Nutritional Therapy for Polymorbid Patients: a Summary of the Recent ESPEN Guidelines

Background In daily clinical practice, malnutrition is a frequent problem and associated with complications, longer hospitalizations and poor outcomes. Polymorbidity is highly prevalent, particularly in medical inpatients. Nonetheless, clinical guidelines largely address individual diseases and rarely account for polymorbidity. The aim of this project was to develop guidelines on nutritional support for polymorbid inpatients in medical wards. This review is a German translation of a recently published guideline. Methods The working group developed twelve key clinical questions addressing several aspects of nutritional support: indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. Systematic literature searches were conducted in three data-bases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines). Relevant studies were selected to develop recommendations. Results In polymorbid inpatients a simple standardized screening for malnutrition should be performed within 48 hours. The total daily energy expenditure can be estimated with "27 - 30 kcal/kg bodyweight (BW)", the daily protein requirement with ">= 1.0 g/kg BW". Oral nutritional supplements should be considered as a cost-effective intervention to improve outcomes. If nutritional requirements cannot be met orally (< 75%), enteral or parenteral nutrition can be administered. Conclusions Despite methodological challenges due to the heterogeneity of the patient population in question and missing large randomized interventional studies, the working group developed evidence-based guidelines for non-disease-specific nutritional therapy in polymorbid inpatients. As a result, they drafted 22 practical recommendations and four statements for use in daily clinical practice. There are still unanswered questions due to insufficient or missing data and further interventional studies are needed.