Dietitian's Journal

Entries in Nutrition Support (2)


"Do not let your patients starve....[feed] by the safest, simplest, most effective route"

Hello, all. This is a surprise to you as much as me: posting two days in a row. I've decided to follow my impulse and begin featuring the resources listed in the previous entry.

First, a resource commissioned by the National Institute for Health and Clinical Excellence (U.K.) in 2006:

National Collaborating Centre for Acute Care, February 2006. Nutrition support in adults - Oral nutrition support, enteral tube feeding and parenteral nutrition. National Collaborating Centre for Acute Care, London (PDF)

Although this resource is several years old, I discovered  it only this past January while I was searching the literature on enteral nutrition delivery topics (e.g., methods, schedules, transitions).  

As the Foreward states (and we dietitians know so well):

Malnutrition is both a cause and a consequence of ill-health. It is surprisingly common in the UK [Canada, too, I would add - ee], especially in those who are unwell. Many older people and those with any long-term medical or psycho-social problems are chronically underweight and so are vulnerable to acute illness. Even people who are well-nourished eat and drink less if they are ill or injured and although this may only be short-lived as part of an acute problem, if it persists the person can become undernourished to an extent that may impair recovery or precipitate other medical conditions (page 2).

Also from the Foreward:

The aim of these guidelines is to improve the practice of nutrition support by providing evidence and information for all healthcare professionals, patients and their carers so that malnutrition whether in hospital or in the community, is recognized and treated by the best form of nutrition support at the appropriate time....

[M]any of the recommendations in this guideline are derived from a combination of clinical evidence, clinical experience and expertise. Many are also quite general, applying to all patients with malnutrition whatever their disease or care setting. However, all healthcare professionals who have contact with patients should find the recommendations relevant for we believe that they contain an obvious, simple message:

'Do not let your patients starve and when you offer them nutrition support, do so by the safest, simplest, most effective route.’

Other versions of this guideline, including a quick reference guide (PDF), are available on the NICE Nutrition Support in Adults Web page.

If you are a clinician working with malnourished patients or clients, I highly recommend you add this valuable document to your library. I've found it to be a practical -- and necessary -- complement to the key A.S.P.E.N. documents I refer to in everyday practice, including the 2009 Enteral Nutrition Practice Guidelines.


Critical Care Nutrition

Until earlier today, I didn't know about this valuable site -- it's Canadian, too -- for critical care dietitians and physicians. I discovered Critical Care Nutrition (CCN) by responding to a request to complete a survey.  I don't have a good excuse for my ignorance other than, from habit, I've always turned to A.S.P.E.N., and more recently, ESPEN for nutrition support practice guidelines.

Now that I've found CCN, I'll be adding the link to my Connotea library and sharing it here, with a brief introduction and description to guide your exploration of this site.

CCN's team consists of physicians and dietitians "dedicated to the improvement in nutrition therapies in intensive care units across the world." The site's resources include downloadable, adaptable:

Another feature is a discussion forum, although its activity seems to be quite low at present.

CCN definitely is a site worth exploring if you are a dietitian looking after critically-ill patients.