The Prevention of Refeeding Syndrome by a Diet Regime in Patient With Head and Neck Cancer
A large weight loss as a result of a longer period (>30 days) of starvation or
semi-starvation will result in a metabolic adaptation to the decreased food intake. To
prevent the degradation of muscle mass into gluco- and ketogenic amino acids to be used for
energy production, a shift from gluconeogenesis to lipolysis occurs. Lipids therefore become
the primary energy fuel, and the body adapts to use ketone bodies instead of glucose. The
reduction in glucose metabolism results in a decreased need for amino acids for use in
gluconeogenesis. This means that less amino acids are needed for gluconeogenesis and
therefore important muscle mass is preserved. At the same time as the lipid stores are
degraded, an intracellular depletion of phosphate, potassium and magnesium occurs. The serum
levels of these electrolytes stay within the normal range as long as the body is in the
adaptive starvation state. A too quick reintroduction of food to the body will result in a
major glucose-induced increase in insulin secretion that will stimulate the transport of
glucose, phosphate, potassium and magnesium from plasma into the cells. Because the
extracellular blood volume is much smaller than the intracellular, an influx of these
electrolytes to the intracellular space will result in a quick and large decrease in the
plasma levels. Likewise, an influx of glucose means that it again can enter the glucolysis,
and the need for phosphate and the co-factor thiamine, for the production of ATP, will
increase. The increased production of adenosine triphosphate (ATP) will activate membrane
pumps and reestablish the membrane potential. This means that sodium will be transported
from the large intracellular space to the small extracellular, with subsequent fluid
retention and edema formation.
Therefore a slowly introduced diet low in sodium and high in slowly absorbed carbohydrates
might prevent the development of refeeding syndrome.
Interventional
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Open Label, Primary Purpose: Prevention
Occurence of Refeeding events
Measured by a decrease in plasma phosphate levels.
daily, starting from day of admission and until day 7 of the treatment period or until discharge from the hospital if before day 7
No
Jens R. Andersen, MD, lektor
Principal Investigator
University of Copenhagen
Denmark: The Ministry of the Interior and Health
HKM refeeding
NCT01845922
May 2013
February 2014
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