Nutrition Publication

NNIW10 - Home Care Enteral Feeding

Editor(s): H. Lochs, D.R. Thomas. Clinical Nutrition vol. 10

As clinical nutrition plays an increasing role in the management of patients at home – often for a much longer period than for a hospital stay – The topic ‘Home Care Enteral Feeding’ was chosen for this 10th Nestlé Nutrition Workshop of the Clinical and Performance Program, which took place in June 2004 in Potsdam, Germany.

Related Articles

Subject Index

Author(s): H. Lochs, D.R. Thomas

As clinical nutrition plays an increasing role in the management of patients at home – often for a much longer period than for a hospital stay – The topic ‘Home Care Enteral Feeding’ was chosen for this 10th Nestlé Nutrition Workshop of the Clinical and Performance Program, which took place in June 2004 in Potsdam, Germany.

Concluding Remarks

Author(s): D.R. Thomas, H. Lochs

As clinical nutrition plays an increasing role in the management of patients at home – often for a much longer period than for a hospital stay – The topic ‘Home Care Enteral Feeding’ was chosen for this 10th Nestlé Nutrition Workshop of the Clinical and Performance Program, which took place in June 2004 in Potsdam, Germany.

Contents

Author(s): H. Lochs, D.R. Thomas

As clinical nutrition plays an increasing role in the management of patients at home – often for a much longer period than for a hospital stay – The topic ‘Home Care Enteral Feeding’ was chosen for this 10th Nestlé Nutrition Workshop of the Clinical and Performance Program, which took place in June 2004 in Potsdam, Germany.

How Can We Modulate Cytokine Production and Action?

Author(s): L. Cynober

The loss of body weight and development of cachexia are common signsassociated with several diseases.Net muscle protein catabolism is the result of a neuronal and endocrinologicalresponse, the main hormone involved in this process being cortisol [1].Besides this, a number of pathological situations (e.g. cancer, infection,trauma, surgery) lead to activation of the immunological system which, inparticular, involves the release of mediators.

Preface and Foreword

Author(s): H. Lochs, D.R. Thomas

The nutritional status of older adults living at home is poor. On average,persons over the age of 70 years consume one third less calories compared toyounger persons. In dietary intake studies, 10% of older men and 20% ofolder women have intakes of protein below the United States RecommendedDaily Allowance (RDA), and one third consume fewer calories than the RDA.Fifty percent of older adults have intakes of minerals and vitamins of lessthan the RDA and 10–30% have subnormal levels of minerals and vitamins.Sixteen to 18 percent of community-dwelling elderly persons consume lessthan 1,000 kcal daily.

Ethics and Economics in Nutritional Support

Author(s): A.L. Buchman

Enteral and parenteral nutritional support was developed to provide sustenanceto patients who ordinarily were unable to meet their nutritionalneeds either because of an inability to eat or an inability to digest and absorbfood. Undernutrition has been associated with increased infection risk, poorwound healing, increased postoperative complications, prolonged hospitalstay, respiratory, cardiac, and hepatic dysfunction, as well as increasedmortality. A clinical decision must be made about the provision of both nutritionas well as hydration fluids for patients otherwise able to eat in the usualfashion.

Pathophysiology of Weight Loss in Older Persons

Author(s): J.E. Morley

It is now well recognized that a physiological anorexia of aging occurs thatis associated with gradual weight loss in older persons [1, 2]. A number of epidemiologicalstudies have shown that weight loss in older persons leads todeath (fig. 1) [3–6]. In addition, weight loss has been shown to be associatedwith hip fracture [7]. When an older person develops a disease, the diseaseinteracts with the propensity for anorexia, leading to severe weight loss andcachexia.

Psychoimmunology of Nutrition

Author(s): B. Lesourd

The relationships between behavior and immune responses have been studiedfor a long time. It is well recognized that persons under psychologicalstresses, such as depression, marital problems, bereavement or alcoholism,are more susceptible to infections. Nevertheless only a few studies were conductedbefore the 1970s. Since then, progress in knowledge of the immunesystem, improvement in questionnaires assessing the characterization andquantification of different moods, and very recently the link between a psychologicalapproach and brain neuron cell functions (neuroimmunology) havepushed to extend research in this new field, called psychoneuroimmunology.

Malnutrition in the Developing World: The Lack of Food Scenario

Author(s): D. Labadarios

The current literature concurs that the prevalence of malnutrition, andstunting among children in particular, is a reasonably accurate reflection onthe prevailing socioeconomic status in a given environment. In this regard,malnutrition is known to adversely impact on mental development, scholasticachievement, productivity, child and woman morbidity and mortality as wellas the risk for infection. As such, it is hardly surprising that nutritional statusis one of the key Millennium Development Goals [1].

Are Older People Starving to Death in a World of Plenty?

Author(s): D.R. Thomas

The indictment by Nightingale has persisted for over a century, aided bythe inadequate attention paid by physicians to nutritional status. Dietaryrestrictions, improper dietary prescriptions, and keeping patients non per orafor considerable lengths of time have contributed to nutritional problems inthe healthcare system [1, 2].

