Department of Surgery, Tygerberg Hospital, Stellenbosch University, Western Cape, South Africa.
Department of Surgery, Khayelitsha District Hospital, Stellenbosch University, Western Cape, South Africa.
Clin Nutr ESPEN. 2021 Dec;46:210-215. doi: 10.1016/j.clnesp.2021.10.006. Epub 2021 Oct 14.
BACKGROUND & AIMS: South Africa's inequitable history has contributed to a malnourished population, further aggravated by high levels of violence and economic uncertainty culminating in a population suffering the sequelae of poverty. The perceived notion is that malnutrition places the South African population at greater risk for development of refeeding syndrome. This study aimed to identify the incidence of refeeding syndrome in the South African population.
All patients admitted into the surgical intensive care unit from 1 November 2019 to 30 September 2020, were screened using the National Institute for Health and Care Excellence (NICE) refeeding risk criteria. Patients started on artificial feeds with one or more risk factors were included in the study. The syndrome was confirmed using the King's College criteria and compared with the American Society for Parenteral and Enteral Nutrition (ASPEN) criteria for refeeding syndrome.
200 Patients were included in this study. The median age of the sample population was 41 years (IQR 30-58) with a male predominance (63%). All patients included had one or more risk factors and 62 (31%) of patients fulfilled the NICE criteria. The sensitivity of the NICE criteria was 33% and specificity was 70%. The most common risk factors identified were little or no nutritional intake for >5 days (55%) followed by a history of alcohol abuse, drugs including insulin, chemotherapy, diuretics or antacids (18%). Specificity values for all risk factors were >80% apart from little or no nutritional intake for >5 days which had a specificity of 64.2%. Sensitivity values for all risk factors were low. 84.5% of patients received artificial nutritional support in the form of enteral feeds, 9% parenteral and 6.5% both enteral and parenteral feeds. A total of 146 patients required electrolyte supplementation. Three patients fulfilled the King's College criteria and one subsequently died. In comparison, 25 patients fulfilled the ASPEN criteria and 3 demised.
Due to the low sensitivity and specificity of the NICE criteria, we advise that it be used merely as a guideline to identify patients at risk of refeeding syndrome and one should remain vigilant in patients with any risk factors present. Due to the small number of patients who fulfilled the King's College criteria and significant difference in incidence when compared to the ASPEN definition, a conclusion regarding the accuracy of both diagnostic criteria could not be made. We recommend a review of the current definition and a global adoption of an agreed criteria for the estimation of the true prevalence.
南非不平等的历史导致人口营养不良，加之暴力水平高和经济不稳定，最终导致民众遭受贫困的后果。人们普遍认为，营养不良使南非人口更容易患上喂养综合征。本研究旨在确定喂养综合征在南非人群中的发生率。
2019 年 11 月 1 日至 2020 年 9 月 30 日期间，所有入住外科重症监护病房的患者均使用英国国家卫生与临床优化研究所（NICE）喂养风险标准进行筛查。凡有一个或多个危险因素开始人工喂养的患者均纳入研究。采用 King's College 标准确诊综合征，并与美国肠外与肠内营养学会（ASPEN）喂养综合征标准进行比较。
本研究共纳入 200 例患者。样本人群的中位年龄为 41 岁（IQR 30-58），男性居多（63%）。所有患者均有一个或多个危险因素，62 例（31%）患者符合 NICE 标准。NICE 标准的敏感性为 33%，特异性为 70%。最常见的危险因素是 5 天以上无或极少营养摄入（55%），其次是酒精滥用史、包括胰岛素在内的药物史、化疗史、利尿剂或抗酸剂史（18%）。除 5 天以上无或极少营养摄入的特异性为 64.2%外，所有危险因素的特异性均>80%。所有危险因素的敏感性均较低。84.5%的患者接受肠内营养支持，9%接受肠外营养，6.5%同时接受肠内和肠外营养。共有 146 例患者需要补充电解质。3 例患者符合 King's College 标准，其中 1 例死亡。相比之下，25 例患者符合 ASPEN 标准，其中 3 例死亡。
由于 NICE 标准的敏感性和特异性较低，我们建议仅将其用作识别喂养综合征风险患者的指南，对于存在任何危险因素的患者应保持警惕。由于符合 King's College 标准的患者数量较少，与 ASPEN 定义相比发病率差异显著，因此无法对这两种诊断标准的准确性得出结论。我们建议对当前定义进行审查，并采用全球公认的标准来估计真实患病率。
