Artificial Nutrition Support: When, What and How
WHEN do you consider artificial nutrition support?
- Nutrition support should be considered in people who are malnourished, as defined by any of the following:
- A body mass index (BMI) of less than 18.5 kg/m2
- Unintentional weight loss > 10% within the last 3–6 months
- A BMI of less than 20 kg/m2 and unintentional weight loss greater than 5% within the last 3–6 months.
- Nutrition support should be considered in people at risk of malnutrition, defined as those who have:
- Anticipated or actual inadequate food intake by mouth for > 5 days.
- A poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs from causes such as catabolism.
NB- Malnutrition Universal Screening Tool (MUST) is an evidence-based and easy-to-use tool for identifying malnutrition (see www.bapen.org.uk for more information)
What are the methods to provide artificial nutrition support?
- Oral nutrition support – for example, fortified food, additional snacks and/or sip feeds
- Enteral tube feeding (ETF) – the delivery of a nutritionally complete feed directly into the gut via a tube like NG/NJ tube, PEG or jejunostomy
- Parenteral nutrition – the delivery of nutrition intravenously.
How to select the most appropriate route of feeding?
The adage ‘if the gut works, use it’ is still valid. It is also cheaper, more physiological, less invasive and associated with less serious complications than parenteral feeding.
- Food fortification and supplementation represent the cheapest and safest methods of artificial nutritional support and are normally the most acceptable for the patient.
- ETF is indicated in patients who have inadequate or unsafe oral intake and a functional gastrointestinal tract.
- Consider gastrostomy or jejunostomy feeding if the patient is likely to need long term (4 weeks or more) ETF.
- Post-pyloric feeding by NJ tube may be advantageous in some patients. The main advantage of post-pyloric feeding is a reduced risk of pulmonary aspiration of the gastric contents.
- Parenteral nutrition- indicated in the presence of a non-functional, inaccessible (like oesophageal obstruction) or perforated gastrointestinal tract.
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