NUTRITIONAL STRATEGIES FOR THE CONTROL AND PREVENTION OF REFEEDING SYNDROME IN PATIENTS WITH ANOREXIA NERVOSA: A SYSTEMATIC REVIEW

Abstract

This study conducts a systematic review of nutritional strategies for the control and prevention of refeeding syndrome (RFS) in patients with anorexia nervosa (AN). The research followed the PRISMA guidelines, with searches in the PubMed, SciELO, BVS, and LILACS databases, encompassing articles from 2015 to 2025 in Portuguese, English, and Spanish, resulting in the analysis of 24 varied studies, such as clinical trials, cohorts, and consensus statements. The literature reveals that initial conservative protocols (1,000-1,200 kcal/day, slow progression) minimize risks in severe malnutrition, but more aggressive protocols (1,400-2,000 kcal/day) accelerate weight gain in mild to moderate cases, with rigorous monitoring of electrolytes such as phosphorus, potassium, and magnesium, reducing hospitalization time without increasing RFS. The oral route is preferred for nutritional rehabilitation, but enteral feeding via tube is effective in refusal or high risk; Diets with lower carbohydrate and higher lipid content attenuate hypophosphatemia. The review concludes that strategies should be individualized, prioritizing prior electrolyte correction and monitoring, to balance efficacy and safety in the holistic management of anorexia nervosa.