Background and Aims: Refeeding syndrome (RFS) is defined by the presence of acute electrolyte disturbances, including hypophosphatemia. Underlying disease(s), malnutrition and hospitalisation are known risk factors for RFS. It can occur in patients with inflammatory bowel disease (IBD). We aimed to determine the frequency of hypophosphatemia and the relationship between hypophosphatemia, disease severity and nutritional status in hospitalized patients with IBD. Methods: This study was performed prospectively in hospitalized adult patients for the treatment of IBD in a tertiary-care hospital. Disease severity was assessed using Truelove and Witts score for ulcerative colitis (UC) and Crohn‘s Disease Activity Index for Crohn’s disease (CD). Nutritional status was determined using Subjective Global Assessment (SGA). Serum phosphate concentration was recorded for first 7 days after hospitalization, and less than 0.65 mmol/l was defined as hypophosphatemia. Results: Fifty participants (33 with UC and 17 with CD) were included in the study. The mean age of the study sample was 43.4±14.9 years, of which 64% were male. A total of 8.8% of patients with UC and 37.5% of patients with CD had severe (>moderate) disease upon study admission. Seventeen patients (34%) were malnourished. During the 7 study days, 23 participants (46%) had at least one episode of hypophosphatemia. Serum phosphate concentration was significantly and moderately correlated with serum potassium concentration in both the patients and the hypophosphatemia group on study day 3 (p<0.05). Multivariate logistic regression analysis showed that the presence of malnutrition [odds ratio (OR) = 3.64, 95% confidence interval (CI): 1.52-5.58, p=0.008), the administration of parenteral nutrition (OR=2.91, 95%Cl: 1.37-4.63, p=0.015), and severe IBD (OR=1.74, 95%CI: 1.03-3.42, p=0.020) were associated with hypophosphatemia. Conclusions: Approximately half of the participants exhibited at least one instance of hypophosphatemia during the study period. Hypophosphatemia was found to be associated with malnutrition, parenteral nutrition, and severe disease in patients with IBD requiring hospitalization.

Adipokines play an important role in the regulation of metabolism. In critical illness, these alter serum levels and suspected to worsen clinical outcomes. But the effect of the route of nutrition on adipokines is not known. The purpose of this study was to evaluate the association between the route of nutrition and adipokine levels in critically ill patients. This prospective study was performed in an intensive care unit (ICU). Patients admitted to the ICU for least 72 h and receiving either enteral nutrition (EN) via tube feeding or parenteral nutrition (PN) were enrolled. Serum was obtained at baseline, 24 h, and 72 h for concentrations of leptin, adiponectin, resistin, glucagon-like peptide 1 (GLP-1), insulin-like growth factors-1 (IGF-1), and ghrelin. A total of 26 patients were included in the study. Thirteen patients received EN and 13 patients received PN. In PN group, leptin level significantly increased (p=0.037), adiponectin and ghrelin significantly decreased during follow-up (p=0.037, p=0.008, respectively). There was no significant change between all adipokines in the EN group and resistin, IGF-1 and GLP-1in the PN group during follow-up. Resistin levels were markedly lower in the EN group at both 24 h (p=0.015) and 72 h (p=0.006) while GLP-1 levels were higher in the EN group at baseline, 24 h, and 72 h (p=0.018, p=0.005, and p=0.003, respectively). There were no differences in leptin, adiponectin, IGF-1, and ghrelin levels over time. The delivery of EN in critical illness was associated with decreased resistin levels and increased GLP-1 levels. Thus, the route of nutrition may impact the clinical outcome in critical illness due to adipokines.

Adipokines regulate metabolic and inflammatory pathways and may be altered during critical illness. We explored sequential serum adipokine concentrations and their associations with nutritional and clinical variables in critically ill COVID-19 patients. This prospective observational, exploratory study included 30 critically ill COVID-19 patients and 10 age- and sex-matched healthy controls. Serum adiponectin, resistin, GLP-1, visfatin, IGF-1, leptin, and acylated ghrelin were measured at intensive care unit admission and on day 7. Biomarker-clinical correlations were analyzed using Spearman correlation, and the Benjamini–Hochberg false discovery rate procedure was applied to account for multiple biomarker comparisons. After false discovery rate correction, longer time to nutrition initiation remained inversely associated with day-7 adiponectin (ρ = −0.464, q = 0.027), GLP-1 (ρ = −0.568, q = 0.015), IGF-1 (ρ = −0.488, q = 0.022), leptin (ρ = −0.539, q = 0.015), and acylated ghrelin (ρ = −0.503, q = 0.021). Several adipokines showed exploratory associations with nutrition-initiation time in this small cohort of critically ill COVID-19 patients. These observational findings do not establish that earlier nutritional support causes changes in adipokine concentrations and require validation in larger, adequately controlled studies.