Refeeding syndrome as treatment complication of anorexia nervosa

Skowrońska, Anna; Sójta, Klaudia; Strzelecki, Dominik

doi:10.12740/pp/onlinefirst/90275

Cited by 15 publications

(29 citation statements)

References 15 publications

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“…The identification of patients at risk for RFS is the first step to prevent the onset of the syndrome, and to avoid an excessive nutritional replenishment in those individuals [21,66]. Risk factors should be carefully investigated before starting either oral, enteral, or parenteral nutrition, because every route of calorie administration is implicated in the occurrence of the RFS [33,58].…”

Section: Prevention and Treatmentmentioning

confidence: 99%

“…Most inpatients with AN are at high risk for RFS [12]; refeeding is the first step of the treatment and must be managed very cautiously [66,69]. International guidelines are based mainly on clinical experience, due to the lack of well-designed trials in inpatients with AN [70,71].…”

Section: Anorexia Nervosamentioning

confidence: 99%

“…At hospital admission, the recommended calorie provision ranges from 5-20 kcal/kg to 30-40 kcal/kg [70,71]. A progressive increase of 5-10 kcal/kg/day (if high risk of RFS) or 10-20 kcal/kg/day (if moderate risk of RFS) could be carried out after the stabilization of the clinical conditions (e.g., improvement of electrocardiographic abnormalities, correction of electrolyte imbalance, replacement of thiamine and vitamins, and stabilization of comorbidities) [48,66,72]. Caloric provision could increase up to 70-100 kcal/kg per day if patients have increased energy requirement such as in case of inappropriate behaviors (throwing or hiding food, vomiting, intense exercise, etc.)…”

Section: Anorexia Nervosamentioning

confidence: 99%

“…Refeeding with a lower calorie provision and a slow energy increase may be a better approach for severely malnourished patients with chronic comorbidity, while higher caloric intakes might be reserved for moderately malnourished patients with acute illnesses [69]. Preventive supplementation with phosphate, potassium, magnesium, thiamine and other vitamins, trace elements, and minerals as well as sodium and fluid restriction are recommended too [66,71]. Both meal-based approaches (with or without oral nutritional supplements) and combined approaches with nasogastric feeding can be used in inpatients requiring higher caloric intakes [69,73].…”

Section: Anorexia Nervosamentioning

confidence: 99%

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The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review

et al. 2020

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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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Section: Prevention and Treatmentmentioning

confidence: 99%

Section: Anorexia Nervosamentioning

confidence: 99%

Section: Anorexia Nervosamentioning

confidence: 99%

Section: Anorexia Nervosamentioning

confidence: 99%

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The Refeeding Syndrome: a neglected but potentially serious condition for inpatients. A narrative review

et al. 2020

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“…Vitamin E deficiency may result in neuropathies, as well as progressive necrosis of the nervous system and muscles. Patients with anorexia may also experience cardiovascular complications, arrhythmias, peripheral edema, and even sudden cardiac arrest [48].…”

Section: Vitamin Ementioning

confidence: 99%

Nutrition Can Help DNA Repair in the Case of Aging

2020

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Micronutrients such as vitamins and trace elements are crucial for maintaining the health of all organisms. Micronutrients are involved in every cellular/biochemical process. They play roles in proper heart and brain functioning, influence immunological responses, and antioxidant defense systems. Therefore, prolonged deficiency in one or more micronutrients leads to cardiovascular or neurodegenerative disorders. Keeping micronutrients at adequate levels is especially important for seniors. They are prone to deficiencies due to age-associated functional decline and often to a diet poor in nutrients. Moreover, lack of micronutrients has an indirect impact on the genome. Their low levels reduce the activity of antioxidant enzymes, and therefore inhibit the efficiency of defense against free radicals which can lead to the formation of DNA lesions. The more DNA damage in the genetic material, the faster aging at the cellular level and a higher risk of pathological processes (e.g., carcinogenesis). Supplementation of crucial antioxidative micronutrients such as selenium, zinc, vitamin C, and vitamin E seems to have the potential to positively influence the condition of an aging organism, including minimizing inflammation, enhancing antioxidative defense, and limiting the formation of DNA lesions. In consequence, it may lead to lowering the risk and incidence of age-related diseases such as cardiovascular diseases, neurodegenerative diseases, and malnutrition. In this article, we attempt to present the synergistic action of selected antioxidant micronutrients (vitamin C, vitamin E, selenium, and zinc) for inhibiting oxidative stress and DNA damage, which may impede the process of healthy aging.

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