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7 Studies report a 100% incidence of hypophosphataemia in patients receiving total parenteral nutrition solutions that do not contain phosphorus. In a study of 10 197 hospitalised patients the incidence of severe hypophosphataemia was 0.43%, with malnutrition being one of the strongest risk factors.
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The true incidence of refeeding syndrome is unknown-partly owing to the lack of a universally accepted definition. 3 These recommendations differ in parts from-and we believe improve on-previous guidelines, such as those of the Parenteral and Enteral Nutrition Group of the British Dietetic Association (box 1). 2 Our article also draws attention to the NICE guidelines on nutritional support in adults, with particular reference to the new recommendations for best practice in refeeding syndrome. The available literature mostly comprises weaker (level 3 and 4) evidence, including cohort studies, case series, and consensus expert opinion. This review aims to raise awareness of refeeding syndrome and discuss prevention and treatment. Yet because clinicians are often not aware of the problem, refeeding syndrome still occurs. In 2006 a guideline was published by the National Institute for Health and Clinical Excellence (NICE) in England and Wales. No randomised controlled trials of treatment have been published, although there are guidelines that use best available evidence for managing the condition. Refeeding syndrome is a well described but often forgotten condition.