Refeeding Syndrome Research Articles

Severe Acute ulcerative Colitis Disease with Severe Celiac Disease Associated with Clostridium difficile Colitis Infection Complicated with Refeeding Syndrome, Challenging Case Report

Severe Acute ulcerative Colitis Disease with Severe Celiac Disease Associated with Clostridium difficile Colitis Infection Complicated with Refeeding Syndrome, Challenging Case Report

Refeeding syndrome and vitamin B1 deficiency in a young man with normal body mass index following starvation in the COVID‐19 era

AbstractCOVID‐19 has spread worldwide and significantly influenced economies. Refeeding syndrome (RFS) is a potentially fatal abnormalities of electrolytes and fluid that can occur in malnourished patients undergoing mechanical refeeding. Herein, we report the case of a man in his 20s with a normal body mass index who presented with RFS and vitamin B1 deficiency. Although it was uncommon under normal circumstances, it occurred because of the severe social situations that were prevalent in the COVID‐19 era. In this era, physicians should carefully evaluate their patients' nutritional status to identify those at risk for RFS, even in young individuals.

Features of refeeding syndrome in pediatric intensive care unit patients (literature review)

Introduction. Restoration of nutrition in patients with nutritional deficiency hospitalized in intensive care units is a complex process due to the high risk of the development of refeeding syndrome. Refeeding syndrome is insufficiently studied in children not only with regard to pathogenesis and intensive care, but also with regard to its influence on the further development of the child.Materials and methods. A non-systematic review of literature sources was performed. Domestic publications were searched in the database on the eLibrary website, foreign publications were searched in PubMed, Google Scholar, Cophrane Library, Cyberleninka, ResearchGate databases in the period 2017–2024. 73 full-text publications describing risk factors, peculiarities of mechanisms of refeeding syndrome development in children, clinical picture and methods of intensive therapy were analyzed.Results. The review analyzed and systematized the stratified risk factors, peculiarities of pathogenesis and clinical picture of refeeding syndrome in children depending on developing metabolic disorders. The connection of refeeding syndrome on the progression of nutritional deficiency is shown. The main methods of intensive therapy, including nutritional support for patients with high-risk and developed refeeding syndrome are determined.Conclusion. Currently, there is no unambiguous definition and diagnostic criteria for refeeding syndrome in children. Timely intensive therapy in cases of refeeding syndrome development allows to correct nutritional deficiency, to increase the survival rate of patients, can influence further growth and development of the child.

Impact of Refeeding Syndrome on the Short-Term Clinical Outcomes of Very-Premature Infants.

Refeeding syndrome (RFS) is a potentially life-threatening condition that can occur in preterm infants if nutritional support is initiated or increased after a period of starvation or malnutrition. The current study aimed to examine the short-term clinical outcomes of RFS in preterm infants born at ≤32 weeks of gestation. Infants with a gestational age of ≤32 weeks and a birth weight of <1500 g who were born and admitted to the level III neonatal intensive care unit and received parenteral nutrition upon admission were retrospectively evaluated. The modified log Poisson regression with generalized linear models and a robust variance estimator was applied to adjust the outcomes of infants. In total, 760 infants met this study's inclusion criteria. Of them, 289 (38%) developed RFS. RFS was significantly associated with a composite outcome of mortality and intraventricular hemorrhage. Based on the multivariate Cox regression analysis adjusted for significant potential confounders, RFS was significantly associated with increased mortality risk, with a hazard ratio for death in infants with RFS being 1.74-fold higher compared to those without RFS. Preterm infants born at ≤32 weeks of gestation who develop RFS within the first week of life are at increased risk for both intraventricular hemorrhage and mortality. This study underscores the need for standardized clinical approaches for managing RFS in the neonatal intensive care unit to improve outcomes. Future research should establish a unified RFS definition and conduct clinical trials to optimize parenteral nutrition strategies for this vulnerable population.

