Refeeding syndrome ‒ What we know and what remains to be explored

Background: refeeding syndrome (RS) is a serious metabolic complication that occurs upon reintroducing nutrition to malnourished individuals. Although formally recognized for more than 70 years, significant gaps in its understanding remain. Objective: to conduct a narrative review on the current state of knowledge regarding RS, its recent advances, existing gaps, and future perspectives. Methods: an integrative review was conducted using articles published between 2000 and 2024 from international databases, following a systematic methodology of literature search, selection, and analysis. Results: the main pathophysiological mechanisms of RS, its multisystemic clinical manifestations, current diagnostic criteria, and risk-based therapeutic strategies were identified. Despite advances in biomarkers and personalized nutrition, challenges remain in early diagnosis, prevention, and treatment, especially in vulnerable populations. Conclusions: RS continues to pose a complex clinical challenge that requires standardized protocols, identification of reliable biomarkers, and increased clinical research, particularly in underrepresented regions such as Latin America. Prevention, based on a multidisciplinary approach, is important to reducing its impact.