Basics in Clinical Medical Nutrition
Nutrition is a basic requirement for life and plays an important role in health and in diseaseprevention, but malnutrition is a common event and a cause of increased morbidity andmortality, particularly in patients with disease-related malnutrition showing inflammationand a catabolic state. Malnutrition is often overlooked, and deterioration in the nutritionalstatus following admission to hospital is common. It should be actively pursued by aubiquitous system of nutrition screening, and full nutritional assessment is required forthose found to be at risk. There are simple screening tools which can be used by all healthcare professionals. Assessment considers body composition, inflammatory status and otheraspects of underlying diseases and their functional consequences; it is a more specialistprocess. It is important to determine the energy and protein needs of each individualpatient. Appropriate nutritional intervention can often be offered by the oral route, usingfood with or without special supplements. When this is insufficient, enteral tube feedingwill normally be sufficient, but there is an important subgroup of patients in whom enteralfeeding is contraindicated or unsuccessful, and in these patients parenteral nutrition(either total or supplemental) is required. A number of immunonutrients and other specialsubstrates have been shown to be helpful in specific circumstances, but their use is notwithout potential hazards, and therefore adherence to international guidelines is recommended.