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Hernando-Calvo A, Mirallas O, Marmolejo D, Saavedra O, Vieito M, Assaf Pastrana JD, Aguilar S, Bescós C, Lorente J, Giralt J, Benavente S, Temprana-Salvador J, Alberola M, Dienstmann R, Garralda E, Felip E, Villacampa G, Brana I. Nutritional status associates with immunotherapy clinical outcomes in recurrent or metastatic head and neck squamous cell carcinoma patients. Oral Oncol 2023; 140:106364. [PMID: 36989964 DOI: 10.1016/j.oraloncology.2023.106364] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 02/04/2023] [Accepted: 03/05/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Beyond programmed death-ligand 1 (PD-L1) assessed by the combined positive score (CPS) and tumor mutational burden (TMB), no other biomarkers are approved for immunotherapy interventions. Here, we investigated whether additional clinical and pathological variables may impact on immunotherapy outcomes in recurrent or metastatic (R/M) head and neck squamous cell carcinoma (HNSCC) patients. METHODS R/M HNSCC patients treated with immunotherapy were reviewed. Analyzed variables at baseline included: clinicopathological, laboratory, and variables reflecting the host nutritional status such as the prognostic nutritional index (PNI) and albumin. The primary endpoint was progression free survival (PFS). The secondary endpoints were overall survival (OS) and objective response rate (ORR). Univariable and multivariable Cox models were fitted and random forest algorithm was used to estimate the importance of each prognostic variable. RESULTS A total of 100 patients were treated with immunotherapy; 50% with single agent and 50% with experimental immunotherapy combinations. In the multivariable analysis, both ECOG performance status (HR: 1.73; 95%CI 1.07-2.82; p = 0.03) and PNI levels (10-point increments, HR: 0.66; 0.46-0.95; p = 0.03) were significantly associated with PFS. However, the derived neutrophil to lymphocyte ratio (dNLR) and lactate dehydrogenase (LDH) were not significantly associated with PFS (p-values > 0.15). In the OS analysis, albumin and PNI were the only statistically significant factors in the multivariable model (p < 0.001). CONCLUSIONS In our cohort, PNI and ECOG performance status were most strongly associated with PFS in R/M HNSCC patients treated with immunotherapy. These results suggest that parameters informative of nutritional status should be considered before immunotherapy.
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Refeeding Syndrome Awareness among Physicians of King Abdullah Medical City in Makkah, Saudi Arabia. Healthcare (Basel) 2023; 11:healthcare11060794. [PMID: 36981452 PMCID: PMC10048025 DOI: 10.3390/healthcare11060794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
Background: Refeeding syndrome (RFS) is a lethal condition of metabolic disturbances that arise from the sudden switch of metabolism from a state of starvation to one of nourishment. Quick recognition would reduce health complications. Physicians who are unaware of the syndrome will not identify and treat it. As nutritional risk is associated with the risk of RFS, physicians should be aware of it. Aim: To determine whether the physicians of King Abdullah Medical City (KAMC) in Makkah know of RFS and, if so, have skills in diagnosis and managing the syndrome. Methods: One hundred and fifty-nine physicians of KAMC were recruited in a cross-sectional study. They were asked to complete a questionnaire by face-to-face interview. The questionnaire was designed to capture physicians’ knowledge and ability to manage RFS based on the awarding of certain scoring points. Results: The level of knowledge among physicians had a significant association between knowledge and age (p = 0.021) and medical specialty (p = 0.010). Additionally, the most knowledgeable physicians were those who work in critical care (21.4%). Around 18% of physicians were not able to manage RFS. Conclusions: Lacking knowledge of RFS and how to manage it leads to critical life-threatening complications. Physicians need nutritional education to help them diagnose RFS and consult dietitians to avoid its complications.
