Refeeding syndrome: A literature review. The incidences of RFS and RH were expressed as percentage and reported with 95% confidence intervals (CI). Prevention is critical in avoiding the life-threatening complications of refeeding syndrome. It is necessary to adapt to the changing circumstances. We use cookies to help provide and enhance our service and tailor content and ads. This guideline covers identifying and caring for adults who are malnourished or at risk of malnutrition in hospital or in their own home or a care home. In the subgroup analyses, inpatients from Intensive Care Units (ICUs) and those initially fed with >20kcal/kg/day seemed to have a higher incidence of both RFS (pooled incidence=44%; 95% CI 36%52%) and RH (pooled incidence=27%; 95% CI 21%34%). Although there are some RCTs examining aspects of NG use in YP with ED the majority of studies were retrospective cohorts or case series. Conversely any hospital admission was significantly longer (P<0.0001) for a YP requiring NG feeding compared to those managing an oral diet in a German retrospective cohort study [37]. Nasogastric tube feeding in line with new dietetic guidelines for the treatment of anorexia nervosa in a specialist children and adolescent inpatient unit: a case series. 2016;101(9):8368. NICE. 2011;19:52630. Refeeding is the process of reintroducing food after malnourishment or starvation. Clinical adaptations/cohorts include variations on upper target (UL-9 with 9.0mmol/L, reducing workload and nutrition responsiveness), and insulin only (IO) with clinically set nutrition at 3 glucose concentrations (71g/L vs. 120 and 180g/L in the TARGET study). Before References were exported and duplicates were removed using the title and abstract. Four databases were systematically searched until September 2020 for retrieving trials and observational studies. Madden S, Miskovic-Wheatley J, Wallis A, et al. Check electrolytes (including magnesium and phosphate), with aggressive repletion as needed. Refeeding with a lower calorie provision and a slow energy increase may be a better approach for severely malnourished patients with chronic comorbidity, while higher caloric intakes might be reserved for moderately malnourished patients with acute illnesses [ 69 ]. 2010;46(6):57782. Death is often caused by cardiac abnormalities associated with extremely low bodyweight [6]. As a result, people at risk require medical supervision at a hospital or specialized facility. Provided by the Springer Nature SharedIt content-sharing initiative. Hypophosphatemia is a common feature of refeeding syndrome. JPEN J Parenter Enteral Nutr. ASPEN Consensus Recommendations for Refeeding 2017;22(5):26972. Nehring I, Kewitz K, Von Kries R, Thyen U. The findings of this systematic review suggested that specific subgroups of population, such as inpatients from ICU and those initially supplied with higher caloric intakes, might have an increased risk for RFS/RH, but robust evidence is still lacking. https://doi.org/10.1515/ijamh-2014-0078. Treatment usually involves replacing essential electrolytes and slowing down the refeeding process. Agostino et al [23] compared a higher calorie (1500-1800kcal/d) continuous NG fed cohort to lower calorie oral bolus cohort (1000-1200kcal/d, divided 6 times per day), results showed mean weight gain was greater in the continuous NG fed group (1.22 kgs per week) than the oral bolus fed group (0.08 kgs per week) over the first 2weeks. https://doi.org/10.7326/0003-4819-102-1-49. This leads to another condition called hypophosphatemia (low phosphate). Young people with eating disorders often restrict food intake to a degree which is detrimental to their physical health. It is important to note that only a subset of patients with heightened risk will develop this life-threatening complication during nutritional rehabilitation. 1. Hypophosphatemia during critical illness has been associated with adverse outcome. In most studies the NG feed supplemented any deficit in oral intake but occasionally also provided additional calories above those prescribed in the oral meal plan [22, 25, 39]. See, treatment of established refeeding syndrome, Treatment of established refeeding syndrome, https://traffic.libsyn.com/secure/ibccpodcast/IBCC_EP_83_-_Refeeding_Syndrome.mp3. Reduce the caloric intake to 20 kCal/hr for at least two days. 2009;18(2):7584. Unfortunately, owing to the high heterogeneity of data, summary incidence measures are meaningless. Any discussion on the risks of the refeeding syndrome should include the increased threat of infection that may often be silent in malnutrition.1 Malnourished patients may develop infection without showing the usual septic markerssuch as an increased temperature, leucocyte count, or C reactive protein. The refeeding syndrome. A systematic review of enteral feeding by nasogastric tube in young people with eating