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Poulter M, Coe S, Graham CAM, Leach B, Tammam J. A systematic review of the effect of dietary and nutritional interventions on the behaviours and mental health of prisoners. Br J Nutr 2024:1-14. [PMID: 38682285 DOI: 10.1017/s0007114524000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Prisoners experience a higher burden of poor health, aggressive behaviours and worsening mental health than the general population. This systematic review aimed to identify research that used nutrition-based interventions in prisons, focusing on outcomes of mental health and behaviours. The systematic review was registered with Prospective Register of Systematic Reviews on 26 January 2022: CRD42022293370. Inclusion criteria comprised of current prisoners with no limit on time, location, age, sex or ethnicity. Only quantitative research in the English language was included. PubMed/Medline, Web of Science, EMBASE, PsycINFO and CINAHL were searched, retrieving 933 results, with 11 included for qualitative synthesis. Studies were checked for quality using the revised tool to assess risk of bias in randomised trials or risk of bias in non-randomised studies of interventions tool. Of the included studies, seven used nutritional supplements, three included diet changes, and one used education. Of the seven supplement-based studies, six included rule violations as an outcome, and only three demonstrated significant improvements. One study included mental health as an outcome; however, results did not reach significance. Of the three diet change studies, two investigated cognitive function as an outcome, with both reaching significance. Anxiety was included in one diet change study, which found a significant improvement through consuming oily fish. One study using diet education did not find a significant improvement in overall mental resilience. Overall, results are mixed, with the included studies presenting several limitations and heterogeneity. Future research should aim to consider increased homogeneity in research design, allowing for a higher quality of evidence to assess the role nutrition can play in improving the health of prisoners.
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Affiliation(s)
- Matthew Poulter
- Centre for Nutrition and Health, Faculty of Health & Life Sciences, Oxford Brookes University, OX3 0BP, Oxford, UK
| | - Shelly Coe
- Centre for Nutrition and Health, Faculty of Health & Life Sciences, Oxford Brookes University, OX3 0BP, Oxford, UK
| | - Catherine Anna-Marie Graham
- Centre for Nutrition and Health, Faculty of Health & Life Sciences, Oxford Brookes University, OX3 0BP, Oxford, UK
- Cereneo Foundation, Center for Interdisciplinary Research (CEFIR), 6354Vitznau, Switzerland
- Lake Lucerne Institute AG, Rubistrasse 9, 6354Vitznau, Switzerland
| | - Bethan Leach
- Practice Plus Group, Hawker House 5-6 Napier Court, Napier Rd, Reading, BerkshireRG1 8BW, UK
| | - Jonathan Tammam
- Centre for Nutrition and Health, Faculty of Health & Life Sciences, Oxford Brookes University, OX3 0BP, Oxford, UK
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Catani M, Howells R. Risks and pitfalls for the management of refeeding syndrome in psychiatric patients. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.bp.106.009878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodWe present two patients who developed refeeding syndrome following admission to a general psychiatry ward. The practical implications of assessing and managing medical consequences in patients with mental illness who start refeeding after a period of starvation are discussed.ResultsPatients presented with overlapping clinical manifestations of mental illness and refeeding syndrome that were difficult to recognise and manage.Clinical ImplicationsAwareness of refeeding syndrome in patients with mental illness may prevent fatal physical complications.
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Revisiting the refeeding syndrome: Results of a systematic review. Nutrition 2017; 35:151-160. [DOI: 10.1016/j.nut.2016.05.016] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 05/28/2016] [Accepted: 05/28/2016] [Indexed: 01/26/2023]
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Lee JL, Oh ES, Lee RW, Finucane TE. Serum Albumin and Prealbumin in Calorically Restricted, Nondiseased Individuals: A Systematic Review. Am J Med 2015; 128:1023.e1-22. [PMID: 25912205 DOI: 10.1016/j.amjmed.2015.03.032] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 03/13/2015] [Accepted: 03/16/2015] [Indexed: 12/18/2022]
Abstract
PURPOSE Undernutrition is often suspected in patients when serum albumin or prealbumin levels are low. We asked whether these measures are indeed low in undernourished people if no inflammatory illness is present. METHODS We did a systematic review to identify otherwise healthy subjects who were severely nutrient-deprived due to poor access to food or unwillingness to eat. We excluded children and pregnant women. We tabulated available measures of nutrient intake, anthropometry, serum albumin and prealbumin, and, when available, changes in these measures during nutritional intervention. RESULTS In otherwise healthy subjects, serum albumin and prealbumin levels remained normal despite marked nutrient deprivation until the extremes of starvation, that is, body mass index <12 or more than 6 weeks of starvation. CONCLUSIONS In these otherwise healthy subjects, serum albumin and prealbumin levels are not "markers of nutritional status." The "markers" failed to identify subjects with severe protein-calorie malnutrition until extreme starvation. That is, they failed to identify healthy individuals who would benefit from nutrition support, becoming abnormal only when starvation was already obvious. In contrast, serum albumin and prealbumin levels are known to fall promptly with injury or illness regardless of nutrient intake. They are negative acute-phase reactants. When these measures are low in sick patients, this cannot be assumed to reflect nutritional deprivation. Decisions about nutrition support should be based on evidence of meaningful benefit from this treatment rather than on assessment of "nutritional markers."