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Zhang W, Zhang SX, Chen SF, Yu T, Tang Y. Development and validation of risk prediction model for refeeding syndrome in neurocritical patients. Front Nutr 2023; 10:1083483. [PMID: 36875840 PMCID: PMC9975392 DOI: 10.3389/fnut.2023.1083483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 01/18/2023] [Indexed: 02/17/2023] Open
Abstract
Background The incidence of refeeding syndrome (RFS) in critically ill patients is high, which is detrimental to their prognoses. However, the current status and risk factors for the occurrence of RFS in neurocritical patients remain unclear. Elucidating these aspects may provide a theoretical basis for screening populations at high risk of RFS. Methods A total of 357 patients from January 2021 to May 2022 in a neurosurgery ICU of a tertiary hospital in China were included using convenience sampling. Patients were divided into RFS and non-RFS groups, based on the occurrence of refeeding-associated hypophosphatemia. Risk factors for RFS were determined using univariate and logistic regression analyses, and a risk prediction model for RFS in neurocritical patients was developed. The Hosmer-Lemeshow test was used to determine the goodness of fit of the model, and the receiver operator characteristic curve was used to examine its discriminant validity. Results The incidence of RFS in neurocritical patients receiving enteral nutrition was 28.57%. Logistic regression analyses showed that history of alcoholism, fasting hours, Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, Sequential Organ Failure Assessment (SOFA) scores, low serum albumin, and low baseline serum potassium were risk factors of RFS in neurocritical patients (p < 0.05). The Hosmer-Lemeshow test showed p = 0.616, and the area under the ROC curve was 0.791 (95% confidence interval: 0.745-0.832). The optimal critical value was 0.299, the sensitivity was 74.4%, the specificity was 77.7%, and the Youden index was 0.492. Conclusion The incidence of RFS in neurocritical patients was high, and the risk factors were diverse. The risk prediction model in this study had good predictive effects and clinical utility, which may provide a reference for assessing and screening for RFS risk in neurocritical patients.
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Affiliation(s)
- Wei Zhang
- Department of Neurosurgery Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Sheng-Xiang Zhang
- Department of Neurosurgery Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Shu-Fan Chen
- Department of Nursing, Soochow University, Suzhou, China
| | - Tao Yu
- Department of Neurosurgery Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Yun Tang
- Department of Neurosurgery Intensive Care Unit, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
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Nutritional prehabilitation in head and neck cancer: a systematic review. Support Care Cancer 2022; 30:8831-8843. [PMID: 35913625 DOI: 10.1007/s00520-022-07239-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Prehabilitation affords an opportunity to support the management of malnutrition that is strongly associated with head and neck cancer. The purpose of this systematic review was to identify the components of nutritional prehabilitation interventions and their effects on nutritional and health outcomes in head and neck cancer patients. METHODS A comprehensive search was completed within Medline (including PubMed), CINHAL, Cochrane database, EMBASE, PRoQUEST, clinical trials registries, and grey literature to identify studies involving a nutritional intervention pre-treatment in head and neck cancer patients receiving any form of curative therapy. Nutritional intervention was defined as a specified period pre-treatment and outcome measures had to include assessment of nutritional status or body composition. Quality of included studies was assessed using Cochrane risk of bias 2. RESULTS From 557 identified studies, two met the inclusion criteria. Due to the low number of studies, a meta-analysis was not indicated. Both studies conducted a nutritional intervention using an "enriched formula" in malnourished patients prior to surgery. Neither study reported the intervention was effective for reducing weight loss, physical function, surgical complications, or length of stay versus the comparison. CONCLUSION There is limited nutritional prehabilitation research within head and neck cancer. An "enriched formula" provided in the prehabilitation period appears no more advantageous than routine standard nutritional formula in mitigating against the weight loss experienced in malnourished head and neck patient. Due to the malnutrition risks on diagnosis and the negative impact of poor nutritional status on clinical and functional outcomes, robust nutritional prehabilitation research is required to inform clinical practice.
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Evaluation of refeeding hypophosphatemia frequency, risk factors, and nutritional status during stem cell transplantation in patients with hematologic malignancy. Clin Nutr ESPEN 2022; 51:385-390. [DOI: 10.1016/j.clnesp.2022.07.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/23/2022] [Accepted: 07/29/2022] [Indexed: 11/23/2022]
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Schönenberger KA, Dürig C, Huwiler VV, Reber E, Stanga Z. [Refeeding Syndrome: Where Do We Stand in 2022?]. PRAXIS 2022; 111:381-387. [PMID: 35611483 DOI: 10.1024/1661-8157/a003863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Refeeding Syndrome: Where Do We Stand in 2022? Abstract. The refeeding syndrome is a potentially life-threatening condition that can occur when refeeding malnourished patients. In recent years, two consensus manuscripts were published by the major clinical nutrition societies ESPEN and ASPEN. Pathophysiological aspects, clinical manifestations, prevention measures and criteria for diagnosis and management have been described in detail. The aim of this mini-review is to provide an evidence-based overview on the refeeding syndrome. For this purpose, the systematic literature search by Friedli et al. 2015 was updated. Evidence that the refeeding syndrome is associated with a negative clinical outcome exists. Many questions about management aspects remain unanswered. A robust randomized controlled trial is urgently needed to answer all these questions in an evidence-based manner and to elicit reliable evidence about independent predictors and an estimate of metabolic risk.
