LB047 - REFEEDING SYNDROME: A SYSTEMATIC REVIEW OF A CLINICAL CHAMELEON

LB047

REFEEDING SYNDROME: A SYSTEMATIC REVIEW OF A CLINICAL CHAMELEON

N. Friedli^1,*, H. Graf¹, J. Odermatt¹, C. Wunderle², F. Gomes^3,4, A. Culkin⁵, D. N. Lobo⁶, P. Schuetz^2,7, Z. Stanga¹

¹Division of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, University Hospital of Bern, Bern, ²Division of General Internal and Family Medicine, Kantonsspital Aarau, Aarau, Switzerland, ³Nova Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal, ⁴Micronutrient Forum, Washington, United States, ⁵Intestinal Failure and Rehabilitation, St Marks Hospital, London, ⁶Nottingham Digestive Diseases Centre, Queen's Medical Centre, Nottingham, United Kingdom, ⁷Medical Faculty, University of Basel, Basel, Switzerland

Rationale: Refeeding syndrome (RFS) remains underrecognized, although increasing use of nutritional therapies may raise its risk. The aim of our study was to synthesize the latest evidence on RFS.

Methods: As an update of the 2017 review¹, we performed a systematic literature search for RCTs and observational studies on RFS and nutrition-associated hypophosphatemia (HP), with data harmonized to the previous report¹.

Results: We included 138 studies (7 RCTs, 131 observational). Definitions of RFS varied widely, with most studies using only biochemical criteria. Reported incidence ranged from 0% to 98% for RFS and 0% to 78% for HP depending on the setting. When reported, electrolyte abnormalities most commonly occurred within 72 hours of refeeding, in nearly all cases within 5 days. Some ICU studies showed a higher mortality for RFS or HP, whereas many others found no clear association, and other adverse events were reported only sporadically. Risk factors for RFS and HP most often included baseline electrolyte abnormalities, markers of disease severity, malnutrition (BMI, weight loss), and alcohol or substance misuse. Evidence on energy targets was heterogeneous: in high‑risk patients, some studies support initial hypocaloric feeding to mitigate the risk of RFS, whereas in patients with anorexia nervosa (AN) higher‑energy content and more rapid refeeding appears safe with careful monitoring and adequate electrolyte and micronutrient replacement.

Conclusion: By tripling the evidence base compared with the 2017 Friedli et al. review^1, our study confirms heterogeneity in definitions and incidence of RFS, consolidates guideline‑listed risk factors, and suggests that energy strategies should be tailored, favoring cautious hypocaloric feeding in acutely ill non‑AN patients while allowing for a less conservative approach in selected AN populations.

References: ¹ Friedli N et al. Revisiting the refeeding syndrome: Results of a systematic review. Nutrition. 2017.

Disclosure of Interest: None declared