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Affiliation(s)
- Jessica L Lee
- Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Esther S Oh
- Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Rebecca W Lee
- Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, Md
| | - Thomas E Finucane
- Division of Geriatric Medicine and Gerontology, The Johns Hopkins University School of Medicine, Baltimore, Md.
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Abstract
A 57-year-old woman presented to the hospital after a 40-day acaloric (water-only) fast, which was motivated by her Christian beliefs and Pentecostal affiliation. She exhibited hyponatremia on admission, and developed hypokalemia, hypophosphatemia and hypomagnesemia during refeeding. The authors are unaware of other published case reports describing medical and religious aspects of prolonged fasting by Christians for spiritual reasons. Nevertheless, this practice is advocated by some Pentecostal and non-Pentecostal sources, and may be more common than is widely recognized.
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Abstract
In recent years nutrition assessment and management in amyotrophic lateral sclerosis (ALS) have drawn increased attention. Frequent evaluation of nutrition status is warranted in ALS, given the common occurrence of dysphagia and hypermetabolism and varying disease progression rates. Nutrition management includes dietary and swallow strategies, possible gastrostomy tube placement, and recommendations for vitamin and mineral supplementation. Strategies to assess and optimize nutrition status and prolong survival in ALS patients are reviewed with recommendations based on current research.
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Old disease, new look? A first report of parkinsonism due to scurvy, and of refeeding-induced worsening of scurvy. PSYCHOSOMATICS 2013; 54:277-83. [PMID: 23473448 DOI: 10.1016/j.psym.2013.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/01/2013] [Accepted: 02/01/2013] [Indexed: 12/27/2022]
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Rio A, Whelan K, Goff L, Reidlinger DP, Smeeton N. Occurrence of refeeding syndrome in adults started on artificial nutrition support: prospective cohort study. BMJ Open 2013; 3:e002173. [PMID: 23315514 PMCID: PMC3549252 DOI: 10.1136/bmjopen-2012-002173] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 11/19/2012] [Accepted: 12/11/2012] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Refeeding syndrome is a potentially life-threatening condition characterised by severe intracellular electrolyte shifts, acute circulatory fluid overload and organ failure. The initial symptoms are non-specific but early clinical features are severely low-serum electrolyte concentrations of potassium, phosphate or magnesium. Risk factors for the syndrome include starvation, chronic alcoholism, anorexia nervosa and surgical interventions that require lengthy periods of fasting. The causes of the refeeding syndrome are excess or unbalanced enteral, parenteral or oral nutritional intake. Prevention of the syndrome includes identification of individuals at risk, controlled hypocaloric nutritional intake and supplementary electrolyte replacement. OBJECTIVE To determine the occurrence of refeeding syndrome in adults commenced on artificial nutrition support. DESIGN Prospective cohort study. SETTING Large, single site university teaching hospital. Recruitment period 2007-2009. PARTICIPANTS 243 adults started on artificial nutrition support for the first time during that admission recruited from wards and intensive care. MAIN OUTCOME MEASURES PRIMARY OUTCOME occurrence of the refeeding syndrome. Secondary outcome: analysis of the risk factors which predict the refeeding syndrome. Tertiary outcome: mortality due to refeeding syndrome and all-cause mortality. RESULTS 133 participants had one or more of the following risk factors: body mass index <16-18.5≥(kg/m(2)), unintentional weight loss >15% in the preceding 3-6 months, very little or no nutritional intake >10 days, history of alcohol or drug abuse and low baseline levels of serum potassium, phosphate or magnesium prior to recruitment. Poor nutritional intake for more than 10 days, weight loss >15% prior to recruitment and low-serum magnesium level at baseline predicted the refeeding syndrome with a sensitivity of 66.7%: specificity was >80% apart from weight loss of >15% which was 59.1%. Baseline low-serum magnesium was an independent predictor of the refeeding syndrome (p=0.021). Three participants (2% 3/243) developed severe electrolyte shifts, acute circulatory fluid overload and disturbance to organ function following artificial nutrition support and were diagnosed with refeeding syndrome. There were no deaths attributable to the refeeding syndrome, but (5.3% 13/243) participants died during the feeding period and (28% 68/243) died during hospital admission. Death of these participants was due to cerebrovascular accident, traumatic injury, respiratory failure, organ failure or end-of-life causes. CONCLUSIONS Refeeding syndrome was a rare, survivable phenomenon that occurred during hypocaloric nutrition support in participants identified at risk. Independent predictors for refeeding syndrome were starvation and baseline low-serum magnesium concentration. Intravenous carbohydrate infusion prior to artificial nutrition support may have precipitated the onset of the syndrome.
