75 and 76 Such assessment, conducted by a qualified and trained clinician (dietitian, nutrition specialist, physician, or nurse), determines the extent of nutritional shortfall. Following assessment, the clinician creates an individualized plan that specifies how, what, and how much to feed.7 Guidelines support prompt intervention (ie targeted nutrition therapy within 24 to 48 hours of admission).15, 16 and 17 Any underlying causes of malnutrition identified during screening or assessment (eg chronic BIBF 1120 solubility dmso disease, oral or swallowing problems, depression) also should
be treated.7, 77 and 78 To facilitate malnutrition diagnosis and help standardize malnutrition care, experts from the American Society for Parenteral www.selleckchem.com/products/ldk378.html and Enteral Nutrition and the Academy of Nutrition and Dietetics defined specific criteria for malnutrition diagnosis.79 This step involves decisions about how much to feed, how and when to feed, and what to feed. It is first necessary to estimate energy and protein needs and to establish
target goals for each patient.16 and 17 Adult energy requirements depend on needs for basal metabolism, physical activity, and metabolic stresses of different disease conditions.80 These requirements may be calculated by predictive equations or measured by indirect calorimetry; predictive equations are less accurate for individual patients, whereas indirect calorimetry requires specialized equipment. The easiest method to estimate energy needs is to use the simple predictive formula that determines daily calorie requirements by multiplying the patient’s actual body weight (in kg) by 25 to 30 kcal (Table 4).17 Ideal or adjusted body weight is used for estimating needs of obese and emaciated adults. Adults with critical Acetophenone illness are at particular risk of sarcopenia, as are those who are of older age.65, 66, 67, 81 and 82 In a patient who is critically ill, muscle loss occurs early and rapidly. A recent study showed a 17% loss
in muscle mass in 10 days in the intensive care unit.83 Protein is an essential nutrient for maintaining muscle synthesis and preventing its degradation. The recommendation for usual adult dietary protein intake is 0.8 g protein per kilogram body weight per day.84 Protein targets for adults with disease or injury are in the range of 1.0 to 2.0 g/kg body weight per day.17 and 85 To maintain lean body mass and function, adults older than 65 years have higher needs than do younger adults (≥1.0 g protein per kilogram body weight per day).85 and 86 In patients with burns or multitrauma, protein need may be as high as 2.0 g/kg body weight per day.17 and 85 Choosing the appropriate form of nutrition therapy is stepwise and systematic.19 Enteral nutrition, feeding by way of the gastrointestinal system, includes providing regular food, adding oral nutritional supplements to the diet, or delivering formulas by tube feeding via nasogastric, nasoenteral, or percutaneous tubes.