Elsevier

Clinical Nutrition

Volume 37, Issue 1, February 2018, Pages 336-353
Clinical Nutrition

ESPEN guidelines on nutritional support for polymorbid internal medicine patients

https://doi.org/10.1016/j.clnu.2017.06.025Get rights and content

Summary

Background & aims

Polymorbidity (also known as multimorbidity) – defined as the co-occurrence of at least two chronic health conditions – is highly prevalent, particularly in the hospitalized population. Nonetheless, clinical guidelines largely address individual diseases and rarely account for polymorbidity. The aim of this project was to develop guidelines on nutritional support for polymorbid patients hospitalized in medical wards.

Methods

The methodology used for the development of the current project follows the standard operating procedures for ESPEN guidelines. It started with an initial meeting of the Working Group in January 2015, where twelve key clinical questions were developed that encompassed different aspects of nutritional support: indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. Systematic literature searches were conducted in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines), until April 2016. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations, which were followed by submission to Delphi voting rounds.

Results

From a total of 4532 retrieved abstracts, 38 relevant studies were analyzed and used to generate a guideline draft that proposed 22 recommendations and four statements. The results of the first online voting showed a strong consensus (agreement of >90%) in 68% of recommendations and 75% of statements, and consensus (agreement of >75–90%) in 32% of recommendations and 25% of statements. At the final consensus conference, a consensus greater than 89% was reached for all of the recommendations.

Conclusions

Despite the methodological difficulties in creating non-disease specific guidelines, the evidence behind several important aspects of nutritional support for polymorbid medical inpatients was reviewed and summarized into practical clinical recommendations. Use of these guidelines offer an evidence-based nutritional approach to the polymorbid medical inpatient and may improve their outcomes.

Keywords

Guidelines
Polymorbidity
Multimorbidity
Nutritional support
Hospitalized patients

Abbreviations

BI
Barthel Index
βHMB
β-hydroxy β-methylbutyrate
CG
Control Group
DRM
disease-related malnutrition
EN
enteral nutrition
GEB
Guidelines Editorial Board
IC
indirect calorimetry
IG
Intervention Group
LOS
length of hospital stay
MNA(-sf)
Mini Nutritional Assessment (short form)
NRS 2002
Nutritional Risk Score 2002
ONS
oral nutritional supplement(s)
PICO
population of interest, interventions, comparisons, outcomes
PN
parenteral nutrition
QoL
quality of life
REE
resting energy expenditure
RCT
randomized controlled trial
SGA
Subjective Global Assessment
SIGN
Scottish Intercollegiate Guidelines Network
TEE
total energy expenditure
WG
Working Group

Cited by (0)

1

F.G. and P.S. contributed equally to this study.

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