Refeeding syndrome is typically characterized by water and electrolyte imbalance and cardiac complications associated with rapid nutritional supplementation in severely malnourished patients. However, the relationship between refeeding syndrome and hypoglycemia has not been clearly elucidated.

This study reviewed 12 Japanese patients with body mass index (BMI) < 14 who developed refeeding syndrome associated with hypoglycemia, 10 of whom developed fatal cardiac complications such as Takotsubo cardiomyopathy and cardiac arrest. The detailed underlying mechanisms remain largely unclear, although it has been postulated to result from hypoglycemia and consequent excessive catecholamine secretion induced by excessive insulin secretion upon rapid energy supplementation in malnutrition, which in turn causes Takotsubo cardiomyopathy. Insufficient energy supply to the cardiac muscle may also be involved in cardiac complications.

Refeeding syndrome can potentially become critical, so systemic management such as electrocardiography monitoring and management of electrolytes and blood glucose level is necessary in patients with severe malnutrition. Prevention of refeeding syndrome and associated metabolic and cardiac complications is vital. In addition, strict nutritional management with appropriate set targets of energy supplementation based on measurement of energy expenditure is essential to safely improve nutritional status.

Aim: To investigate the optimal acute-phase nutrition protocol by using different enteral formulas in patients with stroke.

Subjects and methods: This single-center retrospective analysis included 51 acute stroke patients who received enteral nutrition according to an early enteral feeding protocol from August 2015 to April 2017. The patients were classified into two groups: the 1.0 kcal group who received a standard 1.0 kcal/mL formula (n = 28 patients) and the 1.5 kcal group who received a 1.5 kcal/mL formula (a high protein peptide-based formula followed by a liquid diet [1.5 kcal/mL] and later switched to partially hydrolyzed guar gum (PHGG]-containing liquid diet; n = 23). Clinical progress and outcomes were retrospectively compared between the groups.

Results: Baseline characteristics were similar between both groups. Compared with the 1.0 kcal group, the 1.5 kcal group had a lower protocol incompletion rate owing to gastrointestinal symptoms and fewer number of days needed to complete the protocol. The 1.5 kcal group also had a lower rate of weight loss. Blood biochemistry results showed improvement in nutritional status and inflammatory status.

Conclusion: The nutritional protocol using a 1.5 kcal/mL high protein peptide-based formula and a 1.5 kcal/mL PHGG-containing liquid diet was more beneficial than that using a 1.0 kcal/mL standard formula in acute stroke patients.

Objective : The utility of a newly developed remote dietary support system for cancer outpatients receiving chemotherapy was examined. The system consisted of two types of application software, “record of physical condition” and “search for suitable recipe for physical condition.”

Methods: The tablet/PC-based software was used by 27 cancer outpatients receiving chemotherapy at our hospital over a 3-month test period at home, and its usability and usefulness was evaluated once a month. During the test period, a registered dietitian outside the hospital gave patients once-weekly personalized dietary advice, in the form of comments, and suitable recipes, according to the patient’s self-reported condition.

Results: Twenty patients (15 men, mean age 64.0 years) had a high rate of system use (mean, 93%) during the test period and showed that the system’s usability (i.e., ease of use) and usefulness as a means of dietary support and record-keeping of condition were generally favorable. Dietary advice was highly valued as practical dietary support and as psychological support for the patients and their family.

Conclusion: This system was a good tool for recording the physical condition in cancer outpatients during home care, and the personalized dietary advice offered was particularly useful in providing dietary support.

Aims: This study aimed to examine the impact of obesity at admission on rehabilitation in elderly patients with stroke admitted to a convalescent rehabilitation ward.

Subjects and Methods: We examined 186 elderly stroke patients admitted to a rehabilitation ward and classified them into two groups based on body mass index at admission, the obese group and the standard weight group, and compared the effect of convalescent rehabilitation between the groups. In addition, we performed multivariate analysis adjusted for other confounding factors, such as age, sex, functional independence measure (FIM) on admission, nutritional status, and obesity in order to examine the effect of obesity on good FIM effectiveness.

Results: The obese group comprised 52 patients. FIM at discharge, FIM effectiveness, FIM gain, and FIM efficiency were significantly higher in the obese group than in the standard weight group. Furthermore, multivariate analysis confirmed obesity was significantly associated with good FIM efficiency.

Conclusion: This study showed that in elderly stroke patients admitted to a rehabilitation ward, obesity at admission had a positive impact on rehabilitation during the convalescent phase, and the difference was significant even after adjustment for other confounding factors.

Purpose: There are various obstacles in implementing measures against the increasing incidence of dysphagia after treatment of acute conditions and performing percutaneous endoscopic gastrostomy (PEG). This study aimed to evaluate the activities of a dysphagia management team (DMT) established in January 2018 to facilitate PEG and the current status of elective PEG at our hospital.

Patients and methods: We evaluated the activities and problems of the DMT and cases of elective PEG performed between January and June 2018.

Results: Establishing the DMT enabled the provision of comprehensive multidisciplinary interventions, but issues remained unsolved relating to coordination of roles and time to be spent on DMT activities among the various medical professionals involved, as well as issues with the hospital’s support systems for team activities. PEG was performed in 38 patients (22 men and 16 women, mean age 79.7 years). The indication was mainly due to sequelae of stroke (n=11), progressive dementia (n=10), and worsening of underlying disease (n=10). Preoperative examination for dysphagia was performed in only 57.8% of patients. After PEG, 57.9% of patients underwent only indirect training for dysphagia.

Conclusion: It is necessary to strengthen the support system for DMT activities as well as strengthen and coordinate medical care systems involving multidisciplinary professionals in order to enhance the treatment of dysphagia, including the introduction of PEG.