Poster Presentation Nutrition Society of Australia 50th Annual Scientific Meeting 2026

Refeeding Syndrome Recommendations and Their Application in Indonesia: A Comparative Review of International Guidelines and Mapping of Indonesian Clinical Evidence (147236)

Widya Eka Nugraha 1 , Dafrina Kalyla Lofriman 2 , Iffa Mutmainah 3 , Asri Ragil Kemuning 1
  1. Clinical Division, Faculty of Medicine & Nutrition IPB University, Bogor, INDONESIA, Indonesia
  2. Undergraduate Program, Faculty of Medicine & Nutrition IPB University, Bogor, INDONESIA, Indonesia
  3. Biomedical Science Division, Faculty of Medicine & Nutrition IPB University, Bogor, INDONESIA, Indonesia

Refeeding syndrome (RFS) remains variably defined and managed, and the applicability of international recommendations to resource-constrained settings is uncertain. This comparative review evaluated international RFS recommendations and mapped their application in published Indonesian clinical evidence. Nine international guideline, consensus, or position documents were comparatively reviewed for risk identification, diagnostic criteria, initial energy prescription, feeding advancement, thiamine supplementation, electrolyte management, and monitoring. Indonesian clinical literature was searched in PubMed and GARUDA through August 2026, supplemented by reference-list screening. PubMed and GARUDA yielded 2 and 11 records, respectively. Eligible publications were original studies, case reports, case series, or conference reports containing clinical data on RFS or RFS risk and its nutritional management. International recommendations showed substantial heterogeneity in both diagnosis and feeding strategy. Conservative guidance recommended initial energy provision of 5–15 or 10–20 kcal/kg/day, whereas the 2025 AuSPEN consensus recommended commencing at ≥50% of estimated energy requirements and reaching goal feeding within 24–72 hours when close monitoring is available(1,2). Ten Indonesian clinical publications met inclusion criteria, comprising one pilot randomized trial and nine case-based reports or abstracts. Among adult reports with interpretable weight-based prescriptions, initial or re-initiated energy provision ranged from 10 to 28 kcal/kg/day. Thiamine supplementation and correction of phosphate, potassium, and/or magnesium were commonly described, but doses and biochemical monitoring intensity varied. In the only Indonesian randomized trial, involving 108 children with complicated severe acute malnutrition, ASPEN-defined RFS occurred in 8/108 (7.4%); incidences were 13.9%, 5.6%, and 2.8% with F-75/F-100, standard-energy oral nutritional supplements, and high-energy supplements, respectively (p=0.169). The hospital-prepared F-75 contained 17.5 mg phosphorus/100 mL compared with 153–223.5 mg/100 mL in the oral nutritional supplements(3). Indonesian reports also documented practical constraints, including unavailable phosphate testing and limited early biochemical monitoring. International recommendations and published Indonesian practice remain heterogeneous, particularly in energy initiation and monitoring. Prospective Indonesian studies using standardized RFS definitions, biochemical surveillance, and clinically meaningful outcomes are needed to inform locally feasible protocols.

Keywords: Refeeding syndrome; Malnutrition; Nutrition support

  1. da Silva JSV et al. (2020) Nutr Clin Pract 35, 178–195.
  2. Matthews-Rensch K et al. (2025) Nutr Diet 82, 128–142.
  3. Yuliarti K et al. (2026) Pediatr Gastroenterol Hepatol Nutr 29, 169–182.