Friedli Natalie, Stanga Zeno, Sobotka Lubos, Culkin Alison, Kondrup Jens, Laviano Alessandro, Mueller Beat, Schuetz Philipp
Medical University Department, Clinic for Endocrinology/Metabolism/Clinical Nutrition, Kantonsspital Aarau, Aarau and Medical Faculty of the University of Basel, Switzerland.
Department of Endocrinology, Diabetes and Clinical Nutrition, Bern University Hospital, and University of Bern, Switzerland.
Nutrition. 2017 Mar;35:151-160. doi: 10.1016/j.nut.2016.05.016. Epub 2016 Jun 8.
Although described >70 y ago, the refeeding syndrome (RFS) remains understudied with lack of standardized definition and treatment recommendations. The aim of this systematic review was to gather evidence regarding standardized definition, incidence rate and time course of occurrence, association with adverse clinical outcomes, risk factors, and therapeutic strategies to prevent or treat this condition.
We searched MEDLINE and EMBASE for interventional and observational clinical trials focusing on RFS, excluding case reports and reviews. We extracted data based on a predefined case report form and assessed bias.
Of 2207 potential abstracts, 45 records with a total of 6608 patients were included (3 interventional trials, 16 studies focusing on anorexic patients). Definitions for RFS were highly heterogenous with most studies relying on blood electrolyte disturbances only and others also including clinical symptoms. Incidence rates varied between 0% and 80%, depending on the definition and patient population studied. Occurrence was mostly within the first 72 h of start of nutritional therapy. Most of the risk factors were in accordance with National Institute for Health and Care Excellence guidelines, with older age and enteral feeding being additional factors. There was no strong evidence regarding association of RFS and adverse outcomes, as well as regarding preventive measures and treatment algorithms.
This systematic review focusing on RFS found consensus regarding risk factors and timing of occurrence, but wide variations regarding definition, reported incidence rates, preventive measures and treatment recommendations. Further research to fill this gap is urgently needed.
尽管再喂养综合征（RFS）早在70多年前就有描述，但由于缺乏标准化定义和治疗建议，对其研究仍不足。本系统评价的目的是收集有关标准化定义、发病率和发病时间进程、与不良临床结局的关联、危险因素以及预防或治疗该病症的治疗策略的证据。
我们在MEDLINE和EMBASE中检索了关注RFS的干预性和观察性临床试验，排除了病例报告和综述。我们根据预定义的病例报告表提取数据并评估偏倚。
在2207篇潜在摘要中，纳入了45篇记录，共6608例患者（3项干预性试验，16项针对厌食症患者的研究）。RFS的定义高度异质，大多数研究仅依赖血液电解质紊乱，其他研究还包括临床症状。发病率在0%至80%之间变化，具体取决于所研究的定义和患者群体。发病大多在营养治疗开始后的头72小时内。大多数危险因素符合英国国家卫生与临床优化研究所的指南，年龄较大和肠内喂养是额外的因素。关于RFS与不良结局的关联以及预防措施和治疗算法，没有强有力的证据。
这项针对RFS的系统评价在危险因素和发病时间方面达成了共识，但在定义、报告的发病率、预防措施和治疗建议方面存在很大差异。迫切需要进一步研究来填补这一空白。
