may lead to longer hospitalizations for male adolescents and young adults with eating disorders. These findings suggest that current refeeding approaches may be insufficient for male patients and support the development of individualized treatment protocols for males with eating disorders. Given the rise in hospitalizations for eating disorders during the COVID-19 pandemic, these findings can improve quality of care and healthcare efficiency among an underserved population in a post-pandemic world.
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