Cite this article. A systematic review of approaches to refeeding in patients with anorexia nervosa. https://doi.org/10.1136/archdischild-2016-310506. One of the main guidelines used for the evaluation and treatment of refeeding syndrome is the National Institute for Health Care and Excellence (NICE) 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]. Application criteria of enteral nutrition in patients with anorexia nervosa: correlation between clinical and psychological data in a lifesaving treatment. STAR GC is most effective when nutrition and insulin are modulated together with timely responsiveness to persistent hyperglycaemia. NG feeding is a safe and efficacious method of increasing total calorie intake by either supplementing oral intake or continuously. Therefore, the present systematic review and meta-analyses aimed to estimate the incidence of RFS in adults by considering the definition used by the authors as well as the recent criteria proposed by the ASPEN consensus (when applicable). Three studies reported weight gain in the context of inadequate oral intake [9, 18, 39]. (3) Absence of another obvious cause of hypophosphatemia that is felt to account for the hypophosphatemia. WebRefeedingSyndromeDefinitionandBackground. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Journal of Eating Disorders The flowchart relative to the selection process is reported in Fig. Baseline demographic, comorbidity and preadmission caloric data were collected. Most studies tailored the calorie requirements to the individual patient, accounting for initial weight for height percentage and signs of medical instability. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Refeeding Syndrome: Problems with Definition and Management. https://doi.org/10.1186/s40337-021-00445-1, DOI: https://doi.org/10.1186/s40337-021-00445-1. 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. ACUTE is the first medical unit ever to achieve this designation in the field of eating disorders. See, treatment of established refeeding syndrome, Treatment of established refeeding syndrome, https://traffic.libsyn.com/secure/ibccpodcast/IBCC_EP_83_-_Refeeding_Syndrome.mp3. Until recently, refeeding syndrome (RFS) has lacked standardized diagnostic criteria. In a recent systematic review [32] 9/10 studies in hospitalised ED patients are given continuous or overnight supplemental NG feeding. No study reported a YP developed RS. Int J Eat Disord. J Adolesc Health. 3787-3792, Clinical Nutrition, Volume 40, Issue 6, 2021, pp. The refeeding syndrome (RFS) has been recognized as a potentially life-threatening metabolic complication of re-nutrition, but the definition widely varies and, its incidence is unknown. Background The incidence of refeeding syndrome (RFS) in critically ill patients is high, which is detrimental to their prognoses. Twenty-nine studies met the full criteria. The repletion of calories should be slow and is typically at about 20 calories per kilogram of body weight on average, or around 1,000 calories per day initially. Leeds and York Partnership NHS Foundation Trust, Mill Lodge, 520 Huntington Rd, York, YO32 9QA, UK, You can also search for this author in 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 It is necessary to adapt to the changing circumstances. Paediatr Child Health. Learn more about this condition, what it means for those with diabetes, and why it's so important to find treatment and help. Rhabdomyolysis can occur (causing an elevated creatinine kinase). 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. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. A brief historical perspective has been added to better illustrate the center's growth and transformation. Refeeding Syndrome Among Older Adults From hospital unit to intestinal failure center: Twenty years of history, The goldilocks problem: Nutrition and its impact on glycaemic control. B12, 1000 mcg PO Length of stay was reported in studies from medical and MH ward settings, however, the specific package of treatment YP received in each study was different depending on the country of origin. London: National Institute for a Clinical Excellence; 2004. The majority commenced on daily intake of less than 2000kcal and increased periodically. A blood test that reveals low levels of phosphorus, potassium or magnesium. Furthermore, no relevant association to lengths of stay in intensive care or hospital were detected. 31 While ongoing alcohol use will place individuals at risk for ongoing phosphorus loss, abnormalities in the excretion of urinary phosphate typically resolves after a few weeks of ongoing abstinence. Maginot et al., 2017 [18] and Whitelaw et al., 2010 [9] reported NG bolus feeding in 13.8 and 15% in order to supplement oral diet with a mean weight gain of 3.1kgs and 2.6kgs respectively but did not report if this was specific to NG feeding. A survey of dietitians found 82% considered NG feeding a necessary procedure if oral diet is inadequate [10]. The anabolic processes require minerals and coenzymes such as thiamine [4,6]. The exclusion criteria included: No ability to discern results specific to NG feeding, mental disorders other than eating disorders being the focus, where the majority of participants are over 18years or it is impossible to separate results for adults from YP, reviews or other non-primary research and research published before 2000. Nurs Times. < 40%. 