Post on 12-Jan-2016
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Optimizing Optimizing Nutrition TherapyNutrition Therapy
Prevalence of Malnutrition
• Increased complications• Prolonged length of stay• Higher hospital costs• Increased mortality
Malnutrition occurs frequently in hospitalized patients. It is associated with:
Nutritional Screening and Assessment
• Screening identifies and classifies patients at risk for malnutrition
• Assessment – evaluates nutritional status – biochemical parameters – anthropometric measurements – Subjective Global Assessment (SGA)
Early Detection of Malnutrition
Patients at risk:
History of chronic diseases
Psychiatric disorders
Gastrointestinal diseases Chronic renal insufficiency
Impaired immune function
CancerDiabetesElderlyChronic renal failureCOPD
Normal Energy Metabolism and Nutritional Needs
• Nutrients are necessary to sustain life• The utilization of nutrients depends on availability
(fasting) and the inflammatory response (stress)• Energy requirements vary according to clinical condition • Caloric distribution varies according to metabolic status
Metabolic Response to Starvation and Trauma: Nutritional Requirements
• The metabolic response to starvation is an adaptive mechanism
• Nutritional needs increase in trauma
Nutritional Requirements
• Energy– Harris-Benedict Equation x stress factor– “Rule of thumb”: 25 – 30 kcal/kg BW– Indirect calorimetry
• Protein– Stable patients: 0.8 – 1.0 g/kg BW– Stressed patients: 1.2 – 2.0 g/kg BW
Nutritional Requirements
• Lipids – Stable patient: 25% – 30% of calories – Stressed patient: 20% – 35% of calories
• Carbohydrates – Stable patient: 50% – 65% of calories
• Diabetes mellitus, hyperglycemia, COPD, hypercapnia, may benefit from
– carbohydrates (about 30% of calories)– lipids (about 50% of calories)
Nutritional Requirements
• Vitamins and Minerals – Stable patient: 100% daily recommended intake – Stressed patient: 100% daily recommended intake,
(COPD, cancer, antioxidants critical care)
– Hepatic patient: BCAA, B Vitamins, folate Na, Cu, Fe, Mn
– Renal failure: Na, K, CI, PO4,Vitamin A
– HIV/AIDS: antioxidants,Vitamins B6, B12
Early Intervention as Part of Initial Care
Enteral Nutrition• Oral supplements• Tube feeding
Parenteral Nutrition• Total• Peripheral
“If the gut works, use it!”
Parenteral Nutrition
• Supplies partial or total nutrition through venous access• Supplies practically all essential nutrients• Metabolic monitoring and changes in solution components
are needed to maintain metabolic balance
Benefits of Enteral Nutrition Therapy
• Maintains GI tract structure and function• Enhances intestinal immune function• Reduces bacterial translocation• Decreases risk of sepsis• Fewer complications than with parenteral
nutrition• Lower costs
Improved Patient Outcomes
• Improved wound healing• Decreased risk of complications
– Nosocomial infection• Decreased length of stay• Decreased healthcare costs
Barriers to Nutritional Intervention
• Lack of physician awareness
• Limited physician knowledge of nutrition therapy
• Minimal support from administration
Lack of Physician Awareness
• Physicians consider this the responsibility of other
professionals
• Nutritional assessment not included by physician as part of the initial history and physical
• Only considered important when severe malnutrition is evident
• Nutritional evaluation could be included in patient history and physical exam with minimal effort
Lack of Administrator’s Awareness
Administrator’s lack the knowledge of the positive impact that nutrition therapy can have on patient care and in reducing hospital costs.
Goals of the TNT Program
Improve patient care Give physicians the knowledge to prevent and manage
nutrition-related problems. Teach them how to do this early, safely and efficiently.
TNT Program: Next Steps
• Screening – Establish a nutritional screening and assessment program
• Standards – Develop guidelines and standards of care for
nutrition therapy• Intervention
– Promote early nutrition therapy
TNT Program: Next Steps
• Education – Raise awareness and increase knowledge of
healthcare team members on importance of nutrition therapy
• Research – Collect data on the incidence of malnutrition and
positive clinical outcomes of nutritional intervention
CONGRATULATIONS!
TNT was sponsored by Abbott Laboratories