A comparison of two different refeeding protocols and its effect on hand grip strength and refeeding syndrome: a randomized controlled clinical trial

Aim Does a more assertive compared to a cautious initial refeeding protocol improve patient handgrip strength? Findings In this randomized clinical trial of 85 older adults whom received two different refeeding protocols, with tight control of electrolytes, no significant difference in in by handgrip strength was found (p = 0.78). Message A more assertive refeeding protocol providing 20 kcal/kg/day did not improve hand grip strength nutritional status at 3 months compared with a cautious refeeding protocol (10 kcal/kg/day), neither did it show a higher incidence of mortality..

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 0.78 kg (95% CI − 2.52 to 3.36, p = 0.42). 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..

Medienart:

E-Artikel

Erscheinungsjahr:

2021

Erschienen:

2021

Enthalten in:

Zur Gesamtaufnahme - volume:12

Enthalten in:

European geriatric medicine - 12(2021), 6 vom: 04. Juni, Seite 1201-1212

Sprache:

Englisch

Beteiligte Personen:

Olsen, Sissel Urke [VerfasserIn]
Hesseberg, Karin [VerfasserIn]
Aas, Anne-Marie [VerfasserIn]
Pripp, Are Hugo [VerfasserIn]
Ranhoff, Anette Hylen [VerfasserIn]
Bye, Asta [VerfasserIn]

Links:

Volltext [lizenzpflichtig]

BKL:

44.68 / Gerontologie / Geriatrie / Gerontologie / Geriatrie

Themen:

Enteral nutrition
Hand grip strength
Malnutrition
Phosphate
Refeeding syndrome

Anmerkungen:

© European Geriatric Medicine Society 2021. corrected publication 2022

doi:

10.1007/s41999-021-00520-5

funding:

Förderinstitution / Projekttitel:

PPN (Katalog-ID):

OLC2128622883

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