2018;51(11):121322. Four studies reported weight gain primarily in the context of ED YP with medical instability [24,25,26, 44]. Research is still needed to determine the best way to treat refeeding syndrome. https://doi.org/10.1016/j.encep.2012.06.001. Nutr Clin Pract. 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]. Nasogastric feeding (NG) is a method of enteral nutrition often used in inpatient settings to treat medical instability, to supplement poor oral intake or to increase nutritional intake. between 7.8% and 23.4% (minimal and maximal error), and GNG at day 10 (age, mean and basal blood glucose), with an e.c. You can learn more about how we ensure our content is accurate and current by reading our. 777 Bannock Street 2000;28(4):4705. Akgul S, Pehlivanturk-Kizilkan M, Ors S, Derman O, Duzceker Y, Kanpur N. Type of setting for the inpatient adolescent with an eating disorder: are specialized inpatient clinics a must or will the pediatric ward do? Therefore, a universally accepted definition for the RFS is needed for evaluating its incidence and management in different. A Systematic Review of the Role of Thiamine Increase of parenteral nutrition intake (in % kcal of predicted resting energy expenditure) decreased phosphate concentrations (c=0.002 (95% CI -0.002;0.001). Whether sarcopenia worsens the outcome after esophagectomy is unclear. Therefore, a universally accepted definition for RFS, taking different clinical contexts and groups of patients into account, is still needed to better characterize the syndrome and its approach. 2019. A secondary care hospital in rural India serving a highly tuberculosis (TB) and malnutrition endemic region. Studies published in languages other than English were translated prior to being reviewed. Alternative causes of hypophosphatemia are listed here: Thiamine 200-500 mg IV q8hr-q12hr (use higher dose in the context of any mental status changes, which could reflect the possibility of Wernicke encephalopathy). WebIv or oral multivitamins once daily for 10 days or greater based on clinical status Emad Zarief 2021 29 ASPEN Consensus recommendations for refeeding syndrome. According to these guidelines, patients at the highest risk for refeeding syndrome meet one or more of the following criteria: Body mass index (BMI) under 16; Weight loss of more than 15 percent of his or her body weight in the past 3 to 6 months; Little to no food for the past 10 or more consecutive days; or The pooled impact of refeeding syndrome on length of stay of 2634 patients in 10 studies was weighted mean difference (WMD)=2.91 (95% CI,0.18 6.00; P=0.065) days. Development and validation of risk prediction model for Certain conditions, such as anorexia nervosa or chronic alcohol use disorder, can increase risk. AHRQ publication no. https://doi.org/10.1002/eat.22482. In addition, refeeding often occurs alongside other serious conditions that typically require simultaneous treatment. https://doi.org/10.1093/pch/pxx063. No substantial change in the originally reported incidence of RFS was found by applying the ASPEN criteria. DOI: Lambers WM, et al. Eur Child Adolesc Psychiatry. Refeeding syndrome: A literature review. Nocturnal nasogastric refeeding for hospitalized adolescent boys with anorexia nervosa. Compared to other mental illnesses, EDs have a high mortality rate with young people (YP) with anorexia nervosa (AN) on average 610 times more likely to die than the general population [4, 5]. (2011). Inclusion terms were: enteral feeding by nasogastric tube, under 18years, eating disorders, and primary research. 3729-3740, Clinical Nutrition, Volume 40, Issue 6, 2021, pp. GC is delivered using a single model-based protocol (STAR), with default 4.48.0mmol/L target range via. WebRefeeding syndrome is defined as the potentially fatal shifts in fluids and electrolytes that may. Nutr Clin Pract. Escalation in protein calories provided may occur more rapidly than escalation in carbohydrate calories. https://doi.org/10.1176/appi.ajp.159.8.1347. However, refeeding is also a critical component to recovery and NG feeding will often be utilised if a young person has been unable to manage oral intake in order to prevent signs of physical unwellness [9, 10]. An Australian study [45] (conducted in a paediatric unit) found YP viewed being NG fed as: an unpleasant experience, a necessary intervention, a psychological signifier of illness, and an emphasis in an underlying struggle for control. Ichimaru S. Methods of enteral nutrition Administration in Critically ill Patients: continuous, cyclic, intermittent, and bolus feeding. https://doi.org/10.1002/1098-108X(200012)28:4<470::AID-EAT18>3.0.CO;2-1. Increasing awareness and using screening programs to identify those at risk of developing refeeding syndrome are the next steps in improving the outlook. A team with experience in gastroenterology and dietetics should oversee treatment. clos Nutritional care pathway (NICE, 2006, BAPEN, 2007) Screen for malnutrition (using MUST screening tool) refeeding syndrome: 25-35 kcal/kg/day total energy INCLUDING that derived from protein 0.8 This could have the advantage of reducing LOS in medically stable YP. encourage healthy eating and reaching a healthy body weight cover nutrition, cognitive restructuring, mood regulation, social skills, body image concern, self-esteem, and relapse prevention create a personalised treatment plan based on the processes that appear to be maintaining the eating problem https://doi.org/10.7326/0003-4819-102-1-49. 