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Artificial nutrition support 

Artificial nutrition support

Chapter:
Artificial nutrition support
Author(s):

Jeremy Woodward

DOI:
10.1093/med/9780199204854.003.1106

May 29, 2014: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

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date: 27 April 2017

The prevalence and importance of malnutrition in affluent societies is under-recognized, and nutritional status is a major predictor of outcome for most diseases.

Nutrition screening identifies patients at risk of malnutrition and should be performed in all clinical areas: this requires evaluation of events in the past (recent weight loss); present (current body mass index (BMI) and clinical signs of malnutrition); and future (current nutrient intake and foreseeable likely causes of reduced intake). A BMI of less than 18.5 kg/m2, or weight loss of more than 10% over 3 to 6 months, or BMI of less than 20 kg/m2 with weight loss of more than 5% over 3 to 6 months, is indicative of malnutrition.

Nutrition support is indicated for malnourished patients or those at risk of malnutrition in view of inadequate oral intake or malabsorption. Timing of intervention depends on the pre-existing nutritional status and the likelihood of restoring adequate intake. Nutrient requirements are calculated using weight-based formulae for basal energy and protein requirements, with additional factors for physical activity, severity of illness, or desired weight gain. Increased requirements due to disease are often counterbalanced by reduced activity.

Proper provision of appetizing food of appropriate quantity, texture, temperature, and variety in a conducive environment, with facilities for assistance and encouragement, can obviate the need for artificial nutrition support. Artificial nutrition support can be provided by oral (supplements), enteral, or parenteral routes, but enteral is preferable to parenteral feeding when possible—it maintains gut integrity, appropriately stimulates hormonal regulation of metabolism and gastrointestinal functions, and delivers nutrients to the liver via the portal circulation. Enteral feeding is also cheaper and safer than intravenous nutrition.

Both enteral and parenteral nutrition can be associated with significant complications relating to the means of access or the delivery of nutrients. Catabolic patients are unable to utilize excess protein or energy, and overfeeding results in an increased rate of complications. Oral nutrition support is associated with improved outcomes and significant reductions in mortality in selected patient groups. A multiprofessional team is essential to coordinate and monitor artificial nutrition in the hospital environment, and to provide support for patients fed long-term in the community, most of whom now die from their underlying disease, rather than complications of nutrition support.

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