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Affiliation(s)
- Katja A Schönenberger
- Departement für Diabetologie, Endokrinologie, Ernährungsmedizin und Metabolismus (UDEM), Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz
- Klinische Pharmazie und Epidemiologie, Departement Pharmazeutische Wissenschaften, Universität Basel, Basel, Schweiz
| | - Christa Dürig
- Departement für Diabetologie, Endokrinologie, Ernährungsmedizin und Metabolismus (UDEM), Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz
| | - Valentina V Huwiler
- Departement für Diabetologie, Endokrinologie, Ernährungsmedizin und Metabolismus (UDEM), Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz
- Klinische Pharmazie und Epidemiologie, Departement Pharmazeutische Wissenschaften, Universität Basel, Basel, Schweiz
| | - Emilie Reber
- Departement für Diabetologie, Endokrinologie, Ernährungsmedizin und Metabolismus (UDEM), Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz
| | - Zeno Stanga
- Departement für Diabetologie, Endokrinologie, Ernährungsmedizin und Metabolismus (UDEM), Inselspital, Universitätsspital Bern, Universität Bern, Bern, Schweiz
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Khoory J, Rupal A, Jani C, Singh H, Hu K. Food Coma: Hyperammonemic Encephalopathy From Refeeding Syndrome. Cureus 2021; 13:e18898. [PMID: 34820220 PMCID: PMC8601258 DOI: 10.7759/cureus.18898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2021] [Indexed: 11/05/2022] Open
Abstract
Hyperammonemic encephalopathy (HAE) from extrahepatic causes is increasingly being recognized. Refeeding syndrome is characterized by severe fluid and electrolyte shifts following the reintroduction of nutrition. We describe the case of a 67-year-old man with bilateral maxillary sinus squamous cell carcinoma on nivolumab who became comatose after initiation of enteral feeding. Initial workup was notable for severe hypophosphatemia (<1 mg/dL) and markedly elevated ammonia (226 µmol/L). Neuroimaging was unrevealing. Correction of hypophosphatemia did not improve mental status. Ammonia levels briefly decreased while holding enteral feeding but worsened again on resumption. High-volume continuous renal replacement therapy was recommended but deferred in accordance with family wishes. We hypothesize that HAE may have been precipitated by a combination of refeeding-induced high nitrogen burden and limited detoxification via the urea cycle and extrahepatic pathways in the setting of severe protein-energy malnutrition and underlying malignancy. Nivolumab could have contributed as well.
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Affiliation(s)
- Joseph Khoory
- Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, USA
| | - Arashdeep Rupal
- Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, USA
| | - Chinmay Jani
- Internal Medicine, Mount Auburn Hospital, Harvard Medical School, Cambridge, USA
| | - Harpreet Singh
- Critical Care Medicine, Medical College of Wisconsin, Milwaukee, USA
| | - Kurt Hu
- Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, USA
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Cioffi I, Ponzo V, Pellegrini M, Evangelista A, Bioletto F, Ciccone G, Pasanisi F, Ghigo E, Bo S. The incidence of the refeeding syndrome. A systematic review and meta-analyses of literature. Clin Nutr 2021; 40:3688-3701. [PMID: 34134001 DOI: 10.1016/j.clnu.2021.04.023] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/25/2021] [Accepted: 04/15/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS 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. The aim of this systematic review and meta-analyses was 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 American Society of Parenteral and Enteral Nutrition (ASPEN) consensus. Furthermore, the incidence of refeeding hypophosphatemia (RH) was also assessed. METHODS Four databases were systematically searched until September 2020 for retrieving trials and observational studies. The incidences of RFS and RH were expressed as percentage and reported with 95% confidence intervals (CI). RESULTS Thirty-five observational studies were included in the analysis. The risk of bias was serious in 16 studies and moderate in the remaining 19. The incidence of RFS varied from 0% to 62% across the studies. No substantial change in the originally reported incidence of RFS was found by applying the ASPEN criteria. Similarly, the incidence of RH ranged between 7% and 62%. In the subgroup analyses, inpatients from Intensive Care Units (ICUs) and those initially fed with >20 kcal/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%). However, due to the high heterogeneity of data, summary incidence measures are meaningless. CONCLUSION The incidence rate of both RFS and RH greatly varied according to the definition used and the population analyzed, being higher in ICU inpatients and in those with increased initial caloric supply. 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.
