What are the key risk factors for developing refeeding syndrome in patients undergoing nutritional rehabilitation?

Key risk factors for developing refeeding syndrome in patients undergoing nutritional rehabilitation include:

• BMI less than 16 kg/m2 or less than 18.5 kg/m2 with additional risk factors such as significant recent weight loss NICE CG32.
• Unintentional weight loss greater than 15% within the last 3 to 6 months, or greater than 10% with other risk factors NICE CG32.
• Little or no nutritional intake for more than 5 to 10 days, depending on other risk factors present NICE CG32.
• Pre-existing low levels of key electrolytes such as potassium, phosphate, or magnesium before feeding begins NICE CG32.
• A history of alcohol abuse or use of drugs that affect metabolism and electrolyte balance, including insulin, chemotherapy agents, antacids, or diuretics NICE CG32.
• Severely malnourished states such as anorexia nervosa or other conditions causing prolonged starvation or catabolism Wirth et al. 2018Runde & Sentongo 2019.
• Older age and frailty, which may increase vulnerability to refeeding complications Wirth et al. 2018.

These factors reflect a state of depleted intracellular electrolytes and altered metabolism that predispose patients to the hallmark biochemical disturbances of refeeding syndrome upon nutritional rehabilitation. Careful assessment and cautious initiation of feeding, with close monitoring of electrolytes and clinical status, are essential to mitigate these risks NICE CG32.