Refeeding and metabolic syndromes: two sides of the same coin

Abstract

Refeeding syndrome describes the metabolic and clinical changes attributed to aggressive rehabilitation of malnourished subjects. The metabolic changes of refeeding are related to hypophosphatemia, hypokalemia, hypomagnesemia, sodium retention and hyperglycemia, and these are believed to be mainly the result of increased insulin secretion following high carbohydrate intake. In the past few decades, increased consumption of processed food (refined cereals, oils, sugar and sweeteners, and so on) lowered the intake of several macrominerals (mainly phosphorus, potassium and magnesium). This seems to have compromised the postprandial status of these macrominerals, in a manner that mimics low grade refeeding syndrome status. At the pathophysiological level, this condition favored the development of the different components of the metabolic syndrome. Thus, it is reasonable to postulate that metabolic syndrome is the result of long term exposure to a mild refeeding syndrome.

Impact of caloric intake in critically ill patients with, and without, refeeding syndrome: A retrospective study

“…Increased insulin resistance associated with RFS, also observed in our population, could add to the risk of infection and sepsis [27]. Mechanisms of hyperglycemia and hyperinsulinemia, compatible with an increased insulin resistance among RFS patients have been well described in an article of Obeid et al [28].…”

Starvation and refeeding in rats: effect on some parameters of energy metabolism and electrolytes and changes of hepatic tissue

“…During starvation, intracellular potassium is depleted, while its serum concentration may remain normal. Upon refeeding, potassium enters into cells because of insulin secretion and consequently the serum concentration of this mineral reduces (Mehanna 2008, Obeid et al 2014. In the present study, the potassium level also decreased during refeeding and the serum sodium and potassium levels changed in a relatively opposite manner, which can be associated with Na-K ATPase symporter action.…”

“…Following feeding, low serum phosphate concentration is related to increased blood glucose level and decreased insulin sensitivity (Friedman 2007). Decline in the serum phosphate concentration can take place as a result of insulin secretion (Obeid et al 2014). In refeeding syndrome, total body phosphate depletion occurs.…”

“…Potassium is involved in glucose metabolism and potassium depletion caused by low potassium diet impairs insulin secretion, which in turn leads to glucose intolerance (Obeid et al 2014). Higher intake of potassium via diet is related to decreased risk of insulin resistance and metabolic syndrome (Lee et al 2013).…”

The Effects of Starvation and Refeeding on Oxidative Stress Parameters (MDA, SOD, GPx), Lipid Profile, Thyroid Hormones and Thyroid Histopathology in Male Wistar Rats

“…In the starvation status, the body shifts from carbohydrate to fat and protein utilization to produce glucose and energy. In the refeeding status, the body shifts back instantaneously to carbohydrate metabolism [2][3][4]. Studies on anorexia nervosa patients and fish species showed that the starvation period has prooxidant effects due to both increased lipid peroxidation levels and the reduced level of antioxidant defenses [5][6][7][8].…”