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Affiliation(s)
- Iolanda Cioffi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy.
| | - Valentina Ponzo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126 Turin, Italy
| | - Marianna Pellegrini
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126 Turin, Italy
| | - Andrea Evangelista
- Unit of Clinical Epidemiology, CPO, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - Fabio Bioletto
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126 Turin, Italy
| | - Giovannino Ciccone
- Unit of Clinical Epidemiology, CPO, "Città della Salute e della Scienza" Hospital of Turin, Turin, Italy
| | - Fabrizio Pasanisi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Pansini 5, 80131 Naples, Italy
| | - Ezio Ghigo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126 Turin, Italy
| | - Simona Bo
- Department of Medical Sciences, University of Turin, c.so AM Dogliotti 14, 10126 Turin, Italy
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Ponzo V, Pellegrini M, Cioffi I, Scaglione L, Bo S. The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review. Intern Emerg Med 2021; 16:49-60. [PMID: 33074463 PMCID: PMC7843537 DOI: 10.1007/s11739-020-02525-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/30/2020] [Indexed: 12/11/2022]
Abstract
The Refeeding Syndrome (RFS) is a potentially serious, but still overlooked condition, occurring in individuals who are rapidly fed after a period of severe undernourishment. RFS derives from an abnormal electrolyte and fluid shifts leading to many organ dysfunctions. Symptoms generally appear within 2-5 days of re-feeding and may be absent/mild or severe and life threating, depending on the pre-existing degree of malnutrition and comorbidities. The lack of a standard definition and the nonspecificity of the symptoms make both incidence estimate and diagnosis difficult. In 2020, the American Society for Parenteral and Enteral Nutrition (ASPEN) proposed a unifying definition for the RFS and its severity classification. The awareness of the condition is crucial for identifying patients at risk, preventing its occurrence, and improving the management. The objectives of this narrative review were to summarize the current knowledge and recommendations about the RFS and to provide useful tips to help physicians to recognize and prevent the syndrome.
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Affiliation(s)
- Valentina Ponzo
- Department of Medical Sciences, University of Torino, c.so AM Dogliotti 14, 10126, Turin, Italy
| | - Marianna Pellegrini
- Department of Medical Sciences, University of Torino, c.so AM Dogliotti 14, 10126, Turin, Italy
| | - Iolanda Cioffi
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Luca Scaglione
- Internal Medicine Unit, Città della Salute e della Scienza Hospital of Torino, Turin, Italy
| | - Simona Bo
- Department of Medical Sciences, University of Torino, c.so AM Dogliotti 14, 10126, Turin, Italy.
