Specialized nutrition support

Abstract

Summary Malnutrition is common in hospitalized patients and is associated with adverse clinical outcomes. A variety of factors commonly present in hospital patients contribute to protein–energy malnutrition and loss of essential vitamins, minerals, and electrolytes. Assessment of nutritional status requires comprehensive evaluation and integration of medical and surgical history, current clinical and fluid status, dietary intake patterns, body weight changes, gastrointestinal (GI) symptoms, physical examination, and selected biochemical tests. Current guidelines suggest that goals for caloric intake between 20 and 25 kcal/kg/day and protein/amino acids between 1.2 and 2.0 g/kg/day are appropriate for most adult hospital patients. Adequate vitamins, minerals, electrolytes, essential amino acids, and essential fatty acids must be provided based on recommended allowances for healthy individuals; however, true requirements in subtypes of hospital patients are unknown. The GI (enteral) route should be the first choice for specialized feeding in the hospital setting, with parenteral nutrition modalities, via peripheral or central vein, reserved for those patients in whom adequate enteral nutrition is not possible. Metabolic, infectious, and mechanical complications can occur with both enteral and parenteral feeding modalities and can be prevented or reduced with careful monitoring and adherence to current standards of practice. Relatively few rigorous, randomized controlled clinical trials have been conducted within the field of specialized feeding in the hospital setting, and many areas of uncertainty remain.