In Gaza and Sudan, following periods of food scarcity, there's a heightened risk of refeeding syndrome occurring

In Gaza and Sudan, following periods of food scarcity, there's a heightened risk of refeeding syndrome occurring

In regions of catastrophic hunger, such as Gaza and Sudan, aid organizations are turning to Ready-to-Use Therapeutic Foods (RUTFs) to combat severe malnutrition. These specially designed nutritional supplements, like Plumpy'Nut, a fortified peanut paste, are crucial in preventing refeeding syndrome, a potentially life-threatening condition that can occur when malnourished individuals resume normal eating too quickly.

Refeeding syndrome arises when the body, deprived of essential nutrients, suddenly begins to convert vital fats and proteins into emergency fuel. This process can lead to muscle wasting, severe fatigue, and a weakened immune system. To prevent this, the safe resumption of aid in famine-stricken areas requires international pressure on the respective governments to prioritise safe conditions for aid agencies to resume their work and prevent a humanitarian crisis.

The best practices for preventing refeeding syndrome include careful assessment of at-risk patients, gradual initiation and advancement of caloric intake, close monitoring and correction of electrolyte imbalances, and supplementation of key vitamins like thiamine. In the first 24 hours, calorie intake should be kept low to avoid metabolic overload. Calories are then increased very gradually, with electrolyte abnormalities being aggressively corrected before further increases. Thiamine supplementation and replacement of vitamins/micronutrients are also essential to prevent complications related to vitamin deficiencies.

Enteral feeding and safe infection control practices are crucial to avoid additional risks. If unstable electrolytes or clinical signs of refeeding syndrome are detected, feeds should be suspended or held until stabilization occurs. These principles align with international clinical guidelines for managing refeeding syndrome in critically ill or severely malnourished patients, tailored to resource-limited or humanitarian crisis settings. Close clinical monitoring with available lab tests for electrolytes, fluid balance, and clinical signs is essential.

In Gaza, where 197 people, including 96 children, have died of famine due to Israel's blockade and military offensive, these strategies could be vital in saving lives. Similarly, in Sudan, where 3.2 million children under the age of 5 are predicted to suffer from acute malnutrition in the next year, the use of RUTFs and careful re-feeding strategies could help mitigate the impact of the crisis.

Researchers are also looking into other RUTF products that can be prepared closer to African and Asian sites, where rates of food insecurity are highest. Locally grown foods, such as chickpeas, mung beans, maize, and lentils, could potentially help reduce production costs and allergy risk.

It's important to note that death from starvation most commonly occurs due to an infection the body is too weak to fight, or from organ failure. People with kidney failure, eating disorders, depression, and alcohol issues are most susceptible to refeeding syndrome. Starvation begins when individuals don't get enough calories to keep up with the body's energy demands, causing the body to slow down metabolic processes and organ activity to compensate.

The first step in treating severe acute malnutrition is to introduce food or nutrition slowly, through "stabilization feeds" like special milk formulations and RUTFs. In areas under siege, such as El Fasher, North Dafur, Sudan, where people have been starving for the past year, and in Gaza, where 100,000 Palestinian women and children are facing severe malnutrition, these strategies could mean the difference between life and death.

[1] International Committee of the Red Cross (ICRC). Guidelines for the prevention and treatment of refeeding syndrome. 2013 [2] United Nations Children's Fund (UNICEF). Ready-to-use therapeutic food (RUTF). 2018 [3] World Health Organization (WHO). Refeeding syndrome. 2021 [4] World Food Programme (WFP). Ready-to-use therapeutic food (RUTF). 2021 [5] Medecins Sans Frontieres (MSF). Nutrition in emergencies. 2021

1. The World Health Organization (WHO) offers guidelines for managing refeeding syndrome in critical or severely malnourished patients.
2. In Asia, researchers are exploring the development of RUTF products using locally grown foods, such as chickpeas and maize, to reduce production costs and allergy risks.
3. The United Nations Children's Fund (UNICEF) provides information on the use of Ready-to-Use Therapeutic Foods (RUTFs) in preventing severe malnutrition.
4. To combat severe malnutrition in Africa, aid organizations often utilize specially designed nutritional supplements like Plumpy'Nut.
5. In regions where there is a lack of access to proper nutrition, people can experience chronic kidney diseases such as Chronic Kidney Disease (CKD).
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7. In the Middle East, conflicts like those in Gaza and Sudan have led to large-scale hunger and malnutrition.
8. Medical conditions like eating disorders, depression, and alcohol issues increase the risk of developing Refeeding Syndrome.
9. Governmental entities play a crucial role in facilitating safe conditions for aid agencies to address humanitarian crises caused by famine.
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