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Cited by 169Clinical Nutrition and GastroenterologyDietetics, Nutrition, and EducationNutrition and Health in Aging

Management and prevention of refeeding syndrome in medical inpatients: An evidence-based and consensus-supported algorithm

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Friedli, Natalie, Stanga, Zeno, Culkin, Alison, Crook, Martin, Laviano, Alessandro, Sobotka, Lubos, Kressig, Reto W., Kondrup, Jens +2 more·2018·Nutrition
DOI 10.1016/j.nut.2017.09.007
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Abstract

Objectives Refeeding syndrome (RFS) can be a life-threatening metabolic condition after nutritional replenishment if not recognized early and treated adequately. There is a lack of evidence-based treatment and monitoring algorithm for daily clinical practice. The aim of the study was to propose an expert consensus guideline for RFS for the medical inpatient (not including anorexic patients) regarding risk factors, diagnostic criteria, and preventive and therapeutic measures based on a previous systematic literature search. Methods Based on a recent qualitative systematic review on the topic, we developed clinically relevant recommendations as well as a treatment and monitoring algorithm for the clinical management of inpatients regarding RFS. With international experts, these recommendations were discussed and agreement with the recommendation was rated. Results Upon hospital admission, we recommend the use of specific screening criteria (i.e., low body mass index, large unintentional weight loss, little or no nutritional intake, history of alcohol or drug abuse) for risk assessment regarding the occurrence of RFS. According to the patient's individual risk for RFS, a careful start of nutritional therapy with a stepwise increase in energy and fluids goals and supplementation of electrolyte and vitamins, as well as close clinical monitoring, is recommended. We also propose criteria for the diagnosis of imminent and manifest RFS with practical treatment recommendations with adoption of the nutritional therapy. Conclusion Based on the available evidence, we developed a practical algorithm for risk assessment, treatment, and monitoring of RFS in medical inpatients. In daily routine clinical care, this may help to optimize and standardize the management of this vulnerable patient population. We encourage future quality studies to further refine these recommendations.

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  • Hospital stay is a risk factor for malnutrition.

    “and malnutrition [112, 233, 234].”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [112]

    The section “Which medical inpatients are at risk for RFS?” discusses malnutrition risk scores as predictors of refeeding syndrome, not hospital stay as a risk factor for malnutrition. Searches for malnutrition developing during hospitalization and for hospital-acquired malnutrition found no passage in our copy addressing that claim. (LLM, conf=0.74)

    Experimental — accuracy not yet measured

  • At the hospital, malnutrition is associated with increased mortality, morbidity, length of stay, and costs.

    “At the hospital, 1715 malnutrition is associated with increased mortality, morbidity, length of stay, and costs [112].”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [112]

    The Conclusion (page unavailable) links high morbidity and mortality to refeeding syndrome in malnourished patients, not to hospital malnutrition generally. Searches for malnutrition-related mortality, morbidity, length of stay, and costs found no passage in our copy establishing the claimed associations; the matching references alone do not establish them. (LLM, conf=0.76)

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Authors
Friedli, N., Stanga, Z., Culkin, A., Crook, M., Laviano, A., Sobotka, L., Kressig, R. W., Kondrup, J., Mueller, B., & Schuetz, P.
Affiliations
  • University of Basel (CH)
  • University of Bern (CH)
  • St Mark's Hospital (GB)
  • Sapienza University of Rome (IT)
  • Charles University (CZ)
  • Rigshospitalet (DK)
ORCID
Venue
Nutrition
Publisher
Elsevier BV
Published
2018-03
Volume
47
Pages
13-20
ISSN
0899-9007 (ISSN-L)
DOI
10.1016/j.nut.2017.09.007
OpenAlex
W2759057209
Cited by
169
References
3
Citations by year
2026: 21 · 2025: 17 · 2024: 21 · 2023: 17 · 2022: 21 · 2021: 23 · 2020: 21 · 2019: 21 · 2018: 5 · 2017: 1
FWCI
10.92
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion, other-oa)
  • Bern Open Repository and Information System (University of Bern) (submittedVersion)
Funders
  • National Science Foundation
  • Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (PP00 P3_150531/1)
  • Forschungsrat des Kantonsspitals Aarau (1410.000.044)
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Health Professions › Health Information Management › Dietetics, Nutrition, and Education
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
Keywords
refeeding syndrome, medical inpatients, refeeding, risk assessment, screening criteria, low body mass index, unintentional weight loss, nutritional therapy, electrolyte supplementation, vitamin supplementation, patient monitoring, diagnostic criteria, treatment algorithm, expert consensus recommendations
MeSH terms
Algorithms, Decision Support Techniques, Humans, Inpatients, Mass Screening, Risk Factors, Nutrition Assessment, Practice Guidelines as Topic, Risk Assessment, Consensus, Evidence-Based Practice, Refeeding Syndrome

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