Abstract
Background
Refeeding syndrome (RFS) is a life‐threatening metabolic complication arising when malnourished or catabolic patients resume nutrient intake, defined primarily by hypophosphatemia and concurrent electrolyte disturbances. Among malnourished elderly, RFS has an incidence of ∼50% and is linked to extremely high mortality.
Methods
This retrospective case‐control study included 93 elderly patients (≥ 60 y) with a Nutrition Risk Screening 2002 (NRS 2002) score ≥ 3, admitted to two tertiary hospitals between August 2017 and August 2019. Patients were retrospectively assigned to the “RFS group” (
n
= 42, developed RFS within 1 week of admission) and a non‐RFS group (
n
= 51).
Results
Independent RFS risk factors were low BMI (18.24 ± 1.66 vs. 22.06 ± 1.84 kg/m
2
), low serum albumin (29.97 ± 3.16 vs. 35.29 ± 4.33 g/L), and high D‐dimer (5.02 ± 1.87 vs. 2.34 ± 2.00 μg/mL; all
p
p
Conclusions
Universal micronutrient supplementation at admission combined with targeted energy restriction within the first 10–14 days of hospitalization reduces RFS risk among vulnerable elderly inpatients. Notably, multimicronutrient supplementation exerts a stronger protective effect against RFS than feeding route or initial energy regimen. Low BMI, hypoalbuminemia, and elevated D‐dimer serve as reliable predictors of RFS. Stepwise nutritional intervention with prompt electrolyte correction can shorten hospital stay and enhance 90‐day survival.