Nutritional Intervention is Key to Treating Clinical Malnutrition
Nutrition can be provided to malnourished patients using a variety of methods, including oral, enteral and parenteral nutrition.
Healthcare professionals need to choose the most effective and safest route for nutritional treatment based on the unique requirements of each patient, and initiating therapy as early as possible may lead to better long-term patient outcomes. Treating clinical malnutrition in the hospital has been associated with fewer overall complications, an average reduced length of hospital stay of 2 days, and a 28% percent drop in readmission.4
Oral nutritional supplements or increased amounts of fortified foods and drink are usually given as an initial measure to patients who are unwell or have poor dietary intake. Patients may also need physical help eating and drinking.
Enteral nutrition refers to the delivery of nutrients directly into the stomach or small bowel through a feeding tube. This type of nutritional therapy is often considered for malnourished patients who have a functional gastrointestinal tract, and is often used for a short period of time until the patient can begin to eat normally again.
Parenteral nutrition (PN) can supply all nutritional needs through an intravenous catheter that is inserted directly into the veins. PN is traditionally given to patients when nutrition requirements are not being met with enterals, EN is contraindicated or the intestinal tract has severely diminished function due to underlying disease or treatment. PN can be lifesaving for patients who are severely malnourished or critically ill, and have non-functioning digestive tracts. According to a recent article in the New England Jourrnal of Medicine, there were no significant differences between the parenteral group and the enteral group in the mean number of treated infectious complications. This has been an ongoing concern regarding the use of PN. Systematic reviews suggest adult patients in intensive care units (ICUs) with relative contraindications to early enteral nutrition (EN) may benefit from parenteral nutrition (PN) provided within 24 hours of ICU admission. Total PN solutions contain water, amino acids, (protein) dextrose, (carbohydrate) fatty acids, (fat) vitamins, and minerals, and their composition can vary depending on patient age and condition.
Studies show that 12-71% of critically ill patients who require nutritional therapy receive parenteral nutrition.7 As an essential part of the solution to clinical malnutrition, PN is administered in approximately 360,000 hospital stays a year. Patients who are in the intensive care unit (ICU) are more susceptible to developing malnutrition due to increased metabolic needs and stress, and those who receive PN were reported to have 10 times less mortality than those who only received glucose.7
The 14th most frequent procedure in hospitals is administering parenteral and enteral nutrition, showcasing the prevalence of nutritional care and the life-saving components of macro- and micronutrients in PN formulas.2
1 Goates, S. et al. PLOS ONE. 2016; published online 21 September, 2016.
2 Guenter P., et al. Addressing Disease-Related Malnutrition in Hospitalized Patients: A Call for a National Goal. The Joint Commission Journal on Quality and Patient Safety 2015. 41 (10) 469-473
3 The Unseen US Health Crisis of Malnutrition. Abbott Nutrition.
4 Blancato Bob, et. al.The Malnutrition Quality Collaborative. National Blueprint: Achieving Quality Malnutrition Care for Older Adults.Avalere and Defeat Malnutrition Today. March 2017. 45-46
5 Nutrition support in adults Oral nutrition support, enteral tube feeding and parenteral nutrition. National Collaborating Centre for Acute Care, February 2006
6 Fingar Kathryn, et. al. All-Cause Readmissions Following Hospital Stays for Patients With Malnutrition, 2013. Agency for Healthcare Research and Quality. 2016, 3
7 Singer Pierre, et al. ESPEN Guidelines on Parenteral Nutrition: Intensive care. ELSAVIER. 2009 387–400
8 A.S.P.E.N. Parenteral Nutrition Fact Sheet. American Society for Parenteral and Enteral Nutrition. April 2012