Sissel Urke Olsen1, Karin Hesseberg2, Anne-Marie Aas3, Are Hugo Pripp4, Anette Hylen Ranhoff5,6, Asta Bye7,8. 1. Department of Clinical Dietetics, Diakonhjemmet Hospital, Oslo, Norway. sisselurke@gmail.com. 2. Department of Physiotherapy, Diakonhjemmet Hospital, Oslo, Norway. 3. Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway. 4. Faculty of Health Sciences, Oslo Metropolitan University (OsloMet), Oslo, Norway. 5. Department of Clinical Science, University of Bergen, 7804, Bergen, Norway. 6. Medical Department, Diakonhjemmet Hospital, Bergen, Oslo, Norway. 7. Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway. 8. Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, Oslo, Norway.
Abstract
PURPOSE: Optimal refeeding protocols in older malnourished hospital patients remain unclear. We aimed to compare the effect of two different refeeding protocols; an assertive and a cautious protocol, on HGS, mortality and refeeding syndrome (RFS), in patients ≥ 65 years METHODS: Patients admitted under medical or surgical category and at risk of RFS, were randomized to either an enteral nutrition (EN) refeeding protocol of 20 kcal/kg/day, reaching energy goals within 3 days (intervention group), or a protocol of 10 kcal/kg/day, reaching goals within 7 days (control group). Primary outcome was the difference in hand grip strength (HGS) at 3 months follow-up, in an intention to treat analysis. RFS (phosphate < 0.65 mmol/L) during the hospital stay and mortality rates at 3 months were secondary outcomes. RESULTS: A total of 85 patients were enrolled, with mean (SD) age of 79.8(7.4) and 54.1% female, 41 in the intervention group and 44 in the control group. HGS was similar at 3 months with mean change of 0.42 kg (95% CI - 2.52 to 3.36, p = 0.78). Serum phosphate < 0.65 mmol/L was seen in 17.1% in the intervention group and 9.3% in the control group, p = 0.29. There was no difference in mortality rates (39% vs 34.1%, p = 0.64). An indication of more respiratory distress was found in the intervention group, 53.6% vs 30.2%, p = 0.029. CONCLUSION: A more assertive refeeding protocol providing 20 kcal/kg/day did not result in improved HGS measured 3 months after discharge compared with a cautious refeeding (10 kcal/kg/day) protocol. No difference in incidence of mortality or RFS was found. TRIAL REGISTRATION: ClinicalTrials.gov Protocol Record 2017/FO148295, Registered: 21st of February, 2017.
PURPOSE: Optimal refeeding protocols in older malnourished hospital patients remain unclear. We aimed to compare the effect of two different refeeding protocols; an assertive and a cautious protocol, on HGS, mortality and refeeding syndrome (RFS), in patients ≥ 65 years METHODS: Patients admitted under medical or surgical category and at risk of RFS, were randomized to either an enteral nutrition (EN) refeeding protocol of 20 kcal/kg/day, reaching energy goals within 3 days (intervention group), or a protocol of 10 kcal/kg/day, reaching goals within 7 days (control group). Primary outcome was the difference in hand grip strength (HGS) at 3 months follow-up, in an intention to treat analysis. RFS (phosphate < 0.65 mmol/L) during the hospital stay and mortality rates at 3 months were secondary outcomes. RESULTS: A total of 85 patients were enrolled, with mean (SD) age of 79.8(7.4) and 54.1% female, 41 in the intervention group and 44 in the control group. HGS was similar at 3 months with mean change of 0.42 kg (95% CI - 2.52 to 3.36, p = 0.78). Serum phosphate < 0.65 mmol/L was seen in 17.1% in the intervention group and 9.3% in the control group, p = 0.29. There was no difference in mortality rates (39% vs 34.1%, p = 0.64). An indication of more respiratory distress was found in the intervention group, 53.6% vs 30.2%, p = 0.029. CONCLUSION: A more assertive refeeding protocol providing 20 kcal/kg/day did not result in improved HGS measured 3 months after discharge compared with a cautious refeeding (10 kcal/kg/day) protocol. No difference in incidence of mortality or RFS was found. TRIAL REGISTRATION: ClinicalTrials.gov Protocol Record 2017/FO148295, Registered: 21st of February, 2017.
Authors: Z Stanga; A Brunner; M Leuenberger; R F Grimble; A Shenkin; S P Allison; D N Lobo Journal: Eur J Clin Nutr Date: 2007-08-15 Impact factor: 4.016
Authors: Andrea K Garber; Jing Cheng; Erin C Accurso; Sally H Adams; Sara M Buckelew; Cynthia J Kapphahn; Anna Kreiter; Daniel Le Grange; Vanessa I Machen; Anna-Barbara Moscicki; Allyson Sy; Leslie Wilson; Neville H Golden Journal: JAMA Pediatr Date: 2021-01-01 Impact factor: 16.193
Authors: Joshua S V da Silva; David S Seres; Kim Sabino; Stephen C Adams; Gideon J Berdahl; Sandra Wolfe Citty; M Petrea Cober; David C Evans; June R Greaves; Kathleen M Gura; Austin Michalski; Stephen Plogsted; Gordon S Sacks; Anne M Tucker; Patricia Worthington; Renee N Walker; Phil Ayers Journal: Nutr Clin Pract Date: 2020-03-02 Impact factor: 3.080
Authors: Philipp Schuetz; Rebecca Fehr; Valerie Baechli; Martina Geiser; Manuela Deiss; Filomena Gomes; Alexander Kutz; Pascal Tribolet; Thomas Bregenzer; Nina Braun; Claus Hoess; Vojtech Pavlicek; Sarah Schmid; Stefan Bilz; Sarah Sigrist; Michael Brändle; Carmen Benz; Christoph Henzen; Silvia Mattmann; Robert Thomann; Claudia Brand; Jonas Rutishauser; Drahomir Aujesky; Nicolas Rodondi; Jacques Donzé; Zeno Stanga; Beat Mueller Journal: Lancet Date: 2019-04-25 Impact factor: 79.321
Authors: Andrea K Garber; Susan M Sawyer; Neville H Golden; Angela S Guarda; Debra K Katzman; Michael R Kohn; Daniel Le Grange; Sloane Madden; Melissa Whitelaw; Graham W Redgrave Journal: Int J Eat Disord Date: 2015-12-12 Impact factor: 4.861