What is a common effect of prolonged malnutrition that can lead to refeeding syndrome?

Prolonged malnutrition leads to a variety of metabolic changes in the body, one of which is the depletion of phosphate levels. When a person is malnourished, their body begins to conserve energy and nutrients, leading to decreased levels of important electrolytes and minerals, such as phosphate, potassium, and magnesium.

When feeding is restarted, especially with high-carbohydrate nutrition, insulin is released in response to the influx of glucose. This can cause a sudden shift of these depleted electrolytes into the cells, which leads to critically low levels in the bloodstream. This condition, known as refeeding syndrome, can have serious complications, including cardiac issues, neurological disturbances, and muscle weakness. Therefore, the depletion of phosphate levels is a common and significant factor that predisposes individuals to refeeding syndrome, making it a key concept to understand in the context of nutritional rehabilitation after a period of prolonged malnutrition. Other choices do not directly relate to the most pressing biochemical changes seen in refeeding syndrome.