disorders, https://doi.org/10.1186/s40337-021-00445-1, https://www.ncbi.nlm.nih.gov/books/NBK436876/, https://doi.org/10.1136/bmjopen-2018-027339, https://doi.org/10.1016/j.encep.2012.06.001, https://doi.org/10.7326/0003-4819-102-1-49, https://doi.org/10.1016/j.jadohealth.2009.11.207, https://doi.org/10.1186/s40337-016-0132-0, https://doi.org/10.1177/0148607106030003231, https://doi.org/10.1097/00004703-200412000-00005, https://doi.org/10.1017/S0033291714001573, https://doi.org/10.1016/j.jadohealth.2013.06.005, https://doi.org/10.1186/s40337-015-0047-1, https://doi.org/10.12968/bjmh.2019.8.3.124, https://doi.org/10.1136/archdischild-2016-310506, https://doi.org/10.1080/10640260902991236, https://doi.org/10.1007/s40519-018-0572-4, https://doi.org/10.24953/turkjped.2016.06.010, https://doi.org/10.1002/1098-108X(200012)28:4<470::AID-EAT18>3.0.CO;2-1, https://doi.org/10.1176/appi.ajp.159.8.1347, https://doi.org/10.5694/j.1326-5377.2009.tb02487.x, https://doi.org/10.1007/s00787-008-0706-8, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Moreover, for clinicians, there is currently conflicting guidance on how to manage NG feeding in YP with ED, in particular how and when to transition between oral and NG feeding [20, 21]. Predictive factors of length of inpatient treatment in anorexia nervosa. Three studies were qualitative interview studies, examining patient or staff feelings towards NG feeding in practice which increases the risk of confirmation bias. AHRQ publication no. Am J Psychiatry. The refeeding syndrome (RFS) is described as a set of metabolic and electrolyte alterations occurring as the result of the reintroduction of calories through oral, enteral, parenteral nutrition after a period of consistent reduction of energy intake or starvation in individuals with pre-existent malnutrition and/or in a catabolic state [ [1], NG feeding may be administered through different methods such as continuously, multiple single meals (bolus), or overnight to supplement day-time oral intake. There was no disagreement between CF and KH who assessed which studies were included. Refeeding protocols daily calorie intake varied greatly between studies particularly as many studies were evaluating the outcome of higher calorie refeeding protocols [9, 18, 22, 24, 31]. https://doi.org/10.1002/eat.20164. (2011). The most common symptoms are as follows: Unfortunately, there is no uniform definition of refeeding syndrome. 608 patients (363 female, 245 male, mean age 55.55 year) from all over Poland were treated between December 1999 and December 2019. Overall, this review found 5 studies [9, 18, 23, 24, 29] reported some incidence of electrolyte disturbance, 2 studies [29, 39] described epistaxis and 1 study [39] described behavioural problems associated with the procedure. Ann Intern Med. Our results suggest that a robust model might be built, but requires a prospective study including a larger number of patients. 29002-0025.) 1 Malnourished J Nutr Metab. 1, 2 Its principles regard the family as the best treatment resource for recovery, hospitalization as a temporary solution, and Inclusion in an NLM database does not imply endorsement of, or agreement with, 2020;29(6):118191. Crook MA, et al. In addition, refeeding often occurs alongside other serious conditions that typically require simultaneous treatment. None developed clinical RFS. Routine NG feeding may allow greater initial caloric intake, which does not increase risk of medical complications, and may actually increase initial weight gain thus reducing time in hospital. (2014). The incidence of RFS is at present uncertain due to heterogeneity of subjects involved and the lack of a universally accepted definition [3,4,7]. KH gathered data and interpreted results. Background. Patients with renal replacement therapy or unavailable phosphate concentrations were excluded from this analysis. https://doi.org/10.1038/ejcn.2013.244. 167 (prepared by the Duke University evidence-based practice center under contract no. This review aims to assess strategies for the use, tolerance and effectiveness of NG feeding in YP with restrictive ED. Refeeding Syndrome Guideline 2005;13(4):26472. 2017;31(45):427. sharing sensitive information, make sure youre on a federal PLT was based on FBT and included parents reducing child exercise and increasing oral intake. Psychiatric nursing assistants views centred around: NG being an unpleasant practice, becoming sensitized or desensitized, and the importance of developing coping mechanisms to manage the distress. Crook MA, et al. DOI: Hearing SD. 2019;34(3):35970. In some cases, refeeding syndrome can be fatal. Refeeding syndrome. Federal government websites often end in .gov or .mil. The entity of electrolyte depletion and the presence of organ dysfunction allow to define the severity of the syndrome [1]. 2002;159(8):134753. old, P<0.05 [37] and 20% in early onset AN compared to 0% in adult onset AN P<0.05 [43]). Agostino H, Erdstein J, Di Meglio G. Shifting paradigms: continuous nasogastric feeding with high caloric intakes in anorexia nervosa. Certain conditions, such as anorexia nervosa or chronic alcohol use disorder, can increase risk. Two studies [37, 43], found NG feeding was more likely to be required in: patients of a lower age at admission (14.3years compared to 15.3yrs. In this cross-sectional study, we analyzed plasma SCFA levels, HIF3A expression, and CpG methylation of HIF3A intron 1 in peripheral blood from patients with type 2 diabetes presenting with (n=92) and without (n=105) cardiomyopathy.
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