Malnutrition and Refeeding Syndrome

Abstract

The term “malnutrition” encompasses abnormal and/or unbalanced intake of nutrients essential for sustaining life. Protein deficiency is particularly important in this context. Marasmus, kwashiorkor, obesity, and “hidden hunger” represent distinct forms of malnutrition. When prolonged nutritional challenges occur, the body adapts to maintain the homeostasis necessary for the continuity of life. Nutritional therapies that ignore this delicate balance may trigger a process known as the “refeeding syndrome.” Contrary to prevailing knowledge, all age groups worldwide are at risk. Existing protocols for the prevention and treatment of refeeding syndrome have demonstrated limited success. The etiopathogenesis of malnutrition involves free radical damage due to trace element deficiency, coupled with energy insufficiency due to vitamin (thiamine) and mineral (phosphorus) inadequacies. The clinical manifestations of malnutrition are intricately linked to immediate and delayed mitochondrial dysfunction. Thus, refeeding syndrome may be characterized as an acute mitochondrial complication of malnutrition. Successful treatment requires optimization of mitochondrial resuscitation and the suppression of free radical formation. © 2026 Taylor & Francis Group, LLC.