Physiological vs. Pathological Changes of Nutritional Status over Life Time

Author(s): M.J. Müller, A. Bosy-Westphal,

Age-related changes in nutritional status include weight loss as well asweight gain. In the EURONUT-Seneca study on elderly subjects (age 75–80years) who were investigated in different parts of Europe, the prevalence ofa 5-year weight gain of 5 kg was highly variable and reached a highest prevalenceof 9 and 17% in females and males, respectively [1].

Home Enteral Nutrition: Demographics and Utilization in the United States

Author(s): M.H. DeLegge

Enteral nutrition is the act of receiving nutrients through the gut, eitherorally or through an enteral access device. It has long been used in the hospitaland nursing home setting. The number of patients receiving homeenteral nutrition (HEN) in the United States has progressively increased, yetthe absolute numbers remain difficult to determine.

Home Enteral Nutrition: Epidemiology and Legislation in Europe

Author(s): A. Van Gossum

Enteral nutrition is the preferred way of feeding patients who cannot maintainsufficient oral intake but have a functioning gastrointestinal tract. Enteralfeeding has been used for several decades for hospitalized patients, but forthe last 20 years home enteral nutrition (HEN) has been expanding in homecare in many industrialized countries throughout the world. Despite the factthat the number of patients on HEN is now much higher than patients onhome parenteral nutrition (HPN), scientific interest and medical concernwere initially much higher for HPN [1–3].

When Does Malnutrition Become a Risk?

Author(s): L. Gentona, W.G. Van Gemerta, C.H. Dejonga, P.L. Cox-Reijvenb and P.B. Soetersa

Malnutrition has been defined as a deficiency of energy, protein or othertypes of nutrients, which produces alterations in body function, is associatedwith worse outcome from illness and is reversible by nutritional support [1].Global malnutrition generally results from simple starvation or stress starvationand has to be distinguished from deficiency of one micronutrient orvitamin [2]. Starvation results from a pure deficit of all macro- and micronutrientsand occurs for instance in hunger strikers, persons with anorexia,or patients with intestinal diseases leading to malabsorption.

What Are the Goals of Nutritional Support?

Author(s): X. Hébuterne, S.M. Schneider

Artificial nutrition is a supportive medical therapy aiming at achieving predefinedobjectives, which should be adjusted for changing clinical situations[1]. The goals of nutritional support must be clearly predefined within a globaltherapeutic plan. First of all it is necessary to determine whether nutritionalsupport is a medical treatment or basic human care. If it is considered a medicaltreatment, the goal of this treatment is to improve some parametersrelated to disease progression and/or malnutrition (considered as a disease).

Oral Protein and Energy Supplementation in Older People: A Systematic Review of Randomized Trials

Author(s): A.C. Milne, A. Avenella, J. Potter

A report of the UK Royal College of Physicians entitled ‘Nutrition andPatients: A Doctor’s Responsibility’, published in July 2002 [1], highlightedagain the importance of nutritional care for vulnerable groups such as undernourishedelderly people, particularly those who are hospitalized or institutionalized.Older people have longer periods of illness and longer hospitalstays [2], and data show that up to 55% of elderly hospitalized patients areundernourished on admission [3, 4].

Efficacy of Enteral and Parenteral Nutrition in Cancer Patients

Author(s): F. Bozzetti, V. Bozzetti

Before attempting to analyze the potential efficacy of the two differentroutes of administering nutrients to cancer patients, enteral nutrition (EN)versus total parenteral nutrition (TPN), it should be appreciated that patientswho are usually fed via a vein are not the same as those who receive EN.If fact, nowadays, the option for TPN only emerges if a patient is not suitablefor EN because his/her gut is not working.

Interaction between Nutrition, Intestinal Flora and the Gastrointestinal Immune System

Author(s): H. Lochs

The intestinal mucosa is the biggest surface of the body, which isconstantly in close contact with a high number of different bacteria and foodantigens. Furthermore it has to absorb nutrients and in this process to differentiatebetween those molecules which have to pass the mucosal barrier andbe taken up as nutrition and those molecules and organisms which have to bekept out to maintain the sterile condition in the organism. This is a complexfunction which is regulated by different layers of the intestinal barrier as wellas specific transport systems.

How Can We Impact the Immune System with Pre- and Probiotics?

Author(s): E.J. Schiffrin, A. Donnet, S. Blum

In recent years there has been a growing interest in understanding theinfluence of intestinal microbiota on the physiology of the body. Moreover,with the available genomic studies, it is now possible to analyze how componentsof the intestinal microbiota modulate features of human postnataldevelopment and physiology [1]. An area of major interest has been the relationshipbetween the gut bacteria and the immune system, both at the intestinaland systemic level [2].

How Can We Improve Functional Outcomes?

Author(s): M. Elia

Health has multiple dimensions. In a broad sense, health can be consideredin terms of physical, mental and social well-being, but this may be difficult tomeasure, particularly in whole populations. The earliest population indices ofhealth were based on readily available and unambiguous indicators, such asmortality; and these were applied to particular age groups, such as the firstyear of life (infant mortality).