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. ACUTE Earns Prestigious Center of Excellence Designation from Anthem CR168s Summary of Junior Marsipan: Management of really sick patients under 18 with Anorexia Nervosa. Crook MA, et al. A broader view of electrolyte shifts may be a welcome addition, given that prior definitions have focused excessively on phosphate. Patients with renal replacement therapy or unavailable phosphate concentrations were excluded from this analysis. 2014;68(2):1717. However, this study does not discuss the reasons NG was implemented. WebThese guidelines have been written to provide guidance for medical, dietetic and nursing staff managing patients with severe malnutrition and/or at risk of refeeding syndrome Correspondence to Cumulated insulin dose between days 5 and 9 was correlated to EGP at day 10 (R=0.55, P=0.03). 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]. 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]. Sometimes called the hot dog of the sea, imitation crab is a popular ingredient in dishes like seafood salads, crab cakes or California sushi rolls, Protein is essential for building and maintaining muscle mass but consuming too much can negatively affect your health. JAMA Pediatr; doi: 10.1001/jamapediatrics.2020.3359Investigators from multiple The author(s) read and approved the final manuscript. https://doi.org/10.1002/erv.624. 2023 Healthline Media LLC. For nocturnal feeds, oral diet was encouraged during the day. The pooled length of stay of 2965 patients with refeeding syndrome in 11 studies was 25.55 (95% CI, 20.2030.90) days. By comparison, IO only resulted in 6469% BG in range across different nutrition types. As a result, people at risk require medical supervision at a hospital or specialized facility. Therefore, it is important for all patients with extreme forms of anorexia and ARFID to initiate nutritional rehabilitation in an inpatient medical setting that specializes in preventing, identifying and managing this potentially fatal complication. The Charlson Comorbidity Index, however, was superior for preoperative risk stratification. 69.) Refeeding Syndrome Guideline Glycaemic control (GC) may improve outcomes, though safe and effective control has proven elusive. This review aims to assess strategies for the use, tolerance and effectiveness of NG feeding in YP with restrictive ED. To examine the impact of nutritional intake on phosphate concentrations, structural nested mean models with propensity score and censoring models were used. Clinical Nutrition (2002) 21 (6): 515-520. Inpatients were prospectively enrolled. DOI: hopkinsmedicine.org/gim/_pdf/consult/refeeding_syndrome.pdf, med.virginia.edu/ginutrition/wp-content/uploads/sites/199/2014/06/Parrish-September-16.pdf. PLT was based on FBT and included parents reducing child exercise and increasing oral intake. 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. Studies identified 1) a wide range of refeeding regimes depending on country, settings, and the reason for initiation; 2) standard practice is to introduce Nasogastric feeds (NG) if medically unstable or oral intake alone is inadequate; 3) NG may enable greater initial weight gain due to increased caloric intake; 4) there are 3 main types of feeding regime: continuous, nocturnal and bolus; 5) complications included nasal irritation, epistaxis, electrolyte disturbance, distress and tube removal; 6) where NG is routinely implemented to increase total calorie intake, length of stay in hospital may be reduced; however where NG is implemented in correlation to severity of symptoms, it may be increased; 7) both medical and psychiatric wards most commonly report using NG in addition to oral intake. Refeeding syndrome is a potentially fatal complication which generally occurs within 24-72 hours after starting nutrition (although it may occur later on). All selected studies had an observational design, 23 were retrospective cohort studies [. 85% were at risk of RFS by National Institute for Health and Care Excellence (NICE) criteria. ScienceDirect is a registered trademark of Elsevier B.V. ScienceDirect is a registered trademark of Elsevier B.V. 2022, Journal of Parenteral and Enteral Nutrition, Clinical Nutrition, Volume 40, Issue 6, 2021, pp. Treatment of patients with eating disorders. 167 (prepared by the Duke University evidence-based practice center under contract no. When individuals who are at risk are identified early, treatments are likely to succeed. Previous systematic reviews [2,8] showed that studies on RFS were highly heterogenous since most definitions were based on blood electrolyte disturbances, mainly refeeding hypophosphatemia (RH), while others considered the presence of overt signs and symptoms as well (i.e., edema, respiratory or heart failure). In studies where continuous NG was provided, YP were sometimes not given the option of an oral diet so that their calorie intake could be closely monitored [22,23,24, 31]. Three studies were qualitative interview studies, examining patient or staff feelings towards NG feeding in practice which increases the risk of confirmation bias. This systematic review sets out to This systematic review sets out to describe current practice of NG in young people with eating disorders.