Nutrition support professionals include dietitians, nurses, pharmacists, physicians and advanced practice providers. They work across the healthcare continuum in hospitals, clinics, homecare agencies and long-term care facilities.
Evidence from prospective randomized clinical trials, meta-analyses and expert groups suggests that nutritional support positively impacts various patient outcomes for elderly hip fracture patients. Unfortunately, evidence for cancer patients undergoing chemotherapy or bone marrow transplantation remains less conclusive.
Types
Nutritional support refers to the administration of nutrient-rich formulas either through enteral or parenteral means, typically via the gastrointestinal tract; however, thanks to advancements in formulations, equipment, and access devices allowing delivery via other routes has become more commonplace.
Nutrition support has been shown to improve hospitalized patient outcomes, but cost effectiveness can often prevent its implementation. A recent economic model demonstrated that nutritional support is cost-effective when measured against costs per quality-adjusted life day (QALDs).
Family physicians play an essential role in evaluating and providing nutritional support therapy, and choosing an ideal dietary formula through consultation with registered dietitian nutritionists.
Indications
Patients unable to consume sufficient food due to poor appetite or illness can benefit from nutritional support in the form of homemade food supplements, appetite stimulants, tube feedings or enteral or parenteral nutrition therapy.
Nutrition support improves hospital outcomes during hospitalization and following discharge. A recent systematic review and meta-analysis of 27 randomized nutritional trials demonstrated this benefit, leading to lower hospital readmission rates and enhanced survival.
Monitoring response to nutrition support is of equal importance as assessing compliance. Many tests have been developed for this purpose: serum protein concentration (albumin, pre-albumin, transferrin and retinol binding protein); body measurements such as weight change or anthropometric determinations and functional assessments such as handgrip strength assessments. For most accurate results use enteral or parenteral nutrition to measure nitrogen balance.
Routine Monitoring
Diagnostic tests provide valuable data for assessing nutritional status and diagnosing conditions that could contribute to malnutrition. Physicians should check for signs of emaciation as well as possible other issues, such as dehydration or compromised wound-healing functions.
Treatments can help correct nutritional imbalances and keep them from returning. Malabsorption disorders like celiac disease or Crohn’s disease hinder nutrient absorption. Furthermore, medications like proton pump inhibitors and diuretics may reduce nutrient consumption.
Studies suggest that nutritional support improves hospitalization outcomes and may also decrease length of stay, leading to savings from reduced personnel costs. It remains uncertain, however, if its additional costs outweigh its benefits; evidence is limited and further study must take place.
Complications
Patients suffering from inflammatory bowel disease often encounter complications that impede their ability to take in enough calories and nutrients from food, due to weight loss, surgery, obstruction or severe inflammation. When this prevents adequate consumption, nutritional support therapy can provide much-needed assistance.
Enteral and parenteral nutrition can reduce malnutrition rates, shorten lengths of stay, and lessen hospital-acquired infections, while potentially cutting costs by decreasing the need for expensive invasive interventions.
Dietary support therapy can result in serious side effects. Enteral nutrition may cause mechanical issues with its feeding tube, digestive side effects and metabolic disturbances; complications associated with parenteral nutrition (PN) include refeeding syndrome, high glucose levels, bone demineralisation and catheter infections.
Cost
Private health insurance plans and Medicare both provide nutrition services; selecting an in-network dietitian may reduce consultation and treatment costs significantly.
Studies conducted on patients managed by nutrition support teams demonstrated shorter hospital stays by 2.43 days when compared with non-team management groups; these savings were partially offset by salaries for personnel working for nutrition support teams.
Nutritionists provide many services, from individual counseling to group nutrition classes. While one-on-one appointments typically cost more than group sessions but offer more personalized guidance, some providers also offer discounted packages to reduce per session cost. Apps also allow users to remotely access nutritionists at lower costs – ideal for individuals on limited budgets; but these options lack the personal touches provided by in-person visits.
