Nutritional support refers to the delivery of enteral or parenteral nutrition. Most acute care hospitals employ multidisciplinary nutrition support teams composed of physicians, nurses, dietitians, and pharmacists who can administer these nutrients.
Well-designed clinical trials have demonstrated that nutrition support improves survival and quality of life for those suffering from short bowel syndrome.
Symptoms
Nutrition support consists of liquid formulas containing proteins, sugars, fats, vitamins, minerals and other essential nutrients that may include proteins, sugars, fats, vitamins, minerals and other micronutrients. Enteral or parenteral nutrition may be administered, the former through enteral feeding tubes placed directly into the stomach or small intestine and latter intravenously; its benefits have yet to be fully established and its indications largely unidentified; therefore family physicians must recognize when patients could benefit from such intervention.
Signs of nutritional imbalance include fatigue, due to insufficient levels of key nutrients like iron and vitamin B12. Also common are mouth ulcers caused by poor diet; bloating and abdominal distention due to poor eating habits; diarrhea; or frequent infections due to an impaired immune system. Your family physician may suggest blood tests to evaluate levels such as iron and vitamin B12. Muscle weakness or joint pain could also indicate nutritional issues.
Treatment
Nutrition support may be provided orally or intravenously for patients unable to consume sufficient food to maintain a normal body weight, depending on each patient and clinical situation. Types and amounts of nutrient mixtures used will vary based on patient needs and clinical situations.
Enteral and parenteral nutrition are often recommended in cases of gastrointestinal disease as well as malnourished cancer and bone marrow transplantation patients, especially older persons who need treatment, while prospective, randomized clinical trials assessing modified nutrient formulations need further investigation for those living with inflammatory bowel disease, pancreatitis or liver disorders.
Family physicians should closely observe patients receiving either EN or PN feedings for tolerating the feeding regimen, complications of tube placement (e.g., nasal erosion, distention and migration), biochemical abnormalities and metabolic imbalance. One study demonstrated that team management of enterally fed patients resulted in significantly fewer metabolic abnormalities compared to non-team managed ones; possibly due to frequent monitoring and adjustment of formulas. For PN patients this should include monitoring signs of volume overload or dehydration as well as laboratory evaluations such as hematocrit total protein, Triglycerides and magnesium evaluations.
Monitoring
Over the past three decades, great strides have been taken in enteral and parenteral nutrition. Enteral feeding involves tube feeding of special liquid formula into the gastrointestinal tract via tube, while parenteral nutrition involves intravenous administration of nutrients via peripheral or central venous access.
Numerous diagnostic tests can be utilized to monitor the nutritional status of patients receiving nutrition support. These include body measurements (weight changes, anthropometric measurements), body composition studies (total fat percentage and lean mass determinations), urine analyses, functional tests such as handgrip strength assessments, serum chemistry assays including protein markers such as pre-albumin, retinol binding protein and transferrin levels and functional tests such as handgrip strength determinations.
An interprofessional team of nutrition support providers is essential in evaluating the nutritional status and providing appropriate therapy to such patients. Such teams typically include physicians (generalists and specialists), registered nurses, dietitians and pharmacists; some institutions even organize them into separate departments run by physicians, dietitians or pharmacists as directors.
