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Early nutritional therapy for malnourished or nutritionally at‐risk adult medical inpatients - PMC

Official websites use. Share sensitive information only on official, secure websites. Acute illness is associated with loss of appetite, leading to poor nutritional status and risk of malnutrition, particularly in the elderly and frail medical patient population Kubrak Whether loss of appetite associated with acute illness is indeed a protective physiological response or a therapeutic target needing early corrective nutritional therapy remains controversial.

However, some recent data from critical care suggested harmful effects of aggressive early over feeding protocols and glutamine supplementation Casaer ; Heyland ; Schetz Those controversial results may have various explanations: methodological issues such as differences in the patient populations studied or trial design but also factors associated with the nutritional interventions provided such as timing or composition and amounts of nutritional elements provided.

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In particular, there is an ongoing debate on whether excessive use of nutrition including glutamine may have caused the harmful effects. During the acute phase of illness, the body mobilises substrates from muscle and fat tissue to match the increased resting energy expenditure Vincent Exogenous calories, then, no longer inhibit gluconeogenesis.

Excessive nutrition during the acute phase of illness can thus induce occult overfeeding. On the other hand, critical care data cannot unconditionally be transferred to medical inpatients with a lower degree of illness severity.

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Interestingly, recent research reported benefits of tailored support in carefully selected critically ill patients Heidegger The lack of high level evidence on the effectiveness and cost benefits of nutritional support and the absence of data showing which patient population does or does not benefit from the intervention may explain why recommendations including ideal nutritional target, route or timing for nutritional therapy in medical inpatients are still missing Mueller ; Sobotka ; Volkert Malnutrition is a common condition in hospitalised patients with acute and chronic illnesses.

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