Refeeding Edema in Restrictive Eating Disorders: Beyond Acute Body Weight Gain.

Background: One study recently suggested that phosphate supplementation might contribute to the occurrence of refeeding edema in patients with restrictive eating disorders (EDs) with severe malnutrition complications.

Objective: This commentary aims to provide insight into the study while suggesting a more detailed approach to defining malnutrition, refeeding syndrome, and edema.

Main discussion: There are several diagnostic criteria for diagnosing malnutrition, some of which might overlap with the criteria of refeeding syndrome risks. A precise nutritional and hydration status assessment is needed before starting nutritional therapy for patients with restrictive EDs. With the potential occurrence of refeeding edema during the refeeding practice in these individuals, this commentary discusses the available assessment methods to differentiate edema and other conditions that are related to acute body weight gain. Furthermore, this commentary also outlines the potential pathomechanism involved and provides future recommendations for studies and clinical practice.

Conclusions and implications: Understanding the pathomechanism of the development of refeeding edema is important to ensure patient safety during refeeding practices in patients with restrictive EDs. Further studies are needed to understand this complex mechanism, which includes analyzing the involvement of hyperinsulinemia and capillary leakage as a potential etiology of refeeding edema.