Before 2006, the recommended initial refeeding rate was around 20-25kcal/kg/day for severely malnourished patients. But due to the risk of RFS, the National Institute of Health and Clinical Excellence (NICE) in 2006 published new guidelines, recommending a very cautious refeeding level of only 5-10 kcal/kg/day. However, the supporting literature underpinning the evidence that results in the above recommendations is weak, and is mostly based upon cohort studies, case series and consensus expert opinions. RFS was first identified and reported on in the late forties when starved concentration camp inmates and prisoners of war developed cardiac arrest, neuralgic symptoms and/or peripheral edema during recommencement of feeding. Similar symptoms were noticed again during the 1970's and 1980's, when parenteral nutrition was used widely, and carbohydrate provision was not restricted.