Perhaps carbohydrates should initially be limited to <40% of the total energy intake. 3677-3687, Clinical Nutrition, Volume 40, Issue 6, 2021, pp. RS is historically described as a range of metabolic and electrolyte alterations occurring as a result of the rein- troduction Mehanna HM, et al. The decrease of nutritional status has affected one-third hospitalized patients, while there is no widely used definition of malnutrition. It is evident that there is a wide variety of practices regarding implementation and regime of NG feeding in YP with eating disorders globally [9]. Similar to the review conducted by Hale and Logomarsino [33] who found RS to be a rare complication, it is reassuring to find that no study in this review reported YP developing RS despite some studies starting on high calorie NG feeding plans [9, 18, 24, 42]. American Psychiatric Association. One article published prior to 2000 was included in the full text review due to it requiring translation prior to assessing it against the criteria. National Collaborating Centre for Mental Health. Int J Adolesc Med Health. London: National Institute for a Clinical Excellence; 2004. Over time, this change can deplete electrolyte stores. (2016). J Nutr Metab. https://doi.org/10.1186/s40337-016-0132-0. sharing sensitive information, make sure youre on a federal 2014;71(2):1007. Until a consensus definition is obtained, the following criteria seems reasonable: (29901461). Supplemental nocturnal nasogastric refeeding for better short-term outcome in hospitalized adolescent girls with anorexia nervosa. In some cases, refeeding syndrome can be fatal. Cumulated insulin dose between days 5 and 9 was correlated to EGP at day 10 (R=0.55, P=0.03). Clinical Nutrition (2002) 21 (6): 515-520. Bias can also occur due to the different treatment groups being recorded at different times thus confounding variables may include different staff working at the setting and therefore different methods of treating YP.
ASPEN Consensus Recommendations for Refeeding Neiderman M, Farley A, Richardson J, Lask B. Nasogastric feeding in children and adolescents with eating disorders: toward good practice. Preventative therapies: Thiamine 100-200 mg q12-24. STAR GC is most effective when nutrition and insulin are modulated together with timely responsiveness to persistent hyperglycaemia. Provided by the Springer Nature SharedIt content-sharing initiative. This causes insulin secretion to increase. There were no studies from Asia, South America or Africa. A systematic review of enteral feeding by nasogastric tube in young people with eating disorders. Signs and symptoms are a superimposition of various electrolytic abnormalities and thiamine deficiency. 1. This is unknown. 3708-3717, Clinical Nutrition, Volume 40, Issue 6, 2021, pp. To examine the impact of nutritional intake on phosphate concentrations, structural nested mean models with propensity score and censoring models were used. 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].
High Protein Feeds in Refeeding Syndrome This systematic review sets out to describe current practice of NG in young people with eating disorders. As per NICE guidelines, the care plan developed for each patient should specify how the patient will be discharged and reenter community-based care. 58% of the studies included only examined the effect of NG feeding as a secondary outcome of their study. Kezelman S, Crosby RD, Rhodes P, Hunt C, Anderson G, Clarke S, et al. HHS Vulnerability Disclosure, Help Youve consumed little to no food, or well below the calories needed to sustain normal processes in the body, for the past 10 or more consecutive days. In the circumstances that their BMI is detrimentally low, a nasogastric (NG) tube may be placed from nose to stomach to pass nutrition. J Adolesc Health. 2005;38(2):1436. DOI: hopkinsmedicine.org/gim/_pdf/consult/refeeding_syndrome.pdf, med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2014/06/Parrish-September-16.pdf. 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]. 2 of these studies [24, 26] for the first 2472h started with continuous NG feeding, using higher than standard calorie protocols, 24003000kcal per day prevented any initial drop in weight. Only 44% (8/19) of doctors compared with 70% (49/70) of dietitians followed the guidance.