Malnutrition in frail older adults and the risk of refeeding syndrome: a clinical review

Malnutrition in frail older adults and the risk of refeeding syndrome: a clinical review

Refeeding syndrome: don't forget electrolytes

Refeeding syndrome: don't forget electrolytes

The Road to Standardizing Refeeding Protocols: Dietitian-led Education to Critical Care Staff to Improve Electrolyte Management in Preventing and Treating Refeeding Syndrome in High Risk, Critically Ill Patients

The Road to Standardizing Refeeding Protocols: Dietitian-led Education to Critical Care Staff to Improve Electrolyte Management in Preventing and Treating Refeeding Syndrome in High Risk, Critically Ill Patients

Analysis of refeeding syndrome: Paediatric in-patient population study in Dominican Republic

Analysis of refeeding syndrome: Paediatric in-patient population study in Dominican Republic

The Incidence and Risk Factors of Refeeding Syndrome-like Hypophosphatemia in Inflammatory Bowel Disease: A Preliminary Study.

Refeeding syndrome (RFS) is defined by the presence of acute electrolyte disturbances, including hypophosphatemia. Underlying disease(s), malnutrition and hospitalisation are known risk factors for RFS. It can occur in patients with inflammatory bowel disease (IBD). We aimed to determine the frequency of hypophosphatemia and the relationship between hypophosphatemia, disease severity and nutritional status in hospitalized patients with IBD. This study was performed prospectively in hospitalized adult patients for the treatment of IBD in a tertiary-care hospital. Disease severity was assessed using Truelove and Witts score for ulcerative colitis (UC) and Crohn's Disease Activity Index for Crohn's disease (CD). Nutritional status was determined using Subjective Global Assessment (SGA). Serum phosphate concentration was recorded for first 7 days after hospitalization, and less than 0.65 mmol/l was defined as hypophosphatemia. Fifty participants (33 with UC and 17 with CD) were included in the study. The mean age of the study sample was 43.4±14.9 years, of which 64% were male. A total of 8.8% of patients with UC and 37.5% of patients with CD had severe (>moderate) disease upon study admission. Seventeen patients (34%) were malnourished. During the 7 study days, 23 participants (46%) had at least one episode of hypophosphatemia. Serum phosphate concentration was significantly and moderately correlated with serum potassium concentration in both the patients and the hypophosphatemia group on study day 3 (p<0.05). Multivariate logistic regression analysis showed that the presence of malnutrition [odds ratio (OR) = 3.64, 95% confidence interval (CI): 1.52-5.58, p=0.008), the administration of parenteral nutrition (OR=2.91, 95%Cl: 1.37-4.63, p=0.015), and severe IBD (OR=1.74, 95%CI: 1.03-3.42, p=0.020) were associated with hypophosphatemia. Approximately half of the participants exhibited at least one instance of hypophosphatemia during the study period. Hypophosphatemia was found to be associated with malnutrition, parenteral nutrition, and severe disease in patients with IBD requiring hospitalization.

Association between Poor Outcomes and Risk of Refeeding Syndrome among Patients Urgently Admitted to the High Dependency Unit: A Single-Center Cohort Study in Japan.

Background/Objectives: Refeeding syndrome (RFS) is recognized as a potentially fatal metabolic disturbance, particularly concerning for non-critically ill patients who do not receive frequent electrolyte assessments. Assessing the risk of developing RFS and implementing preventive strategies is essential in these cases. We investigated the proportion of risk and its association with prognosis in a high-dependency unit (HDU). Method: This observational study was conducted in a tertiary care hospital's HDU in Japan. We consecutively enrolled all patients who had been admitted urgently to the HDU and hospitalized for three days or more. We evaluated the National Institute for Health and Clinical Excellence (NICE) RFS risk factors at admission and classified patients into four groups based on the modified NICE criteria. The primary outcome was 30-day in-hospital mortality. The secondary outcome was a composite of 30-day in-hospital mortality and transfer to the intensive care unit, or discharge to locations other than home. Using logistic regression, we assessed the association between the four risk groups and outcomes, using the no-risk group as a reference. Results: A total of 955 patients were analyzed, of which 33.1%, 26.7%, 37.8%, and 2.4% were classified into the no-risk, low-risk, high-risk, and very high-risk groups, respectively. The 30-day in-hospital mortality was 4.4%, 5.5%, 5.0%, and 21.7%, respectively (Log-rank trend test: p = 0.047). In multivariable logistic regression, adjusting for sepsis, comorbidities, and age, only the very high-risk group was associated with 30-day in-hospital mortality (odds ratio: 5.54, 95% confidence interval: 1.73-17.79) A similar association was observed for the secondary outcomes. Conclusions: For patients admitted urgently to the HDU, there may be an opportunity to improve outcomes for very high-risk patients through preventive strategies.

