TY - JOUR
T1 - ESPEN guideline on nutritional support for polymorbid medical inpatients
AU - Wunderle, Carla
AU - Gomes, Filomena
AU - Schuetz, Philipp
AU - Stumpf, Franziska
AU - Austin, Peter
AU - Ballesteros-Pomar, María D.
AU - Cederholm, Tommy
AU - Fletcher, Jane
AU - Laviano, Alessandro
AU - Norman, Kristina
AU - Poulia, Kalliopi Anna
AU - Schneider, Stéphane M.
AU - Stanga, Zeno
AU - Bischoff, Stephan C.
N1 - Funding Information:
This work was supported by the ESPEN society as well as by the Swiss National Science Foundation ( SNSF Professorship, PP00 P3_150531/1) and the Research Council of the Kantonsspital Aarau , Switzerland (1410.000.044).
Publisher Copyright:
© 2023 European Society for Clinical Nutrition and Metabolism
PY - 2023/9
Y1 - 2023/9
N2 - Background: Disease-related malnutrition in polymorbid medical inpatients is a highly prevalent syndrome associated with significantly increased morbidity, disability, short- and long-term mortality, impaired recovery from illness, and cost of care. Aim: As there are uncertainties in applying disease-specific guidelines to patients with multiple conditions, our aim was to provide evidence-based recommendations on nutritional support for the polymorbid patient population hospitalized in medical wards. Methods: This update adheres to the standard operating procedures for ESPEN guidelines. We did a systematic literature search for 15 clinical questions in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines), until July 12th. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations (incl. SIGN grading), which was followed by submission to Delphi voting. Results: From a total of 3527 retrieved abstracts, 60 new relevant studies were analyzed and used to generate a guideline draft that proposed 32 recommendations (7x A, 11x B, 10x O and 4x GPP), which encompass different aspects of nutritional support including indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. The results of the first online voting showed a strong consensus (agreement of >90%) on 100% of the recommendations. Therefore, no final consensus conference was needed. Conclusions: Recent high-quality trials have provided increasing evidence that nutritional support can reduce morbidity and other complications associated with malnutrition in polymorbid patients. The timely screening of patients for risk of malnutrition at hospital admission followed by individualized nutritional support interventions for at-risk patients should be part of routine clinical care and multimodal treatment in hospitals worldwide. Use of this updated guideline offers an evidence-based nutritional approach to the polymorbid medical inpatients and may improve their outcomes.
AB - Background: Disease-related malnutrition in polymorbid medical inpatients is a highly prevalent syndrome associated with significantly increased morbidity, disability, short- and long-term mortality, impaired recovery from illness, and cost of care. Aim: As there are uncertainties in applying disease-specific guidelines to patients with multiple conditions, our aim was to provide evidence-based recommendations on nutritional support for the polymorbid patient population hospitalized in medical wards. Methods: This update adheres to the standard operating procedures for ESPEN guidelines. We did a systematic literature search for 15 clinical questions in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines), until July 12th. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations (incl. SIGN grading), which was followed by submission to Delphi voting. Results: From a total of 3527 retrieved abstracts, 60 new relevant studies were analyzed and used to generate a guideline draft that proposed 32 recommendations (7x A, 11x B, 10x O and 4x GPP), which encompass different aspects of nutritional support including indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. The results of the first online voting showed a strong consensus (agreement of >90%) on 100% of the recommendations. Therefore, no final consensus conference was needed. Conclusions: Recent high-quality trials have provided increasing evidence that nutritional support can reduce morbidity and other complications associated with malnutrition in polymorbid patients. The timely screening of patients for risk of malnutrition at hospital admission followed by individualized nutritional support interventions for at-risk patients should be part of routine clinical care and multimodal treatment in hospitals worldwide. Use of this updated guideline offers an evidence-based nutritional approach to the polymorbid medical inpatients and may improve their outcomes.
KW - Guideline
KW - Hospitalized patients
KW - Multimorbidity
KW - Nutritional support
KW - Polymorbidity
UR - http://www.scopus.com/inward/record.url?scp=85164981070&partnerID=8YFLogxK
U2 - 10.1016/j.clnu.2023.06.023
DO - 10.1016/j.clnu.2023.06.023
M3 - Article
C2 - 37478809
AN - SCOPUS:85164981070
SN - 0261-5614
VL - 42
SP - 1545
EP - 1568
JO - CLINICAL NUTRITION
JF - CLINICAL NUTRITION
IS - 9
ER -