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Affiliation(s)
- Alan Rio
- Department of Nutrition and Dietetics, King's College Hospital, London, UK
| | - Kevin Whelan
- Diabetes and Nutritional Sciences Division, King's College London, School of Medicine, London, UK
| | - Louise Goff
- Diabetes and Nutritional Sciences Division, King's College London, School of Medicine, London, UK
| | | | - Nigel Smeeton
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
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Guo H, Qin F, Li R. Clinical and laboratory observations during refeeding after starvation in patients. Eur J Intern Med 2012; 23:e164-5. [PMID: 22863444 DOI: 10.1016/j.ejim.2012.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 06/05/2012] [Accepted: 06/06/2012] [Indexed: 11/19/2022]
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Alempijevic D, Pavlekic S, Jecmenica D, Nedeljkov A, Jankovic M. Ethical and legal consideration of prisoner's hunger strike in Serbia. J Forensic Sci 2011; 56:547-50. [PMID: 21265842 DOI: 10.1111/j.1556-4029.2010.01669.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Hunger strike of prisoners and detainees remains a major human rights and ethical issue for medical professionals. We are reporting on a case of a 48-year-old male sentenced prisoner, intravenous heroin user, who went on a hunger strike and died 15 days later. Throughout the fasting period, the prisoner, who was capable of decision making, refused any medical examination. Autopsy findings were not supporting prolonged starvation, while toxicology revealed benzodiazepines and opiates in blood and urine. Cause of death was given as "heroin intoxication" in keeping with detection of 6-MAM. Legal and ethical issues pertinent to medical examination and treatment of prisoners on hunger strike are explored in accordance with legislation and professional ethical standards in Serbia. A recommendation for the best autopsy practice in deaths following hunger strike has been made.
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Affiliation(s)
- Djordje Alempijevic
- Institute of Forensic Medicine, Faculty of Medicine, University of Belgrade, 31a Deligradska Street, Belgrade 11000, Serbia.
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Boateng AA, Sriram K, Meguid MM, Crook M. Refeeding syndrome: treatment considerations based on collective analysis of literature case reports. Nutrition 2010; 26:156-67. [PMID: 20122539 DOI: 10.1016/j.nut.2009.11.017] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 11/17/2009] [Accepted: 11/23/2009] [Indexed: 12/14/2022]
Abstract
Refeeding syndrome (RFS) represents a group of clinical findings that occur in severely malnourished individuals undergoing nutritional support. Cardiac arrhythmias, multisystem organ dysfunction, and death are the most severe symptoms observed. As the cachectic body attempts to reverse its adaptation to the starved state in response to the nutritional load, symptoms result from fluid and electrolyte imbalances, with hypophosphatemia playing a central role. Because guidelines for feeding the malnourished patient at risk for refeeding syndrome is scarce, we have provided management recommendations based on the knowledge derived from a collection of reported English literature cases of the RFS. A MEDLINE search using keywords including "refeeding syndrome," "RFS," and "refeeding hypophosphatemia" was performed. References from initial cases were utilized for more literature on the subject. We have emphasized the continued importance of managing patients at risk for RFS, compared how management of the severely malnourished patients have evolved over time, and provided comprehensive clinical guidelines based on the sum of experience documented in the case reports for the purpose of supplementing the guidelines available. Based on our review, the most effective means of preventing or treating RFS were the following: recognizing the patients at risk; providing adequate electrolyte, vitamin, and micronutrient supplementation; careful fluid resuscitation; cautious and gradual energy restoration; and monitoring of critical laboratory indices.