Strongyloides Hyperinfection Syndrome and Severe Malnutrition in an Immunocompetent Patient

Aims: Strongyloides Hyperinfection Syndrome (SHS) and disseminated Strongyloidiasis have been extensively reported in immunocompromised patients. In SHS, large parasitic loads of larvae cause symptoms mainly limited to the gastrointestinal tract and lung, whereas in the disseminated form multiple organs can be affected with high mortality if inappropriately treated. Case Presentation: Here we present an unusual case of a 28-year-old (HIV negative) patient with confirmed untreated Helicobacter pylori, symptoms of gastric and pulmonary hyperinfection complicated with severe weight loss, respiratory symptoms with hemoptysis and refeeding syndrome. Discussion: The diagnosis was based on histological confirmation of the parasite in the gastric mucosal biopsy and stool analysis. The patient was successfully treated with ivermectin and discharged in reasonable medical conditions. Conclusion: This case illustrates the importance of considering Strongyloides Hyperinfection in immunocompetent patients presenting with chronic vomiting, weight loss and anemia, especially in developmental countries.

Chinese expert consensus on the application of electrolytes in parenteral nutrition (2024 edition)

As essential nutrients for human beings, electrolytes play a central role in nutritional and metabolic support treatment. To further standardize the use of electrolyte preparations in parenteral nutrition, the China International Exchange and Promotive Association for Medical and Health Care Clinical Nutrition Health Branch, Chinese Medical Doctor Association Nutritionist Professional Committee, Chinese Society of Parenteral and Enteral Nutrition, and Chinese Nutrition Society Branch of Clinical Nutrition, invited authoritative experts in the fields of critical medicine, emergency medicine, internal medicine, surgery, and pharmacology in China to create this expert consensus. This consensus was based on the latest guidelines and evidence-based medicine at home and abroad, and combined with the actual clinical medical environment in China. This consensus covered the following topics: electrolytes monitoring during parenteral nutrition, risk assessment and nutritional treatment of refeeding syndrome, electrolytes supplementation during parenteral nutrition for various diseases (including severe diseases, heart failure, post-surgical short bowel syndrome, perioperative period, trauma, diabetic foot, chronic kidney disease, liver disease, neonates), and the compatibility principles of electrolyte preparations in parenteral nutrition. Finally, 13 clinical questions and 26 recommendations were proposed aiming at providing scientific, standardized, and practical guidance for the rational application of electrolytes in parenteral nutrition.

Risk factors for the development of refeeding syndrome in adults: A systematic review.

Identifying patients with a particularly high risk of refeeding syndrome (RFS) is essential for taking preventive measures. To guide the development of clinical decision-making and risk prediction models or other screening tools for RFS, increased knowledge of risk factors is needed. Therefore, we conducted a systematic review to identify risk factors for the development of RFS. PubMed, EMBASE, Cochrane Library, and Web of Science were searched from January 1990 until March 2023. Studies investigating demographic, clinical, drug use, laboratory, and/or nutrition factors for RFS were considered. The Newcastle-Ottawa Scale was used to appraise the methodological quality of included studies. Of 1589 identified records, 30 studies were included. Thirty-three factors associated with increased risk of RFS after multivariable adjustments were identified. The following factors were reported by two or more studies, with 0-1 study reporting null findings: a previous history of alcohol misuse, cancer, comorbid hypertension, high Acute Physiology and Chronic Health Evaluation II score, high Sequential Organ Failure Assessment score, low Glasgow coma scale score, the use of diuretics before refeeding, low baseline serum prealbumin level, high baseline level of creatinine, and enteral nutrition. The majority of the studies (20, 66.7%) were of high methodological quality. In conclusion, this systematic review informs on several risk factors for RFS in patients. To improve risk stratification and guide development of risk prediction models or other screening tools, further confirmation is needed because there were a small number of studies and a low number of high-quality studies on each factor.

