Evidence-based nutrition for the malnourished, hospitalised patient: one bite at a time.

Merker, Meret; Gomes, Filomena; Stanga, Zeno; Schuetz, Philipp (2019). Evidence-based nutrition for the malnourished, hospitalised patient: one bite at a time. Swiss medical weekly, 149, w20112. EMH Media 10.4414/smw.2019.20112

[img]
Preview
Text
smw_2019_20112 (1).pdf - Published Version
Available under License Creative Commons: Attribution-Noncommercial-No Derivative Works (CC-BY-NC-ND).

Download (491kB) | Preview

Although malnutrition is a highly prevalent condition in the inpatient setting, particularly in older patients with multiple morbidities, the medical community has struggled to find efficient, evidence-based approaches for its prevention and treatment. From an evolutionary perspective, illness-related low appetite may be seen as a protective response with the goals to accelerate recovery from disease by improving autophagy. In line with this, earlier trials in the intensive care setting including severely ill patients have demonstrated unwarranted effects of overnutrition on patient outcomes. Uncertainties regarding the best approach to the malnourished inpatient in conjunction with a lack of strong trial data may, in part, explain the low level of attention that hospital medical staff have paid to the issue of malnutrition in the non-critical care inpatient setting. The recent Effect of early nutritional support on Frailty, Functional Outcomes and Recovery of malnourished medical inpatients Trial (EFFORT) study, however, has shown that individualized nutritional support reduces severe complications and improves mortality in medical inpatients, with positive effects on functional outcomes and quality of life. These results from a high quality effectiveness trial in conjunction with other studies, such as the NOURISH trial, should prompt us to improve our management of malnutrition in the inhospital setting. This procedure should start with a systematic screening for risk of malnutrition of admitted patients, effective assessment of nutritional status in multidisciplinary teams including dieticians, nurses and physicians, and early start of individualized adequate nutritional support of at risk patients to reach nutritional goals. Understanding the optimal use of nutritional support in patients with acute illness is complex because timing, route of delivery, and the amount and type of nutrients may all affect patient outcomes. Also, particularly for patients on the medical ward, factors like the logistics of catering, staffing to provide food and support the patient (i.e., number of nurses and dieticians), motivation/understanding of the patient to eat in defiance of appetite, the empathic human factor of nutritional care, the quality of meals, the taste of supplements, and unnecessary fasting for diagnostic or therapeutic procedures have a strong influence on nutritional care of patients. Further research and clinical trials are required to better understand, step by step, how we can use clinical nutrition best to maximize recovery of our patient and improve their functional status and their quality of life. Such evidence regarding nutritional therapy may allow us to implement  personalized nutrition-driven interventions in the future.

Item Type:

Journal Article (Review Article)

Division/Institute:

04 Faculty of Medicine > Department of Gynaecology, Paediatrics and Endocrinology (DFKE) > Clinic of Endocrinology, Diabetology and Clinical Nutrition

UniBE Contributor:

Stanga, Zeno

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1424-3997

Publisher:

EMH Media

Language:

English

Submitter:

Regula Maria Schneider

Date Deposited:

23 Jan 2020 12:18

Last Modified:

27 Apr 2023 17:00

Publisher DOI:

10.4414/smw.2019.20112

PubMed ID:

31401806

BORIS DOI:

10.7892/boris.138390

URI:

https://boris.unibe.ch/id/eprint/138390

Actions (login required)

Edit item Edit item
Provide Feedback