Early enteral nutrition may reduce the incidence of refeeding syndrome for patients with severe corona virus disease 2019 and high nutritional risk

Liuniu Xiao; Xiao Ran; Shusheng Li

doi:10.3892/etm.2025.13029

Early enteral nutrition may reduce the incidence of refeeding syndrome for patients with severe corona virus disease 2019 and high nutritional risk

Exp Ther Med. 2025 Nov 28;31(2):34. doi: 10.3892/etm.2025.13029. eCollection 2026 Feb.

Authors

Liuniu Xiao^{1

2}, Xiao Ran^{1

2}, Shusheng Li^{1

2

3}

Affiliations

¹ Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China.
² Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China.
³ Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College and State Key Laboratory for Diagnosis and Treatment of Severe Zoonotic Infectious Disease, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China.

Abstract

Nutritional therapy is an essential supportive intervention for patients with COVID-19 who are at high nutritional risk, although the optimal timing for initiating nutritional support remains unclear. The present study investigated the association between the initiation of enteral nutrition (EN) and the incidence of refeeding syndrome (RS) in severely ill patients with COVID-19 and high nutritional risk. Patients from Tongji Hospital (Wuhan, China), with a Nutrition Risk Screening-2002 score ≥3 and who received EN, were retrospectively analyzed and categorized into an early EN (EEN) group and a late EN (LEN) group based on the time-frame of EN initiation. Serum electrolyte levels were assessed on the third day after EN initiation to evaluate the incidence of RS. A total of 211 patients were included in this analysis (EEN group, n=125; LEN group, n=86). The mean time to EN initiation was 2 days in the EEN group and 5 days in the LEN group. Both the incidence and severity of RS were markedly higher in the LEN group, and serum potassium, sodium, phosphorus and magnesium levels were significantly lower in the LEN group on the third day after EN initiation. These findings suggest that early EN initiation may help reduce the risk of RS in critically ill patients with COVID-19 and high nutritional risk.

Keywords: corona virus disease 2019; enteral nutrition; refeeding syndrome.