title: Detection and treatment of medical inpatients with or at-risk of malnutrition: Suggested procedures based on validated guidelines.
abstract: OBJECTIVE
  Despite the high prevalence of malnutrition in the general inpatient population, there is a lack of knowledge in regard to detecting disease-related malnutrition and implementing nutritional support. Our aim was to suggest practical procedures for screening and treating malnourished or at-risk patients hospitalized in medical wards, thereby fostering a straightforward implementation of nutritional therapy independent of the underlying disease and comorbidities.
  
  
  METHODS
  A working group of experts in clinical nutrition selected and analyzed published disease-specific European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines relevant for our aim. Eight questions in population, intervention, control, outcome format were defined to cover topics such as screening, nutritional targets, and routes of feeding. Individual studies were extracted from the guidelines by applying inclusion and exclusion criteria targeting the heterogeneous population of medical inpatients with or at-risk of disease-related malnutrition. We used those studies as evidence, as well as recommendations from the selected ESPEN guidelines, to formulate answers to the questions. Final agreement with the statement was obtained by consensus of the whole working group.
  
  
  RESULTS
  Procedures on how to provide integrated nutritional therapy (oral, enteral, and parenteral) to a heterogeneous patient population were suggested, including how to identify malnourished or at-risk patients, nutrient targets, choice of feeding route, monitoring, and assessment of patients. We also developed a simple algorithm to facilitate the implementation of a nutritional care plan for the general medical inpatient population.
  
  
  CONCLUSIONS
  By compiling evidence and recommendations from disease-specific guidelines, we were able to suggest a nutritional strategy applicable to large and heterogeneous group of malnourished or at-risk patients admitted to hospitals. A large randomized controlled trial is currently investigating whether this strategy improves clinical outcomes of patients.
authors.affiliation: Department of Endocrinology, Diabetes and Clinical Nutrition, University Department of Internal Medicine, Cantonal Hospital Aarau, Aarau, Switzerland.
authors.forename: Lisa
authors.initials: L
authors.lastname: Bounoure
authors.affiliation: Department of Endocrinology, Diabetes and Clinical Nutrition, University Department of Internal Medicine, Cantonal Hospital Aarau, Aarau, Switzerland.
authors.forename: Filomena
authors.initials: F
authors.lastname: Gomes
authors.affiliation: Department of Endocrinology, Diabetes and Clinical Nutrition, University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Zeno
authors.initials: Z
authors.lastname: Stanga
authors.affiliation: Endocrine Practice, University of Basel, Basel, Switzerland.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Keller
authors.affiliation: Gastrocenter Obach, Solothurn, Switzerland.
authors.forename: Rémy
authors.initials: R
authors.lastname: Meier
authors.affiliation: Department of Medicine, Canton Hospital Winterthur, Winterthur, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Ballmer
authors.affiliation: Department of Endocrinology, Diabetes and Clinical Nutrition, University Department of Internal Medicine, Cantonal Hospital Aarau, Aarau, Switzerland.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Fehr
authors.affiliation: Department of Endocrinology, Diabetes and Clinical Nutrition, University Department of Internal Medicine, Cantonal Hospital Aarau, Aarau, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Mueller
authors.affiliation: Clinical Nutrition, University Hospitals of Geneva, Geneva, Switzerland.
authors.forename: Laurence
authors.initials: L
authors.lastname: Genton
authors.affiliation: University Hospital Lausanne (CHUV), Switzerland.
authors.forename: Pauline Coti
authors.initials: PC
authors.lastname: Bertrand
authors.affiliation: Charité Medical University Berlin, Berlin, Germany.
authors.forename: Kristina
authors.initials: K
authors.lastname: Norman
authors.affiliation: Cantonal Hospital Luzern, Luzern, Switzerland.
authors.forename: Christoph
authors.initials: C
authors.lastname: Henzen
authors.affiliation: Department of Clinical Medicine, Sapienza University, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Laviano
authors.affiliation: University of Hohenheim, Stuttgart, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Bischoff
authors.affiliation: University Hospital, University of Nice Sophia-Antipolis, Faculty of Medicine, Nice, France.
authors.forename: Stéphane M
authors.initials: SM
authors.lastname: Schneider
authors.affiliation: University Hospital Rigshospitalet and University of Copenhagen, Copenhagen, Denmark.
authors.forename: Jens
authors.initials: J
authors.lastname: Kondrup
authors.affiliation: University Hospital Rigshospitalet and University of Copenhagen, Copenhagen, Denmark. Electronic address: Philipp.Schuetz@unibas.ch.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
mesh_terms: D006801:Humans; D000208:Acute Disease; D000465:Algorithms; D007297:Inpatients; D044342:Malnutrition / Q000175:diagnosis / Q000178:diet therapy; D015596:Nutrition Assessment; D044623:Nutrition Therapy / Q000379:methods; D009752:Nutritional Status; D017410:Practice Guidelines as Topic; D015203:Reproducibility of Results
keywords: Acute disease; Clinical algorithm; Disease-related malnutrition; Medical wards; Nutritional therapy; Procedures