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Affiliation(s)
- Akwasi Afriyie Boateng
- Surgical Metabolism and Nutrition Laboratory, Department of Surgery, University Hospital, Upstate Medical University, State University of New York, Syracuse, NY 13210, USA
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Patel U, Sriram K. Acute respiratory failure due to refeeding syndrome and hypophosphatemia induced by hypocaloric enteral nutrition. Nutrition 2009; 25:364-7. [DOI: 10.1016/j.nut.2008.09.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 07/12/2008] [Accepted: 09/18/2008] [Indexed: 01/30/2023]
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Luque S, Berenguer N, Mateu de Antonio J, Grau S, Morales-Molina JA. [Patients at risk of malnutrition: assessment of 11 cases of severe malnutrition with individualised total parenteral nutrition]. FARMACIA HOSPITALARIA 2008; 31:238-42. [PMID: 18052619 DOI: 10.1016/s1130-6343(07)75380-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To describe and assess the efficacy and safety of individualised nutritional support during the first week of total parenteral nutrition in moderately to severely malnourished patients who are susceptible to the refeeding syndrome. METHOD Retrospective observational study carried out between January 2003 and June 2006, including adult patients with moderate to severe malnutrition who received = 5 days total parenteral nutrition. The nutritional support was described and the appearance of severe hydroelectrolytic and metabolic disturbances were assessed during the first week of nutrition. RESULTS The study included 11 patients with a mean body mass index of 15.4 kg/m2. These patients received an average of 23 Kcal/kg/day. They did not show any signs of severe hydroelectrolytic or metabolic disturbances. Three patients presented with hypophosphataemia, five with hypokalaemia and four with hypomagnesaemia, all of which were mild to moderate and with the exception of two cases, all were corrected within one week of feeding. CONCLUSIONS Individualised nutritional support in moderately to severely malnourished patients does not produce refeeding syndrome. Individualised nutrition is an essential strategy for avoiding complications associated with overfeeding.
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Affiliation(s)
- S Luque
- Servicio de Farmacia, Hospital del Mar-IMAS, Passeig Marítim 25-29, Barcelona, Spain
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Korbonits M, Blaine D, Elia M, Powell-Tuck J. Metabolic and hormonal changes during the refeeding period of prolonged fasting. Eur J Endocrinol 2007; 157:157-66. [PMID: 17656593 DOI: 10.1530/eje-06-0740] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The discovery of leptin, a hormone primarily involved in adaptation to fasting, led to an increased interest in appetite regulation and appetite-modulating hormones. Here, we present unique data from a case of extreme starvation and refeeding, showing changes in plasma concentrations of appetite-modulating and metabolic hormones as well as biochemical changes, and draw attention to the dangers of the refeeding syndrome. PATIENTS AND METHODS We studied the refeeding period of a 44-day voluntary fast uncomplicated by underlying disease. Biochemical and hormonal variables were compared with 16 matched subjects such that the BMI range of the controls covered the entire spectrum for the index subject's recovering BMI. RESULTS Lack of calorie intake with free access to water resulted in 25% loss of body weight. Haemoconcentration was observed and feeding was started with a low sodium, hypocaloric liquid formulation. During early refeeding, marked hypophosphataemia, haemodilution and slight oedema developed. Vitamins B1, B12 and B6 were depleted while serum free fatty acids, ketone bodies and zinc levels were abnormally high; abnormal liver function developed over the first week. The hormonal profile showed low IGF-I and insulin levels, and elevated IGF-binding protein-1 concentrations. Appetite-regulating hormones were either very low (leptin and ghrelin) or showed no marked difference from the control group (peptide YY, agouti-related peptide, alpha-melanocyte-stimulating hormone, neuropeptide Y and pro-opiomelanocortin). Appetite was low at the beginning of refeeding and a transient increase in orexin and resistin was observed coincidently with an increase in subjective hunger. CONCLUSIONS Our study illustrates the potential dangers of refeeding and provides a comprehensive insight into the endocrinology of prolonged fasting and the refeeding process.
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Affiliation(s)
- Márta Korbonits
- Department of Endocrinology, Barts and the London Medical School, UK.