Anorexia nervosa: Disease process, challenges and hope

Anorexia nervosa, as a psychiatric disorder with a progressively high prevalence, is characterized by the following features: high mortality rate, serious harm, long-lasting effects, difficult to cure and easy to relapse. In recent years, Awareness of anorexia nervosa is different than in the past, going deeper: it is a complex disorder involving multiple systems. Many disciplines are also actively exploring it. However, there are still problems such as Pathologic mechanism unclear, no clear indicators of disease, no targeted drugs, and insufficient public awareness. This article analyses research in the fields of social environment, immunology and brain science in the order of disease onset, evolution and treatment (including difficulties in the treatment process, such as in Refeeding syndrome), and puts forward some recommendations for earlier intervention, comprehensive treatment, and optimization and maintenance of therapeutic efficacy in anorexia nervosa. It is also hoped that public awareness and attention will be raised. There are still many gaps in the road to overcoming anorexia nervosa, which has a large research space and is also not less challenging. Future research could focus on finding objective indicators for diagnosing anorexia nervosa or suggesting recovery, and finding targeted drugs from the perspective of multi-system interactions.

Early hypophosphataemia and refeeding syndrome in extremely low birthweight babies and outcomes to 2 years of age: secondary cohort analysis from the ProVIDe trial

ObjectiveTo investigate in extremely low birthweight (ELBW; <1000 g) babies the associations between refeeding syndrome (serum phosphate <1.4 mmol·L-1 and serum total calcium>2.8 mmol·L-1) and hypophosphataemia in the first week...

Incidence and Risk Factors of Refeeding Syndrome in Preterm Infants.

This study aimed to evaluate the incidence and risk factors associated with refeeding syndrome (RFS) in preterm infants (≤32 weeks gestational age) during their first week of life. Infants (gestational age ≤ 32 weeks; birth weight < 1500 g) who were admitted to the neonatal intensive care unit (NICU), level III, and received parenteral nutrition between January 2015 and April 2024 were retrospectively evaluated. Modified log-Poisson regression with generalized linear models and a robust variance estimator was applied to adjust the relative risk of risk factors. Of the 760 infants identified, 289 (38%) developed RFS. In the multivariable regression analysis, male, intraventricular hemorrhage (IVH), and sodium phosphate significantly affected RFS. Male infants had significantly increased RFS risk (aRR1.31; 95% CI 1.08-1.59). The RFS risk was significantly higher in infants with IVH (aRR 1.71; 95% CI 1.27-2.13). However, infants who received higher sodium phosphate in their first week of life had significantly lower RFS risk (aRR 0.67; 95% 0.47-0.98). This study revealed a notable incidence of RFS among preterm infants aged ≤32 gestational weeks, with sex, IVH, and low sodium phosphate as significant risk factors. Refined RFS diagnostic criteria and targeted interventions are needed for optimal management.

The Inpatient Management of Adolescents with Eating Disorders.

Eating disorders affect individuals of all ages, genders, sexual orientations, ethnicities, races, and socioeconomic statuses. They can lead to serious medical complications that require inpatient treatment. The eating disorders that are most likely to lead to medical complications requiring medical inpatient stabilization include anorexia nervosa, atypical anorexia nervosa, avoidant-restrictive food intake disorder, bulimia nervosa, and purging disorder. There are criteria that can help determine if a patient requires inpatient stabilization. Nearly all body systems may be affected. Patients are often treated by following a refeeding protocol that reduces the risk of developing refeeding syndrome, a dangerous and life-threatening state of metabolic derangements that can arise when a malnourished individual begins a renourishment process. Following stabilization, patients should receive further care through a number of different treatment options directed at their underlying eating disorder and by working with a multidisciplinary team. [Pediatr Ann. 2024;53(8):e283-e287.].