Refeeding Syndrome Guideline Eur Eating Disord Rev. This exploratory study is based on the data from the Supplemental Parenteral Nutrition study 2 (SPN2), which measured EGP and GNG at days 4 and 10 in 23 critically ill patients. The incidence of refeeding syndrome is difficult to determine, as there isnt a standard definition. (2014). https://doi.org/10.24953/turkjped.2016.06.010. Glycaemic control (GC) may improve outcomes, though safe and effective control has proven elusive. Further research is warranted to determine whether refeeding syndrome prolongs the length of stay, and to verify the effect of different energy intakes during refeeding on the length of stay in people with malnutrition.
National Center for Biotechnology Information Fiber intake depends on age, gender, and sex. Int J Eat Disord. All authors assessed bias risk. 2016;58(6):6419. We therefore advocate septic screening and a low threshold for broad spectrum antibiotic cover for any patients with unexplained hypothermia, hypoglycaemia, and evidence of malnutrition.
Refeeding Syndrome Among Older Adults Madden S, Morris A, Zurynski YA, Kohn M, Elliot EJ. This could have the advantage of reducing LOS in medically stable YP. Increase of parenteral nutrition intake (in % kcal of predicted resting energy expenditure) decreased phosphate concentrations (c=0.002 (95% CI -0.002;0.001). Leeds and York Partnership NHS Foundation Trust, Mill Lodge, 520 Huntington Rd, York, YO32 9QA, UK, You can also search for this author in Nutr Clin Pract. Medical wards used continuous feeding more frequently than MH wards, however this tended to be for a short period of time while the YP was medically unstable, after this they would be transitioned to an oral diet [22, 23, 25, 26]. However, there is no high-quality evidence that this reduces the risk of refeeding syndrome. NG feeding involves a fine bore tube passed via the nasal passage into the stomach in order to administer nutrition. Together, these processes can lead to decreased concentrations of minerals in the blood, of which hypophosphatemia is the most characteristic [14]. Recent guidance from the British Dietetic Association [14] for NG feeding under restraint advised 12 bolus feeds per day even in those with high risk of refeeding syndrome (RS); it also concluded further research into this area was required. The correlation between EGP and GNG and 83 potential clinical indicators were explored, using single-stage and multivariate analysis. Patients randomized to late-PN had a lower chance of developing early RFH, which may be explained by the more gradual build-up of nutrition. For patients with the highest risk of refeeding syndrome, starting with 5 kcal/kg/day might even be considered (e.g., for a patient with BMI <14 kg/m2 and no nutritional intake for two weeks). https://doi.org/10.1038/ejcn.2013.244. 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.
NICE CG32 Refeeding Guidelines: Retrospective audit Cells need electrolytes like phosphate to convert glucose to energy, but phosphate is in short supply. The primary physiologic problems are deficiencies of thiamine, phosphate, magnesium, and potassium (especially phosphate). Neiderman et al [40] qualitative study describes patients time receiving NG varying from 1 to 476days (methods not explained). Webreport, literature review and clinical guidelines. Three studies reported weight gain in the context of inadequate oral intake [9, 18, 39]. See additional information. 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. Studies using bolus feeds stated that oral intake was encouraged and it was only when this was not fully achieved that supplementary NG was used [39]. < 40%. 2002;159(8):134753. Furthermore, no relevant association to lengths of stay in intensive care or hospital were detected. KH gathered data and interpreted results. Anorexia nervosa. WebThe NICE (National Institute for Health and Clinical Excellence) in England has listed criteria for identifying a patient who may be at increased risk for refeeding problems. Available literature suggests the following interventions may be reasonable: Want to Download the Episode?Right Click Here and Choose Save-As. Adolescents with severe restrictive eating disorders often require enteral feeding to provide lifesaving treatment. Rhabdomyolysis can occur (causing an elevated creatinine kinase). Refeeding syndrome or refeeding hypophosphatemia: a systematic review of cases. WebThese consensus recommendations are intended to provide guidance regarding recognizing risk and identifying, stratifying, avoiding and managing RS. Nasogastric (NG) feeding use in YP with ED may be used as a lifesaving treatment when patients are physically unwell [7, 8]. It includes gluconeogenesis (GNG) from non-carbohydrate substrates and hepatic glycogenolysis. Although complications such as electrolyte abnormalities did occur there was no evidence that this was attributable to the NG feeding compared to oral diet [9, 18, 23, 24]. 