Cantonal Hospital Aarau and University of Basel, Switzerland.
Cantonal Hospital Aarau and University of Basel, Switzerland; NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal.
Clin Nutr. 2023 Sep;42(9):1545-1568. doi: 10.1016/j.clnu.2023.06.023. Epub 2023 Jul 8.
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.
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.
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.
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.
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.
多病症住院患者的疾病相关营养不良是一种高发综合征，与发病率、残疾率、短期和长期死亡率显著增加、疾病康复受损以及治疗费用增加有关。
由于在多种疾病患者中应用特定疾病指南存在不确定性，我们的目的是为住院内科病房的多病症患者人群提供营养支持的循证推荐意见。
本更新内容符合 ESPEN 指南的标准操作程序。我们在三个不同的数据库（Medline、Embase 和 Cochrane Library）以及辅助来源（例如已发表的指南）中针对 15 个临床问题进行了系统文献检索，检索到的摘要进行了筛选，以确定用于制定推荐意见（包括 SIGN 分级）的相关研究，然后提交给 Delphi 投票。
从总共检索到的 3527 篇摘要中，分析了 60 篇新的相关研究，并用于生成指南草案，该草案提出了 32 条推荐意见（7x A、11x B、10x O 和 4x GPP），涵盖了营养支持的不同方面，包括适应证、喂养途径、能量和蛋白质需求、微量营养素需求、特定疾病营养素、时机、监测和干预程序。第一次在线投票的结果显示，对 100%的推荐意见的一致性非常高（>90%的同意率）。因此，不需要进行最终的共识会议。
最近的高质量试验提供了越来越多的证据表明，营养支持可以减少多病症患者营养不良相关的发病率和其他并发症。在医院入院时及时筛查营养不良风险，然后对高危患者进行个体化营养支持干预，应成为全球医院常规临床护理和多模式治疗的一部分。使用本更新后的指南为多病症内科住院患者提供了循证营养方法，并可能改善他们的预后。