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Højvig JH, Pedersen NJ, Charabi BW, Wessel I, Jensen LT, Nyberg J, Mayman-Holler N, Kehlet H, Bonde CT. Microvascular reconstruction in head and neck cancer - basis for the development of an enhanced recovery protocol. JPRAS Open 2020; 26:91-100. [PMID: 33225037 PMCID: PMC7666314 DOI: 10.1016/j.jpra.2020.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/30/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction Microvascular reconstructions after head and neck cancer are among the most complicated procedures in plastic surgery. Postoperative complications are common, which often leads to prolonged hospital stay. Enhanced recovery after surgery (ERAS) is a peri- and postoperative care concept with the aim of achieving pain- and risk-free surgery. It has been previously established as superior to conventional care for a wide variety of procedures, including microsurgical procedures such as reconstructions of the breast. Several ERAS protocols for microvascular head and neck cancer reconstructions have been proposed, although most of these are based on extrapolated evidence from different surgical specialties. Results from the implementation of ERAS for these procedures are inconsistent. Methods The current study investigates our clinical experience of head and neck cancer reconstruction for the period of 2014-2016 with the aim of establishing a list of functional discharge criteria. By combining these with the current published knowledge on the subject, we developed an ERAS protocol. Results We performed 89 microvascular procedures in the study period, of which 58 were in the oral cavity/sinuses and 31 were laryngopharyngeal. Most cases were squamous cell carcinoma (89%). The average LOS was 20.3 days in both groups. Postoperative complications included infection (37%), 30-days re-operations (19%), and re-admissions (17%). Furthermore, we identified the following discharge criteria: adequate pain relief, ambulation, sufficient nutritional intake, normal infection-related blood parameter results and absence of fever, bowel function, and closure of tracheostomy. Conclusion Based on our retrospective analysis and identified discharge criteria, we present an approach to develop an ERAS protocol for microvascular reconstruction after head and neck cancer.
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Affiliation(s)
- Jens H Højvig
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nicolas J Pedersen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Birgitte W Charabi
- Department of Otorhinolaryngology, Head and Neck surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Irene Wessel
- Department of Otorhinolaryngology, Head and Neck surgery & Audiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lisa T Jensen
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jan Nyberg
- Department of Oral and Maxillofacial surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Nana Mayman-Holler
- Department of Anaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Kehlet
- Department of Surgical Pathophysiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian T Bonde
- Department of Plastic Surgery and Burns Treatment, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Matthews‐Rensch K, Capra S, Palmer M. Systematic Review of Energy Initiation Rates and Refeeding Syndrome Outcomes. Nutr Clin Pract 2020; 36:153-168. [DOI: 10.1002/ncp.10549] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Kylie Matthews‐Rensch
- School of Human Movement and Nutrition Sciences University of Queensland St Lucia Queensland Australia
- Nutrition and Dietetics Royal Brisbane and Women's Hospital Herston Queensland Australia
| | - Sandra Capra
- School of Human Movement and Nutrition Sciences University of Queensland St Lucia Queensland Australia
| | - Michelle Palmer
- Nutrition and Dietetics, Logan Hospital Meadowbrook Queensland Australia
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Abstract
Clinical nutrition is emerging as a major area in gastroenterology practice. Most gastrointestinal disorders interfere with digestive physiology and compromise nutritional status. Refeeding syndrome (RS) may increase morbidity and mortality in gastroenterology patients. Literature search using the keywords "Refeeding Syndrome", "Hypophosphatemia", "Hypomagnesemia" and "Hypokalemia". Data regarding definition, pathophysiology, clinical manifestations, risk factors, management and prevention of RS were collected. Most evidence comes from case reports, narrative reviews and scarse observational trials. RS results from the potentially fatal shifts in fluid and electrolytes that may occur in malnourished patients receiving nutritional therapy. No standard definition is established and epidemiologic data is lacking. RS is characterized by hypophosphatemia, hypomagnesemia, hypokalemia, vitamin deficiency and abnormal glucose metabolism. Oral, enteral and parenteral nutrition may precipitate RS. Awareness and risk stratification using NICE criteria is essential to prevent and manage malnourished patients. Nutritional support should be started using low energy replacement and thiamine supplementation. Correction of electrolytes and fluid imbalances must be started before feeding. Malnourished patients with inflammatory bowel disease, liver cirrhosis, chronic intestinal failure and patients referred for endoscopic gastrostomy due to prolonged dysphagia present high risk of RS, in the gastroenterology practice. RS should be considered before starting nutritional support. Preventive measures are crucial, including fluid and electrolyte replacement therapy, vitamin supplementation and use of hypocaloric regimens. Gastroenterology patients must be viewed as high risk patients but the impact of RS in the outcome is not clearly defined in current literature.
