Refeeding syndrome in hospitalized patients over 60 years of age undergoing nasoenteral nutrition therapy
DOI:
https://doi.org/10.33448/rsd-v14i7.49158Keywords:
Refeeding Syndrome, Malnutrition, Elderly, Frailty.Abstract
Introduction: Hospitalized elderly patients often have difficulty with oral feeding, and in some cases, an alternative route of nutrition, such as enteral feeding, is indicated. This can cause metabolic changes leading to anabolic reactions and culminating in Refeeding Syndrome (RFS).Objectives: To assess hospitalized patients over 60 years old who required a transition from oral to nasoenteral feeding, and the frequency of Refeeding Syndrome (RFS) onset.Methods: An ecological, observational, analytical, and prospective study of 100 elderly individuals (over 60 years old) hospitalized in general wards of a philanthropic hospital who required nasoenteral feeding, recruited through the hospital’s nutrition department. RFS was characterized by a serum reduction in potassium, magnesium, and phosphate levels of 10–20% (mild), 20–30% (moderate), or over 30% (severe), with or without organ dysfunction, within three to five days after reintroducing caloric intake that had been previously restricted.Results: A total of 100 patients were included, with a mean age of 75±9 years (range 60–99), 56% were women, 24% had dementia, and 81% had an infection. Among the included patients, 26% developed RFS; however, only 25% of these received preventive measures or treatment with thiamine (p = 0.001). Frail patients accounted for 42.3% of those who developed RFS. The most commonly used diet was normocaloric and normoproteic (75%).Conclusion: RFS is a frequent condition in frail hospitalized elderly patients, mainly due to a lack of awareness regarding its prevention and management in those requiring enteral replacement nutrition.
References
Akamine, C. T. & Yamamoto, R. K. (2009). Estudo dirigido: estatística descritiva. (3ed). Editora Érica.
Attaluri, P., Castillo, A., Edriss, H. & Nugent, K. (2018). Thiamine Deficiency: An Important Consideration in Critically Ill Patients. The American Journal of the Medical Sciences. 356 (4): 382–90.
Aubry, E., Friedli, N., Schuetz, P., & Stanga, Z. (2018). Refeeding syndrome in the frail elderly population: Prevention, diagnosis and management. Clinical and Experimental Gastroenterology, 11, 255–64. https://doi.org/10.2147/CEG.S136429.
Bekman, O. R. & Costa Neto, P. L. O. (2009). Análise estatística da decisão. (2ed). Ed. Edgar Blucher.
Bell, C. L., Tamura, B. K., Masaki, K. H. & Amella, E. J. (2013). Prevalence and Measures of Nutritional Compromise Among Nursing Home Patients: Weight Loss, Low Body Mass Index, Malnutrition, and Feeding Dependency, A Systematic Review of the Literature. Journal of the American Medical Directors Association. 14 (2): 94–100.
Bonnefoy, M., Berrut, G., Lesourd, B., Ferry, M., Gilbert, T., Guerin, O. et al. (2014). Frailty and nutrition: Searching for evidence. The journal of nutrition, health & aging. 19 (3): 250–7.
Church, S., Rogers, E., Rockwood, K. & Theou, O. (2020). A scoping review of the Clinical Frailty Scale. BMC Geriatrics. 20 (1), 393. doi: 10.1186/s12877-020-01801-7.
Corkins, M. R., Guenter, P., DiMaria-Ghalili, R. A., Jensen, G. L., Malone, A., Miller, S. et al. (2013). Malnutrition Diagnoses in Hospitalized Patients. Journal of Parenteral and Enteral Nutrition. 38 (2): 186 95. https://onlinelibrary.wiley.com/doi/full/10.1177/0148607113512154.
Crochemore, I., Lévy, P., Roux, C., Nicolas, P., & Cynober, L. (2012). The impact of refeeding on blood fatty acids and amino acid profiles in elderly patients: A metabolomic analysis. Clinical Nutrition. 31 (4), 567–73. https://doi.org.
