Oral and sip feeding

Transcription

1 Life Long Learning Module 8.2 Oral and sip feeding Kristina Norman, MSc Dept. of Gastroenterology, Hepatology & Endocrinology Universitätsmedizin tsmedizin Berlin, Germany

2 Oral and sip feeding Why is oral nutrition important in hospital patients? Requirements of oral nutrition in hospital Monitoring and improving oral intake Fortification of standard hospital food and oral supplements (sip feeds)

3 Why is oral nutrition important in hospital? Malnutrition is common in hospitals Prevalence Ireland: Corish 2000 N= UK: Edington 2004 N= Latin America: Correia 2003 N= Argentina: Wyszynski 2003 N= Denmark: Rasmussen 2006 N= Germany: Pirlich 2006 N=

4 Who is at risk for malnutrition? GERIATRICS ONCOLOGY GASTROENTEROLOGY OTHER MEDICAL CARDIOLOGY UROLOGY SURGERY GYNECOLOGY 172 / / / / / / / / Prevalence of malnutrition (SGA B+C) [%] Pirlich M et al, German Hospital Malnutrition Study, Clin Nutr 2006; 25: Copyright 2006 by ESPEN

5 Why is oral nutrition important in hospital? Nutritional status deteriorates during hospital stay 80 PREVALENCE 80 PREVALENCE % % Weinsier et al., Am J Clin Nutr 1979; Coats et al., J Am Diet Assoc 1993; 32: : Copyright 2006 by ESPEN

6 Why is oral nutrition important in hospital? Nutritional intake is suboptimal in hospital * ** *<minimum and ** < recommended intake Dupertuis et al Clin Nutr Apr;22(2):115-23

7 Incalzi et al Arch Intern Med Feb 26;156(4):425-9 Copyright 2006 by ESPEN Why is oral nutrition important in hospital? Reasons for inadequate nutritional intake apart from clinical routine Recommended intake >70% 40-70% <40% WEAK APPETITE CANNOT CHEW UNSAVORY FOOD MONOTONOUS FOOD FOOD TOO WARM / TOO COLD MEALTIME DIFFERS FROM HOME

8 Requirements of oral nutrition in hospital Macronutrient ratio, meal pattern, menus and diets vary between European countries national recommendations either on governmental level or guidelines by clinical nutrition societies

9 Requirements of oral nutrition in hospital what can you eat? A variety of menus targeted to specific patient categories and needs must be available in hospital such as diets on medical indication Standard hospital menu & vegetarian/vegan alternative Diets on medical indication Texture modified diets

10 Requirements of oral nutrition in hospital 45 55% macronutrient ratio of the standard hospital food (general menu) Carbohydrates Fibre: g! 30 35% 15 20% Fat Protein

11 Requirements of oral nutrition in hospital Diets on medical indication I Protein BASICS IN CLINICAL NUTRITION Third Edition Protein restricted: : g x kg -1 Renal insufficiency Nephrotic syndrome Hep. Encephalopathy (transient!) Protein enhanced: : g x kg -1 Pts on haemodialysis Pts on peritoneal dialysis Liver cirrhosis with malnutrition Copyright 2006 by ESPEN

12 Requirements of oral nutrition in hospital Diets on medical indication II Energy Energy reduced / Fat reduced Obesity, hyperlipidaemia Energy enhanced: Malnutrition

13 Requirements of oral nutrition in hospital Diets on medical indication III Gastroenterological diets e.g. gluten free, lactose free, diets for malassimilation, maldigestion and malabsorbtion Special diets e.g. puric acid free, fructose free, germ reduced

14 Requirements of oral nutrition in hospital Comparison of types of diets on medical indications recommended in, respectively DK, S and D Extract from COE ON NUTRITION, FOOD SAFETY AND CONSUMER HEALTH AD HOC GROUP NUTRITION PROGRAMMES IN HOSPITALS

15 Requirements of oral nutrition in hospital Diets on medical indication and texture modified food CAVE AT! Indications must be well grounded if dietary restrictions are instituted for medical reasons, since undernutrition can result from unnecessary restrictive diets

16 Improving intake Ensuring adequate nutritional intake Protected Mealtimes Policy (HCA) >>3 mealtimes free from avoidable and unnecessary interruptions<< In between snacks! Feeding assistance?

17 Monitoring nutritional intake Early detection of reduced nutritional intake is key for the prevention of malnutrition MONITORING OF NUTRITIONAL INTAKE Copyright 2006 by ESPEN

18 Monitoring nutritional intake Dietary protocol Supervision of tray collection

19 Monitoring and improving intake Monitoring provides knowledge on nutritional intake Reason for inadequate Intake Plan of Action Copyright 2006 by ESPEN

20 Monitoring and improving intake 1. Reduced nutritional intake? YES 2. < 60 % of recommended intake for >10 days? NO Energy and protein dense diet Fortification YES Oral sip feeds

21 Monitoring and improving intake Fortification Protein: powder form Fat: cream, butter, oil Carbohydrates: maltodextrines,, dextrose Copyright 2006 by ESPEN

22 Monitoring and improving intake Fortification Advantages Simple Single macronutrients can be added Disadvantages Sensoric limitation! Copyright 2006 by ESPEN

23 Oral supplementation Types in comparison Rich in energy and protein PROTEIN Rich in fat Immuno- nutrition glutamine arginine Energy and protein restricted Fat free CARBO HYDRATES FAT omega 3 fatty acids restricted electrolyte content content Copyright 2006 by ESPEN

24 Oral supplementation Indications In malnutrition! First line measure as adjuvant nutritional therapy: Tumour patients before major surgery If tolerated in radiotherapy Concomitant therapy in patients with Crohn's Disease when tube feeding not wanted

25 Oral and sip feeding Conclusions Nutritional intake in hospital is suboptimal Malnutrition is common Monitoring of nutritional intake provides immediate knowledge on nutritional intake Dietary restrictions instituted for medical reasons must be well grounded and supervised Nutritional intake can be improved by simple measures (protected mealtimes, in between snacks, fortification, ) Oral sip feeds must be administered in malnutrition and should be considered in some settings