Detection and treatment of medical inpatients with or at-risk of malnutrition: Suggested procedures based on validated guidelines.
- Bounoure L Department of Endocrinology, Diabetes and Clinical Nutrition, University Department of Internal Medicine, Cantonal Hospital Aarau, Aarau, Switzerland.
- Gomes F Department of Endocrinology, Diabetes and Clinical Nutrition, University Department of Internal Medicine, Cantonal Hospital Aarau, Aarau, Switzerland.
- Stanga Z Department of Endocrinology, Diabetes and Clinical Nutrition, University Hospital and University of Bern, Bern, Switzerland.
- Keller U Endocrine Practice, University of Basel, Basel, Switzerland.
- Meier R Gastrocenter Obach, Solothurn, Switzerland.
- Ballmer P Department of Medicine, Canton Hospital Winterthur, Winterthur, Switzerland.
- Fehr R Department of Endocrinology, Diabetes and Clinical Nutrition, University Department of Internal Medicine, Cantonal Hospital Aarau, Aarau, Switzerland.
- Mueller B Department of Endocrinology, Diabetes and Clinical Nutrition, University Department of Internal Medicine, Cantonal Hospital Aarau, Aarau, Switzerland.
- Genton L Clinical Nutrition, University Hospitals of Geneva, Geneva, Switzerland.
- Bertrand PC University Hospital Lausanne (CHUV), Switzerland.
- Norman K Charité Medical University Berlin, Berlin, Germany.
- Henzen C Cantonal Hospital Luzern, Luzern, Switzerland.
- Laviano A Department of Clinical Medicine, Sapienza University, Rome, Italy.
- Bischoff S University of Hohenheim, Stuttgart, Germany.
- Schneider SM University Hospital, University of Nice Sophia-Antipolis, Faculty of Medicine, Nice, France.
- Kondrup J University Hospital Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
- Schuetz P University Hospital Rigshospitalet and University of Copenhagen, Copenhagen, Denmark. Electronic address: Philipp.Schuetz@unibas.ch.
- 2016-05-11
Published in:
- Nutrition (Burbank, Los Angeles County, Calif.). - 2016
Acute disease
Clinical algorithm
Disease-related malnutrition
Medical wards
Nutritional therapy
Procedures
Acute Disease
Algorithms
Humans
Inpatients
Malnutrition
Nutrition Assessment
Nutrition Therapy
Nutritional Status
Practice Guidelines as Topic
Reproducibility of Results
English
OBJECTIVE
Despite the high prevalence of malnutrition in the general inpatient population, there is a lack of knowledge in regard to detecting disease-related malnutrition and implementing nutritional support. Our aim was to suggest practical procedures for screening and treating malnourished or at-risk patients hospitalized in medical wards, thereby fostering a straightforward implementation of nutritional therapy independent of the underlying disease and comorbidities.
METHODS
A working group of experts in clinical nutrition selected and analyzed published disease-specific European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines relevant for our aim. Eight questions in population, intervention, control, outcome format were defined to cover topics such as screening, nutritional targets, and routes of feeding. Individual studies were extracted from the guidelines by applying inclusion and exclusion criteria targeting the heterogeneous population of medical inpatients with or at-risk of disease-related malnutrition. We used those studies as evidence, as well as recommendations from the selected ESPEN guidelines, to formulate answers to the questions. Final agreement with the statement was obtained by consensus of the whole working group.
RESULTS
Procedures on how to provide integrated nutritional therapy (oral, enteral, and parenteral) to a heterogeneous patient population were suggested, including how to identify malnourished or at-risk patients, nutrient targets, choice of feeding route, monitoring, and assessment of patients. We also developed a simple algorithm to facilitate the implementation of a nutritional care plan for the general medical inpatient population.
CONCLUSION
By compiling evidence and recommendations from disease-specific guidelines, we were able to suggest a nutritional strategy applicable to large and heterogeneous group of malnourished or at-risk patients admitted to hospitals. A large randomized controlled trial is currently investigating whether this strategy improves clinical outcomes of patients.
Despite the high prevalence of malnutrition in the general inpatient population, there is a lack of knowledge in regard to detecting disease-related malnutrition and implementing nutritional support. Our aim was to suggest practical procedures for screening and treating malnourished or at-risk patients hospitalized in medical wards, thereby fostering a straightforward implementation of nutritional therapy independent of the underlying disease and comorbidities.
METHODS
A working group of experts in clinical nutrition selected and analyzed published disease-specific European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines relevant for our aim. Eight questions in population, intervention, control, outcome format were defined to cover topics such as screening, nutritional targets, and routes of feeding. Individual studies were extracted from the guidelines by applying inclusion and exclusion criteria targeting the heterogeneous population of medical inpatients with or at-risk of disease-related malnutrition. We used those studies as evidence, as well as recommendations from the selected ESPEN guidelines, to formulate answers to the questions. Final agreement with the statement was obtained by consensus of the whole working group.
RESULTS
Procedures on how to provide integrated nutritional therapy (oral, enteral, and parenteral) to a heterogeneous patient population were suggested, including how to identify malnourished or at-risk patients, nutrient targets, choice of feeding route, monitoring, and assessment of patients. We also developed a simple algorithm to facilitate the implementation of a nutritional care plan for the general medical inpatient population.
CONCLUSION
By compiling evidence and recommendations from disease-specific guidelines, we were able to suggest a nutritional strategy applicable to large and heterogeneous group of malnourished or at-risk patients admitted to hospitals. A large randomized controlled trial is currently investigating whether this strategy improves clinical outcomes of patients.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1016/j.nut.2016.01.019
- PMID 27160498
- Persistent URL
- https://sonar.ch/global/documents/169856
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