refeeding

Refeeding is the process of resuming nutrition after a period of inadequate intake due to famine, severe malnutrition, illness, or prolonged weight loss. The goal is to restore energy and nutrients while minimizing complications that can arise when feeding is restarted too rapidly.

Refeeding syndrome is a potential complication of refeeding in severely malnourished individuals. It stems from shifts in fluids and electrolytes that occur when carbohydrate intake is reintroduced. Common problems include low levels of phosphate, potassium, and magnesium, along with fluid retention. These changes can affect the heart, lungs, and nervous system and may occur within days of starting nutrition.

Risk factors include very low body mass or unintentional weight loss, prolonged fasting, little oral intake for more than several days, and conditions such as anorexia nervosa, chronic alcoholism, cancer cachexia, or after major surgery. People with kidney, liver, or heart disease may also be at higher risk.

Management emphasizes careful assessment and gradual reintroduction of calories. Before feeding, clinicians often correct electrolyte deficiencies and provide thiamine to prevent Wernicke’s encephalopathy. Feeding typically starts at a low level and is increased slowly over several days, with close monitoring of vital signs, intake, weight, and laboratory values. Hydration and electrolyte balance are carefully managed, and the route of feeding may be oral, enteral (via tube), or parenteral if necessary.

Refeeding should be guided by healthcare professionals, particularly for high-risk individuals, to reduce the risk of refeeding syndrome while restoring nutritional status.