Current practices in the nutrition management of people with amyotrophic lateral sclerosis (ALS): a survey of U.S. ALS care teams

Objective To assess current practices of U.S. professionals providing outpatient ALS nutrition care. Methods A cross-sectional survey assessing nutrition care practices was distributed in February/March 2023 through electronic mailing lists of relevant professional organizations. Results Of the 87 professionals completing the survey, 85.1% were registered dietitians and 50.6% had five or fewer years of experience in ALS care. Many (44.2%) professionals reported receiving no training on the nutrition care of people with ALS (PALS), and 40.2% reported having no other ALS dietitians in their close network. Methods utilized to estimate calorie and protein requirements in PALS varied widely. Although 95.4% of respondents reported that their clinic’s dietitian participates in feeding tube discussions, many practitioners may be waiting until ALS symptoms negatively impact PALS’ breathing, eating, swallowing, or weight to begin discussing feeding tubes. Additionally, few professionals reported institutional practices conducive for refeeding syndrome prevention or monitoring. Conclusions Many professionals providing outpatient nutrition care to PALS possess limited experience, received insufficient training, and are not connected to other ALS dietitians. Specific nutrition care practices, including nutrient need estimation, vary widely among health professionals. Practices surrounding feeding tube discussions and refeeding syndrome may be suboptimal at many institutions. These findings highlight the need for initiatives that educate and connect practitioners providing nutrition care to PALS.

Hypophosphataemia and late-onset sepsis in extremely preterm neonates: A case-control study.

Late-onset sepsis (LOS) is common in extreme prematurity. These infants are at risk of refeeding syndrome-associated hypophosphataemia. Our objective was to investigate whether hypophosphataemia predisposes to LOS in extremely premature neonates. A retrospective case-control study of neonates born before 29 weeks' gestation in an Australian NICU from 2016 to 2020. Cases developed LOS or localised infection. Two controls, matched within 2 gestational weeks and 90 calendar days, were selected per case. Amongst 48 cases and 93 controls, cases were smaller at birth (767 g vs. 901 g, P = 0.01), but were otherwise comparable. Hypophosphataemia was more common in cases (26% vs. 15%, P = 0.18). Increased intravenous protein intake in the first week was protective against LOS (OR = 0.9, 95% CI 0.76-1.00, P = 0.04); median 2.1 g/kg/day in cases, 2.3 g/kg/day in controls. Hypophosphataemia as part of refeeding syndrome is prevalent and under-recognised in extremely premature neonates. We did not find an association between hypophosphataemia and LOS. Low intravenous protein may be an independent risk factor for infection.

Impact of early high protein intake in critically ill patients: a randomized controlled trial

BackgroundConflicting findings regarding the impact of High protein intake during the early phase in critically ill patients have been reported. Therefore, we aimed to assess the influence of higher early protein intake on the prognosis of critically ill patients.MethodsThis randomized controlled trial involved 173 critically ill patients who stayed in the Intensive Care Unit/Emergency ICU (ICU/EICU) for at least 7 days. The Low group (n = 87) and High group (n = 86) received protein supplementation of 0.8 g/kg.d and 1.5 g/kg.d, respectively, within 1–3 days of enteral nutrition (EN) initiation, with both groups transitioning to 1.5 g/kg.d on the 4th day. The serum prealbumin (PA), blood urea nitrogen/creatinine, and rectus femoris muscle thickness and cross-sectional area of all patients was measured on the 1th, 3rd, 5th, 7th day, and the day of ICU/EICU discharge.ResultsPatients in both Low and High groups showed no significant differences in age, APACHE II scores, or other demographic and baseline characteristics. There were also no significant differences in the primary outcome (28-day mortality rate) and secondary outcomes (incidence rate of refeeding syndrome and EN tolerance score) between the two groups. However, the Low group exhibited a significantly higher 28-day mortality rate (HR = 2.462, 95% CI: 1.021–5.936, P = 0.045) compared to High group, as determined by Cox proportional hazards models incorporating the time factor. The High group exhibited significantly shorter durations of mechanical ventilation and ICU stay compared to the Low group. Serum PA levels were higher, and rectus femoris muscle atrophy rates were lower in the High group. Furthermore, for septic patients, high protein intake significantly reduced the 28-day mortality rate despite a small sample size (n = 34).ConclusionsOur study indicates that increasing early protein intake to 1.5 g/kg.d may be safe and help improve the nutritional status and prognosis of critically ill patients.Trial registrationThis study was registered with the Chinese Clinical Trial Registry (ChiCTR2000039997, https://www.chictr.org.cn/).