Enteral Nutrition in Hospitalized Adults
Leah Gramlich, M.D., and Peggi Guenter, Ph.D., R.N.
Enteral nutrition is defined as the provision of essential nutrients through an enteral tube to prevent or treat disease-related malnutrition in patients who are unable to consume adequate nutrients by mouth.1 The interplay of inadequate dietary intake and inflammation that characterizes disease-related malnutrition affects a patient’s response to medical nutrition therapy, including enteral nutrition. Randomized, controlled trials performed over the past 15 years, involving mainly critically ill patients, as well as recent studies involving medical and surgical patients who were not critically ill, have informed our current understanding of enteral nutrition. This review considers enteral nutrition in the context of disease-related malnutrition, provides evidence for the use of enteral nutrition in hospitalized patients, and discusses practice considerations. Disease-related malnutrition is a complex syndrome involving inadequate nutrient intake, insufficient nutrient utilization, and disease-related systemic inflammation, factors that result in altered body composition and diminished bodily function.2 This disorder is associated with a high risk of adverse health and economic outcomes, including death, prolonged hospitalization, hospital readmission, and high health care costs.3,4 Globally, 30 to 45% of hospitalized adults are malnourished on admission.2,3,5,6 Data published in the past 5 years indicate that enteral nutrition was used in 5.2% and 4.9% of malnourished hospitalized patients in the United States and Europe, respectively.7,8 These findings highlight the need to identify patients with disease-related malnutrition in order to prevent continued nutritional decline, with the use of enteral nutrition when appropriate.9 During hospitalization, most patients in the intensive care unit (ICU) and up to 1 in 20 non–critically ill medical or surgical patients receive enteral nutrition.7,8 The terms medical nutrition therapy and nutrition support are often used interchangeably. Whereas medical nutrition therapy includes patient counseling and the use of oral nutritional supplements in addition to enteral and parenteral nutrition, nutrition support refers only to enteral and parenteral nutrition.10,11 The benefits of medical nutrition therapy in malnourished patients were shown in the landmark EFFORT (Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial) investigation.4 The EFFORT researchers randomly assigned more than 2000 patients at nutritional risk who were not receiving enteral nutrition to receive individualized medical nutrition therapy or standard care.
LEGGI TUTTO https://www.nejm.org/doi/abs/10.1056/NEJMra2406954#:~:text=DOI%3A%2010.1056/NEJMra2406954