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Başoğlu M, Yetimalar Y, Gürgör N, Büyükçatalbaş S, Kurt T, Seçil Y, Yeniocak A. Neurological complications of prolonged hunger strike. Eur J Neurol 2006; 13:1089-97. [PMID: 16987161 DOI: 10.1111/j.1468-1331.2006.01531.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We investigated neurological findings in 41 prisoners (mean age: 28.6) who participated in a hunger strike between 2000 and 2002. All cases were evaluated using neuropsychological, neuroradiological, and electrophysiological methods. The total duration of fasting ranged from 130 to 324 days (mean 199 days). All cases had 200-600 mg/day thiamine orally for 60-294 days (mean 156) during the hunger strike, and had neurological findings consistent with Wernicke-Korsakoff syndrome. All 41 patients exhibited altered consciousness which lasted from 3 to 31 days. All patients also presented gaze-evoked horizontal nystagmus and truncal ataxia. Paralysis of lateral rectus muscles was found in 14. Amnesia was apparent in all cases. Abnormal nerve conduction study parameters were not found in the patient group, but the amplitude of compound muscle action potential of the median and fibular nerves and sensory nerve action potential amplitude of the sural nerve were lower than the control group, and distal motor latency of the posterior tibial nerve was significantly prolonged as compared with the control group. The latency of visual evoked potential was prolonged in 22 cases. Somatosensory evoked potential (P37) was prolonged but not statistically significant. Our most significant finding was that the effect of hunger was more prominent on the central nervous system than on the neuromuscular system, despite the fact that all patients were taking thiamine. In our opinion, partial recovery of neurological, and neurocognitive signs in prolonged hunger could be a result of permanent neurological injury.
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Affiliation(s)
- M Başoğlu
- Neurology Department, Atatürk Training and Research Hospital, Izmir, Turkey
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Schneider SM. Nutrition entérale : quelle est sa place dans notre arsenal thérapeutique ? ACTA ACUST UNITED AC 2006; 30:988-98; quiz 987, 1007-8. [PMID: 17075446 DOI: 10.1016/s0399-8320(06)73361-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Stéphane M Schneider
- Fédération d'Hépato-Gastroentérologie et de Nutrition Clinique, CHU de Nice, Hopital de l'Archet, 06202 Nice cedex 3.
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Fung AT, Rimmer J. Hypophosphataemia secondary to oral refeeding syndrome in a patient with long‐term alcohol misuse. Med J Aust 2005; 183:324-6. [PMID: 16167875 DOI: 10.5694/j.1326-5377.2005.tb07066.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2005] [Accepted: 08/11/2005] [Indexed: 11/17/2022]
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Flesher ME, Archer KA, Leslie BD, McCollom RA, Martinka GP. Assessing the metabolic and clinical consequences of early enteral feeding in the malnourished patient. JPEN J Parenter Enteral Nutr 2005; 29:108-17. [PMID: 15772389 DOI: 10.1177/0148607105029002108] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is often thought that enteral feeding should be initiated slowly in those who are severely malnourished. This descriptive study examined the effect of an enteral feeding protocol on the typical metabolic consequences seen in refeeding syndrome. METHODS A retrospective chart review was conducted on 51 patients who had been placed on hospital-wide enteral feeding and electrolyte replacement protocols over a 9-month period to determine whether there were any negative clinical consequences to early feeding. RESULTS Goal feeding rate was achieved within 17.6 +/- 8.7 hours. Forty patients (80%) developed depletions in phosphate, magnesium, or potassium after initiation of enteral feeding, including 93% of those deemed "at risk" and 74% of those "not at risk." All patients received electrolyte replacement according to protocols, and no patients showed any negative clinical effect. CONCLUSIONS This study showed that malnourished patients at risk for refeeding syndrome can be fed early without observed negative clinical consequences. An electrolyte replacement protocol may be an effective means of minimizing the electrolyte imbalances associated with early feeding. It also demonstrated the significance of applying such protocols to all patients requiring enteral support, as current methods of assessing "risk"for refeeding syndrome may be inadequate.
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Temprano Ferreras JL, Bretón Lesmes I, de la Cuerda Compés C, Camblor Alvarez M, Zugasti Murillo A, García Peris P. Síndrome de realimentación. Revisión. Rev Clin Esp 2005; 205:79-86. [PMID: 15766481 DOI: 10.1157/13072501] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Refeeding syndrome is a complex clinical picture that encompass all those alterations that can occur as a consequence of the nutritional support (oral, enteral or parenteral) in malnourished patients. Refeeding syndrome is classically characterized by neurological alterations, respiratory symptoms, cardiac arrhythmias and heart failure few days after beginning of refeeding, with life-threatening outcome. Its pathogenesis includes alterations in the corporal fluids, and in some electrolytes, minerals and vitamins. In this article a review of refeeding syndrome pathogenesis and clinical manifestations is carried out, with a final series of recommendations for lowering the risk of this syndrome and for facilitate the early diagnosis and the treatment.