608 patients (363 female, 245 male, mean age 55.55 year) from all over Poland were treated between December 1999 and December 2019. Conclusions: The strategy for assessing the risk of refeeding syndrome, nutritional management and implemented follow-up were successful in preventing the 2018;51(11):121322. Esophageal cancer patients often suffer from cancer-related malnutrition and, as a result, sarcopenia. There is no high-quality evidence on this. For more information about refeeding syndrome symptoms and warning signs, contact us. Encephalitis. https://doi.org/10.1136/archdischild-2016-310506. For this reason, acute medical intervention is often warranted in order to reduce mortality. WebBACKGROUND. While there is no single definitive marker to identify which patients will develop refeeding syndrome, the National Institute for Health and Clinical Excellence (NICE) has published two sets of criteria for identifying patients at heightened risk for this complication. Neither of these guidelines are specific for children and adolescents. Univariate, unadjusted long-term survival analysis revealed that lower MRA and lower SMI were associated with shorter survival (P=0.03). EDs usually manifest prior to adulthood, with an average age of onset of approximately 15years, although this is decreasing; with new research from NICE demonstrating that incidence in children aged 12 and under had increased between 2005 and 2015 in the UK [2, 3]. https://doi.org/10.1002/eat.22968. Structured, supported feeding admissions for restrictive eating disorders on paediatric wards. Youve taken in little to no food for the past 5 or more consecutive days. https://doi.org/10.1007/s00787-008-0706-8. By comparison, IO only resulted in 6469% BG in range across different nutrition types. The author(s) read and approved the final manuscript. All rights reserved. 2016;49(3):293310. Table1 includes a summary of included studies. https://doi.org/10.1002/erv.624. Changes in these symptoms were not attributed to the rate of weight restoration suggesting a rapid refeeding schedule would not exacerbate psychiatric symptoms. The present study showed that the incidence of RFS is highly dependent on the definition used and the population analyzed, ranging from 0% up to 62%. 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. https://doi.org/10.7326/0003-4819-102-1-49. From this systematic review 3 methods of NG feeding in YP with ED were found: continuous [23, 25], nocturnal [26, 29], and bolus meal replacement [9]. Research on NG feeding in YP has tended to focus on the acute refeeding phase in paediatric or psychiatric wards to reduce the risk of RS [17]. More on how to calculate tube feeding rates here: Insulin appears to play a central role in the generation of refeeding syndrome. This study sought to (1) determine whether RFS, as operationalized in the 2020 American Society for Parenteral and Enteral Nutrition (ASPEN) guideline definition, is associated with adverse clinical outcomes and (2) identify key risk This study aids the understanding of clinical nutrition strategies to prevent and treat refeeding syndrome. Regulation of endogenous glucose production (EGP) is essential for glucose homeostasis. The risk of bias was serious in 16 studies and moderate in the remaining 19. 11 Historically, recommendations for nutritional rehabilitation in inpatient settings have been conservative, 12 16 for fear of precipitating the refeeding syndrome, a constellation of electrolyte disturbances and multiorgan dysfunction that can develop early in the Nutr Dietetics. https://doi.org/10.7748/ns.2017.e10509. Agostino H, Erdstein J, Di Meglio G. Shifting paradigms: continuous nasogastric feeding with high caloric intakes in anorexia nervosa. DOI: Khan LUR, et al. No study discussed in detail the strategy used to transition from NG feeds back to an oral diet. Refeeding syndrome: (2021) Rapid renutrition improves health status in severely malnourished inpatients with AN - score-based evaluation of a high caloric refeeding protocol in In Australian based studies, NG was given due to refusal of oral intake in 2 studies [9, 10] as well as to treat medical instability [26].