Malnutrition is a common issue among hospital inpatients and has been shown to negatively impact health outcomes, yet clinical trials on its effects have been limited by insufficient sample sizes of homogenous patients and concurrent treatments.
Nutrition support refers to care processes that provide protein- and energy-rich food items, fluids, menus, oral nutritional supplements, enteral tube feeding and parenteral nutrition (PN). This guideline recommends healthcare professionals screen all people in hospital settings and in their communities for signs of malnutrition.
Cost
Nutritional support can be an expensive intervention and it is vital that healthcare professionals accurately identify patients in need of it. A multidisciplinary team should manage enteral and parenteral nutrition therapy administration – this could include physicians, dietitians, nurses or pharmacists. Some institutions have dismantled nutrition support teams due to belief they could be done by other members of the clinical team instead – but this has proven ineffective due to increased resource usage as well as potential complications for some patients.
Hospital inpatients and outpatients should be screened for malnutrition upon admission and at each subsequent clinic appointment. All acute hospitals should create a nutrition steering committee as part of their clinical governance structure, composed of doctors (such as gastroenterologists or GI surgeons, intensivists), dietitians, specialist nutrition nurses, pharmacists and biochemistry/microbiology laboratory support staff. ASPEN’s Enteral Nutrition Formula Comparison Charts provide a list of commercially available enteral formulas with indications, indications and caloric content information.
Indications
Nutrition support is used when an individual cannot meet his/her nutritional needs by mouth alone, typically provided via tube feeding – total parenteral nutrition (TPN). In hospital settings, nutrition support teams consist of physicians, registered nurses, registered dietitians, and pharmacists working in freestanding departments.
Multiple studies indicate that nutrition support helps hospitalized patients avoid complications related to protein-energy undernutrition and shorten hospital stays, though evidence on its impact in other clinical settings remains scarce.
Family physicians should monitor laboratory values of people receiving nutrition support to assess its efficacy. Laboratory monitoring may occur more or less frequently depending on a person’s clinical situation; depending on which solution(s) PN offers (three-in-one total admixture solutions or more frequently two-in-one mixtures combining dextrose, amino acids and fat emulsions with fat emulsions infused separately), medications are usually incompatible with them so must either be avoided altogether or given at separate times from when taking nutrients via infusing fat emulsions injected directly.
Methods
People suffering from protein-energy malnourishment due to illness, injury or surgery require nutritional support in the form of essential nutrients (protein, carbohydrates, fats, vitamins and minerals) delivered directly into their mouth, stomach or small intestine via tube feeding.
Oral and enteral tube feedings are short-term nutritional support techniques used with nasogastric, jejunostomy or ileostomy tubes to provide liquid or solid food sources. Nutritional formulas available through tube feeding may come either in ready-to-use liquid solution form or commercially prepared powder form.
Parenteral nutrition (PN) is an intricate medical therapy with the potential to cause significant morbidity and mortality if administered incorrectly. Nutrition support teams consist of physicians, dietitians, nurses or pharmacists as directors along with appropriate employees who work together on providing this service. Some nutrition support teams function independently while others have multidisciplinary structures; studies have indicated that nutrition support teams result in less metabolic abnormalities among their patients.
Safety
Malnutrition increases morbidity and mortality rates during hospital admission, prolongs length of stay, and decreases functional outcomes. An effective nutritional management program can lessen this impact by early identification of risks as well as providing tailored support to address them.
This updated meta-analysis of RCTs evaluated oral and enteral nutrition support with no treatment and evaluated its association with clinical outcomes in medical inpatients at risk for malnutrition. Despite heterogeneity and variation in quality, this analysis demonstrated that nutritional support was associated with decreased mortality rates, nonelective hospital readmissions, length of hospital stay durations, infections rates, daily caloric and protein intake levels as well as weight change – evidence supporting its inclusion into standard of care protocols for medical inpatients at malnutrition risk. This analysis provided compelling evidence supporting its inclusion into standard of care protocols for medical inpatients at risk for malnutrition risk.
