Optimizing nutrition therapy
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Optimizing Nutrition Therapy. Prevalence of Malnutrition. Malnutrition occurs frequently in hospitalized patients. It is associated with:. Increased complications Prolonged length of stay Higher hospital costs Increased mortality. Nutritional Screening and Assessment.

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Prevalence of malnutrition
Prevalence of Malnutrition

Malnutrition occurs frequently in hospitalized patients. It is associated with:

  • Increased complications

  • Prolonged length of stay

  • Higher hospital costs

  • Increased mortality

Nutritional screening and assessment
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
Early Detection of Malnutrition

Patients at risk:

History of chronic diseases

Psychiatric disorders

Gastrointestinal diseases

Chronic renal insufficiency

Impaired immune function




Chronic renal failure


Normal energy metabolism and nutritional needs
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
Metabolic Response to Starvation and Trauma: Nutritional Requirements

  • The metabolic response to starvation is an adaptive mechanism

  • Nutritional needs increase in trauma

Nutritional requirements
Nutritional Requirements 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 requirements1
Nutritional Requirements 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 requirements2
Nutritional Requirements 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
Early Intervention Requirementsas Part of Initial Care

  • Enteral Nutrition

  • Oral supplements

  • Tube feeding

  • Parenteral Nutrition

  • Total

  • Peripheral

“If the gut works, use it!”

Parenteral nutrition
Parenteral Nutrition Requirements

  • 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
Benefits of Enteral Nutrition Therapy Requirements

  • 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 Patient Outcomes Requirements

  • Improved wound healing

  • Decreased risk of complications – Nosocomial infection

  • Decreased length of stay

  • Decreased healthcare costs

Barriers to nutritional intervention
Barriers to Nutritional Intervention Requirements

  • Lack of physician awareness

  • Limited physician knowledge of nutrition therapy

  • Minimal support from administration

Lack of physician awareness
Lack of Physician Awareness Requirements

  • 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
Lack of Administrator’s Awareness Requirements

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
Goals of the TNT Program Requirements

  • 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
TNT Program: Next Steps Requirements

  • 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 steps1
TNT Program: Next Steps Requirements

  • 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


TNT was sponsored by Abbott Laboratories