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Cited by 274Clinical Nutrition and GastroenterologyEating Disorders and BehaviorsNutrition and Health in Aging

Revisiting the refeeding syndrome: Results of a systematic review

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Friedli, Natalie, Stanga, Zeno, Sobotka, Lubos, Culkin, Alison, Kondrup, Jens, Laviano, Alessandro, Mueller, Beat, Schuetz, Philipp·2017·Nutrition
DOI 10.1016/j.nut.2016.05.016
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Abstract

Objective Although described >70 y ago, the refeeding syndrome (RFS) remains understudied with lack of standardized definition and treatment recommendations. The aim of this systematic review was to gather evidence regarding standardized definition, incidence rate and time course of occurrence, association with adverse clinical outcomes, risk factors, and therapeutic strategies to prevent or treat this condition. Methods We searched MEDLINE and EMBASE for interventional and observational clinical trials focusing on RFS, excluding case reports and reviews. We extracted data based on a predefined case report form and assessed bias. Results Of 2207 potential abstracts, 45 records with a total of 6608 patients were included (3 interventional trials, 16 studies focusing on anorexic patients). Definitions for RFS were highly heterogenous with most studies relying on blood electrolyte disturbances only and others also including clinical symptoms. Incidence rates varied between 0% and 80%, depending on the definition and patient population studied. Occurrence was mostly within the first 72 h of start of nutritional therapy. Most of the risk factors were in accordance with National Institute for Health and Care Excellence guidelines, with older age and enteral feeding being additional factors. There was no strong evidence regarding association of RFS and adverse outcomes, as well as regarding preventive measures and treatment algorithms. Conclusion This systematic review focusing on R…

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  • Criteria to identify RFS vary from reduced phosphate or any electrolyte serum concentration, the coexistence of electrolyte disturbances and clinical symptoms.

    “Criteria to identify RFS vary from reduced phosphate or any electrolyte serum concentration, the coexistence of electrolyte disturbances and clinical symptoms (e.g.peripheral edema, acute circulatory fluid overload, disturbance to organ function) (175).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [175]

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Authors
Friedli, N., Stanga, Z., Sobotka, L., Culkin, A., Kondrup, J., Laviano, A., Mueller, B., & Schuetz, P.
Affiliations
  • University of Basel (CH)
  • University of Bern (CH)
  • Charles University (CZ)
  • St Mark's Hospital (GB)
  • Rigshospitalet (DK)
  • Sapienza University of Rome (IT)
ORCID
Venue
Nutrition
Publisher
Elsevier BV
Published
2017-03
Volume
35
Pages
151-160
ISSN
0899-9007 (ISSN-L)
DOI
10.1016/j.nut.2016.05.016
OpenAlex
W2415268029
Cited by
274
References
3
Citations by year
2026: 21 · 2025: 23 · 2024: 27 · 2023: 32 · 2022: 25 · 2021: 28 · 2020: 41 · 2019: 35 · 2018: 24 · 2017: 17
FWCI
3.40
Type
journal article
Language
en
Open access
Licence
Locations
  • Nutrition (acceptedVersion)
  • PubMed (publishedVersion)
  • BORIS (University Library Bern) (submittedVersion)
  • edoc (University of Basel) (submittedVersion)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
Funders
  • Swiss National Science Foundation (PP00 P3_150531/1)
  • Research Council of the Kantonsspital Aarau (1410.000.044)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
Keywords
refeeding syndrome, incidence, risk factors, anorexia nervosa, enteral nutrition, nutritional therapy, electrolyte imbalance, prevention, treatment, adverse clinical outcomes
MeSH terms
Enteral Nutrition, Humans, Risk Factors, Water-Electrolyte Imbalance, Meta-Analysis as Topic, Randomized Controlled Trials as Topic, Databases, Factual, Refeeding Syndrome, Observational Studies as Topic

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