Detection and treatment of medical inpatients with or at-risk of malnutrition: Suggested procedures based on validated guidelines.

Bounoure, Lisa; Gomes, Filomena; Stanga, Zeno; Keller, Ulrich; Meier, Rémy; Ballmer, Peter; Fehr, Rebecca; Mueller, Beat; Genton, Laurence; Bertrand, Pauline Coti; Norman, Kristina; Henzen, Christoph; Laviano, Alessandro; Bischoff, Stephan; Schneider, Stéphane M; Kondrup, Jens; Schuetz, Philipp (2016). Detection and treatment of medical inpatients with or at-risk of malnutrition: Suggested procedures based on validated guidelines. Nutrition, 32(7-8), pp. 790-798. Elsevier 10.1016/j.nut.2016.01.019

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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.

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-Nodari, Zeno

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0899-9007

Publisher:

Elsevier

Language:

English

Submitter:

Lia Bally

Date Deposited:

17 May 2017 09:41

Last Modified:

25 Sep 2020 13:27

Publisher DOI:

10.1016/j.nut.2016.01.019

PubMed ID:

27160498

Uncontrolled Keywords:

Acute disease; Clinical algorithm; Disease-related malnutrition; Medical wards; Nutritional therapy; Procedures

BORIS DOI:

10.7892/boris.95087

URI:

https://boris.unibe.ch/id/eprint/95087

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