Da Silva, J. S. V., Seres, D. S., Sabino, K., Adams, S. C., Berdahl, G. J., Citty, S. W. et al. (2020). ASPEN Consensus Recommendations for Refeeding Syndrome. Nutrition in Clinical Practice. 35 (2): 178–95. https://aspenjournals.onlinelibrary.wiley.com/doi/10.1002/ncp.10474.
Friedli, N., Stanga, Z., Culkin, A., Crook, M., Laviano, A., Sobotka, L. et al. (2018). Management and prevention of refeeding syndrome in medical inpatients: An evidence based and consensus-supported algorithm. Nutrition (Burbank, Los Angeles County, Calif). 47: 13–20. https://www.ncbi.nlm.nih.gov/pubmed/29429529.
Genton, L., & Pichard, C. (2019). The Refeeding Syndrome in the Elderly Population: From Hospital to Home. Revue Médicale Suisse. 15 (657), 1408–12. PMID: 31496189.
Ni Lochlainn, M., Cox, N. J,, Wilson, T., Hayhoe, R. P. G., Ramsay, S. E., Granic, A. et al. (2021). Nutrition and Frailty: Opportunities for Prevention and Treatment. Nutrients. 13 (7): 2349. https://www.mdpi.com/2072-6643/13/7/2349.
Palesty, J. A. & Dudrick, S. J. (2006). The Goldilocks Paradigm of Starvation and Refeeding. Nutrition in Clinical Practice. 21 (2): 147–54.
Pourhassan, M., Cuvelier, I., Gehrke, I., Wirth, R., & Diermayr, M. (2018). Prevalence of Risk Factors for the Refeeding Syndrome in Older Hospitalized Patients. The Journal of Nutrition, Health & Aging. 22 (3), 321–7. https://doi.org/10.1007/s12603-017-0957-x.
Pereira A. S. et al. (2018). Metodologia da pesquisa científica. [free e-book]. Ed.UAB/NTE/UFSM.
Reber, E., Gomes, F., Bally, L., Schuetz, P. & Stanga, Z. (2019). Refeeding syndrome in older hospitalized patients: Incidence, management, and outcomes. Nutrition, 62, 111–6. https://doi.org/10.1016/j.nut.2018.11.023.
Reuben, D. B. (2007). Quality Indicators for the Care of Undernutrition in Vulnerable Elders. Journal of the American Geriatrics Society. 55: S438–42.
Rockwood, K. & Theou, O. (2020). Using the Clinical Frailty Scale in Allocating Scarce Health Care Resources. Canadian Geriatrics Journal. 23 (3): 254–9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7458601/.
Schuetz, P., Seres, D., Lobo, D.N., Gomes, F., Kaegi-Braun, N. & Stanga, Z. (2021). Management of disease-related malnutrition for patients being treated in hospital. Lancet. 398, 1927–38.
Shitsuka, R. et al. (2014). Matemática fundamental para a tecnologia. Ed. Érica.
Solomon, S. & Kirby, D. (1990). The refeeding syndrome: a review. Journal of Parenteral and Enteral Nutrition. 14 (1): 90–7.
Terlisten K, Wirth R, Daubert D. & Pourhassan M. (2023). Refeeding Syndrome in Older Hospitalized Patients: Incidence, Management, and Outcomes. Nutrients. 15 (18): 4084–4.
Wirth, R., Diekmann, R., Janssen, G., Fleiter, O., Fricke, L., Kreilkamp, A., Modreker, M. K., Marburger, C., Nels, S., Pourhassan, M., Schaefer, R., Willschrei, H. P., Volkert, D. Arbeitsgruppe Ernährung und Stoffwechsel der Deutschen Gesellschaft für Geriatrie (DGG). (2018). Refeeding syndrome in geriatric patients: A frequently overlooked complication. Internist (Berl), 59 (4), 326–33. https://doi.org/10.1007/s00108-018-0399 0.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Maria Eduarda Rodrigues Santos; Thainá Calabrez Amorim; Mariane Lima Giro; Luana Schneider Almeida Dantas Silva; Victor Ribeiro Cantudo de Souza; Pedro Henrique Correia Silva; Renato Lírio Morelato
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.