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Abstract
OBJECTIVE Although refeeding syndrome has been well documented in starved patients, obese patients, those with anorexia nervosa, malnourished elderly individuals, and certain postoperative patients, little is known about the presence and the importance of refeeding syndrome in patients with gastrointestinal fistula and insufficient nutrition support over the long term. The objective of this study was to estimate the morbidity of this syndrome in these patients, to assess the safety and efficacy of our graduated refeeding regimen, and to emphasize the importance of this syndrome. METHODS One hundred fifty-eight patients with gastrointestinal fistula during the past 2 y were reviewed. RESULTS Fifteen of these patients were diagnosed as having refeeding syndrome. They were started on the refeeding procedure according to our regimen, and changes in their serum levels of electrolytes were recorded. The symptoms and signs they presented were noted. All patients were successfully advanced to full nutrition support. During the refeeding procedure, patients presented with weakness, paralysis of limbs, slight dyspnea, paresthesia, tachycardia, edema, and diarrhea. Serum phosphorus concentration decreased in all patients within 24 h of refeeding, reaching a mean nadir after 3.3 +/- 1.5 d and another 6.1 +/- 2.1 d to return to above 0.70 mM/L upon phosphorus supplementation. Three patients treated with growth hormone presented more severe hypophosphatemia (<0.20 mM/L) than the others. CONCLUSIONS 1) Refeeding syndrome occurs commonly in patients with malnutrition secondary to gastrointestinal fistula. 2) Alterations in phosphate metabolism are central to the refeeding syndrome. 3) Supplementation with electrolytes (including especially phosphate) and vitamins is the focal point of the treatment of this syndrome. 4) Growth hormone treatment may aggravate hypophosphatemia.
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Affiliation(s)
- Chao-Gang Fan
- Clinical School of Medical College, Nanjing University, Research Institute of General Surgery, Jinling Hospital, Nanjing, Jiangsu Province, People's Republic of China.
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de Menezes FS, Leite HP, Fernandez J, Benzecry SG, de Carvalho WB. Hypophosphatemia in critically ill children. ACTA ACUST UNITED AC 2004; 59:306-11. [PMID: 15543405 DOI: 10.1590/s0041-87812004000500015] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The purpose of this paper is to review clinical studies on hypophosphatemia in pediatric intensive care unit patients with a view to verifying prevalence and risk factors associated with this disorder. We searched the computerized bibliographic databases Medline, Embase, Cochrane Library, and LILACS to identify eligible studies. Search terms included critically ill, pediatric intensive care, trauma, sepsis, infectious diseases, malnutrition, inflammatory response, surgery, starvation, respiratory failure, diuretic, steroid, antiacid therapy, mechanical ventilation. The search period covered those clinical trials published from January 1990 to January 2004. Studies concerning endocrinological disorders, genetic syndromes, rickets, renal diseases, anorexia nervosa, alcohol abuse, and prematurity were not included in this review. Out of 27 studies retrieved, only 8 involved pediatric patients, and most of these were case reports. One clinical trial and one retrospective study were identified. The prevalence of hypophosphatemia exceeded 50%. The commonly associated factors in most patients with hypophosphatemia were refeeding syndrome, malnutrition, sepsis, trauma, and diuretic and steroid therapy. Given the high prevalence, clinical manifestations, and multiple risk factors, the early identification of this disorder in critically ill children is crucial for adequate replacement therapy and also to avoid complications.
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Affiliation(s)
- Fernanda Souza de Menezes
- Discipline of Nutrition and Metabolism and the Pediatric Intensive Care Unit, Department of Pediatrics, Federal University of São Paulo - São Paulo/SP, Brazil
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Abstract
In this review we discuss the refeeding syndrome. This potentially lethal condition can be defined as severe electrolyte and fluid shifts associated with metabolic abnormalities in malnourished patients undergoing refeeding, whether orally, enterally, or parenterally. It can be associated with significant morbidity and mortality. Clinical features are fluid-balance abnormalities, abnormal glucose metabolism, hypophosphatemia, hypomagnesemia, and hypokalemia. In addition, thiamine deficiency can occur. We describe which patient groups are more at risk for this syndrome and the clinical management of the condition.
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Affiliation(s)
- M A Crook
- Department of Chemical Pathology, Guy's and St Thomas' Hospital and University Hospital, Lewisham, London, UK.
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