European Archives of Oto-Rhino-Laryngology

, Volume 275, Issue 5, pp 1049–1058 | Cite as

Malnutrition and refeeding syndrome prevention in head and neck cancer patients: from theory to clinical application

  • Akil Kaderbay
  • Ihab Atallah
  • Eric Fontaine
  • Marine Chobert-Bakouline
  • Stephanie Schmitt
  • Philipp Mitariu
  • Christian Adrien Righini
Review Article



The goal of this review is to raise awareness about refeeding syndrome (RFS) and to give a comprehensive presentation of recent guidelines and latest scientific data about nutritional management among head and neck cancer (HNC) patients while focusing on RFS prevention.


A review of literature for nutritional assessment and RFS management was conducted. Electronic searches of Medline, Cochrane, PubMed and Embase databases for articles published in peer-reviewed journals were conducted from February to September 2017 using the keywords: “nutrition assessment”, “head and neck cancer”, “refeeding syndrome” and “guidelines”. Articles, reviews, book references as well as national and international guidelines in English and French were included.


The prevalence of malnutrition is high in HNC patients and a large number of them will need artificial nutritional support or refeeding intervention. RFS is characterized by fluid and electrolyte imbalance associated with clinical manifestations induced by rapid refeeding after a period of malnutrition or starvation. Regarding risk factors for malnutrition and RFS, HNC patients are particularly vulnerable. However, RFS remains unrecognized among head and neck surgeons and medical teams. Practical data are summarized to help organizing nutritional assessment and refeeding interventions. It also summarizes preventive measures to reduce RFS incidence and morbidity in HNC population.


Nutritional assessment and early refeeding interventions are crucial for HNC patients care. As prevention is the key for RFS management, early identification of patients with high risks is crucial and successful nutritional management requires a multidisciplinary approach.


Head and neck cancer Refeeding syndrome Malnutrition Nutritional assessment 


Compliance with ethical standards

Conflict of interest

Akil Kaderbay, Ihab Atallah, Eric Fontaine, Marine Chobert-Bakouline, Stephanie Schmitt and Philipp Mitariu and Christian Adrien Righini declare that they have no conflicts of interest concerning this article.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Otolaryngology DepartmentGrenoble Alpes University HospitalGrenobleFrance
  2. 2.Nutrition DepartmentGrenoble Alpes University HospitalGrenobleFrance
  3. 3.Grenoble Alpes UniversityGrenobleFrance
  4. 4.UGA/UMR/CNRS 5309/Inserm 1209Institut Albert BonniotGrenobleFrance
  5. 5.UGA/Inserm U1205, Braintech LabGrenobleFrance
  6. 6.UGA/Inserm U1055GrenobleFrance
  7. 7.Otolaryngoloy Department of Grenoble Alpes University HospitalHôpital Nord MichallonGrenoble Cedex 9France

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