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Kaderbay A, Atallah I, Fontaine E, Chobert-Bakouline M, Schmitt S, Mitariu P, Righini CA. Malnutrition and refeeding syndrome prevention in head and neck cancer patients: from theory to clinical application. Eur Arch Otorhinolaryngol 2018; 275:1049-1058. [PMID: 29569135 DOI: 10.1007/s00405-018-4935-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/13/2018] [Indexed: 12/23/2022]
Abstract
PURPOSE The goal of this review is to raise awareness about refeeding syndrome (RFS) and to give a comprehensive presentation of recent guidelines and latest scientific data about nutritional management among head and neck cancer (HNC) patients while focusing on RFS prevention. METHODS A review of literature for nutritional assessment and RFS management was conducted. Electronic searches of Medline, Cochrane, PubMed and Embase databases for articles published in peer-reviewed journals were conducted from February to September 2017 using the keywords: "nutrition assessment", "head and neck cancer", "refeeding syndrome" and "guidelines". Articles, reviews, book references as well as national and international guidelines in English and French were included. RESULTS The prevalence of malnutrition is high in HNC patients and a large number of them will need artificial nutritional support or refeeding intervention. RFS is characterized by fluid and electrolyte imbalance associated with clinical manifestations induced by rapid refeeding after a period of malnutrition or starvation. Regarding risk factors for malnutrition and RFS, HNC patients are particularly vulnerable. However, RFS remains unrecognized among head and neck surgeons and medical teams. Practical data are summarized to help organizing nutritional assessment and refeeding interventions. It also summarizes preventive measures to reduce RFS incidence and morbidity in HNC population. CONCLUSION Nutritional assessment and early refeeding interventions are crucial for HNC patients care. As prevention is the key for RFS management, early identification of patients with high risks is crucial and successful nutritional management requires a multidisciplinary approach.
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Affiliation(s)
- Akil Kaderbay
- Otolaryngology Department, Grenoble Alpes University Hospital, Grenoble, France.
- Grenoble Alpes University, Grenoble, France.
- UGA/Inserm U1205, Braintech Lab, Grenoble, France.
- Otolaryngoloy Department of Grenoble Alpes University Hospital, Hôpital Nord Michallon, CS 10217, 38043, Grenoble Cedex 9, France.
| | - Ihab Atallah
- Otolaryngology Department, Grenoble Alpes University Hospital, Grenoble, France
- Grenoble Alpes University, Grenoble, France
- UGA/UMR/CNRS 5309/Inserm 1209, Institut Albert Bonniot, Grenoble, France
- Otolaryngoloy Department of Grenoble Alpes University Hospital, Hôpital Nord Michallon, CS 10217, 38043, Grenoble Cedex 9, France
| | - Eric Fontaine
- Nutrition Department, Grenoble Alpes University Hospital, Grenoble, France
- UGA/Inserm U1055, Grenoble, France
| | | | - Stephanie Schmitt
- Otolaryngology Department, Grenoble Alpes University Hospital, Grenoble, France
| | | | - Christian Adrien Righini
- Otolaryngology Department, Grenoble Alpes University Hospital, Grenoble, France
- Grenoble Alpes University, Grenoble, France
- UGA/UMR/CNRS 5309/Inserm 1209, Institut Albert Bonniot, Grenoble, France
- Otolaryngoloy Department of Grenoble Alpes University Hospital, Hôpital Nord Michallon, CS 10217, 38043, Grenoble Cedex 9, France
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Windpessl M, Mayrbaeurl B, Baldinger C, Tiefenthaller G, Prischl FC, Wallner M, Thaler J. Refeeding Syndrome in Oncology: Report of Four Cases. World J Oncol 2017; 8:25-29. [PMID: 28983382 PMCID: PMC5624659 DOI: 10.14740/wjon1007w] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 11/11/2022] Open
Abstract
The term refeeding syndrome (RFS) refers to the metabolic perturbations and its attendant complications in subjects who are refed after fasting. The syndrome is characterized by profound shifts of electrolytes and fluids. Its consequences are widespread and sometimes fatal. Patients with malignancies are especially vulnerable due to the presence of multiple comorbidities. We report the course of four patients with malignant or hematological disorders who developed RFS while being treated for their underlying illness. All physicians caring for susceptible patients should be cognizant of the risks of refeeding and treat RFS appropriately to reduce patient morbidity as well as mortality.
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Affiliation(s)
- Martin Windpessl
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Beate Mayrbaeurl
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Christian Baldinger
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | | | - Friedrich C Prischl
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Manfred Wallner
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
| | - Josef Thaler
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria
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