Nütrisyonel destek yaklaşımında karşılaşılan sorunlar ve çözüm önerileri

Malnütrisyon yetersiz besin alımı sonrası gelişen vücut kompozisyonlarında ve fonksiyonlarında değişiklik ile sonuçlanan bir klinik tablodur. Özellikle, yaşlı bireyler, kanser hastaları, yoğun bakım hastaları, majör cerrahi gerektiren hastalar, hastanede yatan hastalar malnütrisyon açısından değerlendirilmelidir. Bu yazıda malnütriyonun değerlendirilmesi ve tedavisinde yaşanan zorluklar ve sıklıkla yapılan hataların gözden geçirilmesi amaçlandı.  
Anahtar Kelimeler:

Malnütrisyon

Problems And Proposals For Solutıon in Nutritional Support

Malnutrition is a clinical situation due to inadequate feeding that results in changes of body composition and function. Especially, cancer patients, intensive care patients, major surgery patients, hospitalized patients  and elderly fragile population are prone to malnutrion and should be evaluated for it. Here, we  overview frequent mistakes as well as difficulties in assessment and treatment of malnutrition.
Keywords:

Malnutrition,

___

  • Soeters PB, Rejiven PL, Van Bokhorst-de van Schueren MA et al. A rational approach to nutritional assessment. Clin Nutr 2008; 27: 706-716.
  • Cederholm T, Bosaeus I, Barazzoni R, et al. Diagnostic criteria for malnutrition An ESPEN Consensus Statement. Clinical Nutrition. 2015; 34: 335-340. White JV, Guenter P, Jensen G, Malone A, Schofield M; Academy Malnutrition Work Group; A.S.P.E.N. Malnutrition Task Force; A.S.P.E.N. Board of Directors. Consensus statement: Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: characteristics recommended for the identification and documentation of adult malnutrition (undernutrition). JPEN J Parenter Enteral Nutr. 2012; 36(3):275-83. Evans WJ, Morley JE, Argilés J, et al. Cachexia: a new definition. Clin Nutr. 2008;27(6):793-9. Edwards MH, Buehring B. Novel Approaches to the Diagnosis of Sarcopenia. J Clin Densitom. 2015;18(4):472-7. Laur CV, McNicholl T, Valaitis R, Keller HH. Malnutrition or frailty? Overlap and evidence gaps in the diagnosis and treatment of frailty and malnutrition. Appl Physiol Nutr Metab. 2017;42(5):449-458. Cederholm T, Barazzoni R, Austin P, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017;36(1):49-64. Elia M. Defining, Recognizing, and Reporting Malnutrition. Int J Low Extrem Wounds. 2017;16(4):230-237. Feinberg J, Nielsen EE, Korang SK, et al. Nutrition support in hospitalised adults at nutritional risk. Cochrane Database Syst Rev. 2017;5:CD011598. Norman K1, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition Clin Nutr. 2008;27(1):5-15. Correia MI1, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003 ;22(3):235-9. Korfali G, Gündoğdu H, Aydintuğ S, et al. Nutritional risk of hospitalized patients in Turkey. Clin Nutr. 2009; 28 (5):533-7. Jensen GL1, Compher C, Sullivan DH, Mullin GE. Recognizing malnutrition in adults: definitions and characteristics, screening, assessment, and team approach. JPEN J Parenter Enteral Nutr. 2013;37(6):802-7. Jones JM. The methodology of nutritional screening and assessment tools. J Hum Nutr Diet. 2002;15(1):59-71. Correia MITD. Nutrition Screening vs Nutrition Assessment: What's the Difference? Nutr Clin Pract. 2017:884533617719669. Hamilton C1, Boyce VJ. Addressing malnutrition in hospitalized adults. JPEN J Parenter Enteral Nutr. 2013;37(6):808-15. Leslie WS, Woodward M, Lean ME, Theobald H, Watson L, Hankey CR. Improving the dietary intake of under nourished older people in residential care homes using an energy-enriching food approach: a cluster randomised controlled study. J Hum Nutr Diet. 2013 ;26(4):387-94. Gupta RD, Ramachandran R, Venkatesan P, Anoop S, Joseph M, Thomas N. Indirect Calorimetry: From Bench to Bedside. Indian J Endocrinol Metab. 2017;21(4):594-599. Westerterp KR, Schols AMWJ, Singer P. Enerji Metabolizması. In Sobotka L Klinik nütrisyonun temelleri. 4. Baskı Galen 2013: 96- 103. Sugrue D, Jarrell AS, Kruer R, Davis S, Johnson D, Tsui E, Snyder S, Crow J. Appropriateness of peripheral parenteral nutrition use in adult patients at an academic medical center. Clin Nutr ESPEN. 2018; 23: 117-121. Elke G, van Zanten AR, Lemieux M, et al. Enteral versus parenteral nutrition in critically ill patients: an updated systematic review and meta-analysis of randomized controlled trials. Crit Care. 2016;20(1):117. Zhao XF, Wu N, Zhao GQ, Liu JF, Dai YF. Enteral nutrition versus parenteral nutrition after major abdominal surgery in patients with gastrointestinal cancer: a systematic review and meta-analysis. J Investig Med. 2016;64(5):1061-74. Ni MZ, Huddy JR, Priest OH, et al. Selecting pH cut-offs for the safe verification of nasogastric feeding tube placement: a decision analytical modelling approach. BMJ Open. 2017;7(11):e018128. Initial and Ongoing Verification of Feeding Tube Placement in Adults. Crit Care Nurse. 2017;37(5):100. Jones NE, Dhaliwal R, Day AG, Ouellette-Kuntz H, Heyland DK. Factors predicting adherence to the Canadian Clinical Practice Guidelines for nutrition support in mechanically ventilated, critically ill adult patients. J Crit Care. 2008;23(3):301-7. Reignier J, Mercier E, Le Gouge A, et al; Clinical Research in Intensive Care and Sepsis (CRICS) Group. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA. 2013;309(3):249-56. Montejo JC1, Miñambres E, Bordejé L et al. Gastric residual volume during enteral nutrition in ICU patients: the REGANE study. Intensive Care Med. 2010;36(8):1386-93. Friedli N, Stanga Z, Culkin A et al. Management and prevention of refeeding syndrome in medical inpatients: An evidence-based and consensus-supported algorithm. Nutrition. 2018;47:13-20.