Clinical nutrition

Clinical nutrition is nutrition of patients in health care. Clinical in this sense refers to the management of patients, including not only outpatients at clinics, but also (and mainly) inpatients in hospitals. It incorporates primarily the scientific fields of nutrition and dietetics. It aims to keep a healthy energy balance in patients, as well as providing sufficient amounts other nutrients such as protein, vitamins, minerals.

Dietary needs and disease processes

Normally, individuals obtain the necessary nutrients their bodies require through normal daily diets that process the foods accordingly within the body. Nevertheless, there are circumstances such as disease, distress, stress, and so on that may prevent the body from obtaining sufficient nutrients through diets alone. In such conditions, a dietary supplementation specifically formulated for their individual condition may be required to fill the void created by the specific condition. This can come in form of Medical Nutrition.[1]

Methods of nutrition

Among the routes of administration, the preferred means of nutrition is, if possible, oral administration. Alternatives include enteral administration (in nasogastric feeding) and intravenous (in parenteral nutrition).

Clinical malnutrition

In the field of clinical nutrition, malnutrition has causes, epidemiology and management distinct from those associated with malnutrition that is mainly related to poverty.

The main causes of clinical malnutrition are:

Clinical malnutrition may also be aggravated by iatrogenic factors, i.e., the inability of a health care entity to appropriately compensate for causes of malnutrition.

There are various definitions of clinical malnutrition. According to one of them, patients are defined as severely undernourished when meeting at least one of the following criteria: BMI < or = 20 kg/m2 and/or > or = 5% unintentional weight loss in the past month and/or > or = 10% unintentional weight loss in the past 6 months. By the same system, the patient is moderately undernourished if they met at least one of the following criteria: BMI 20.1–22 kg/m2 and/or 5-10% unintentional weight loss in the past six months.[2]

Medical nutrition therapy

Medical nutrition therapy (MNT) is the use of specific nutrition services to treat an illness, injury, or condition.[3] It was introduced in 1994 by the American Dietetic Association to better articulate the nutrition therapy process. It involves the assessment of the nutritional status of the client and the actual treatment, which includes nutrition therapy, counseling, and the use of specialized nutrition supplements,[3][4] devised and monitored by a medical doctor physician or registered dietitian nutritionist (RDN).[5] Registered dietitians started using MNT as a dietary intervention for preventing or treating other health conditions that are caused by or made worse by unhealthy eating habits.[6]

The role of MNT when administered by a physician or dietitian nutritionist (RDN) is to reduce the risk of developing complications in pre-existing conditions such as type 2 diabetes as well as ameliorate the effects any existing conditions such as high cholesterol. Many medical conditions either develop or are made worse by an improper or unhealthy diet.[7][8][9]

An example is the use of macronutrient preload in type 2 diabetes.[10][11]

Administration

In most cases the use of Medical Nutrition is recommended within international and professional guidelines.[1] It can be an integral part of managing acute and short-term diseases. It can also play a major role in supporting patients for extended periods of time and even for a lifetime in some special cases.[1] Medical Nutrition is not meant to replace the treatment of disease but rather complement the normal use of drug therapies prescribed by physicians and other licensed healthcare providers.[1]

Unlike Medical Foods which are defined by the U.S. Department of Health and Human Services Food and Drug Administration, within their Medical Foods Guidance Documents & Regulatory Information guide in section 5(b) of the Orphan Drug Act (21 U.S.C. 30ee (b) (3)); as “a food which is formulated to be consumed or administered enterally under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation,”[12]

Advantages

The following advantages come with medical nutrition:

Disadvantages

The following are some disadvantages of medical nutrition:

  • A patient may need to follow a strict diet to see benefits while using a medical nutrition plan.[15]
  • Some forms of medical nutrition can be very expensive. A poor patient may not afford such.[14]

Journals

The American Journal of Clinical Nutrition is the highest-ranked journal in ISI's nutrition category.[16]

See also

Notes and references
  1. "What is Medical Nutrition?". nutritioncollege.org. Archived from the original on 11 May 2017. Retrieved 3 May 2016.
  2. Kruizenga HM, de Vet HC, Van Marissing CM, et al. (2010). "The SNAQ(RC), an easy traffic light system as a first step in the recognition of undernutrition in residential care". J Nutr Health Aging. 14 (2): 83–9. doi:10.1007/s12603-009-0147-1. PMID 20126953.
  3. "RDNs and Medical Nutrition Therapy Services". eatright.org. 12 June 2014. Retrieved 3 May 2016.
  4. Sara F., Morris, et all. "Medical Nutrition Therapy: A Key to Diabetes Management and Prevention". clinical.diabetesjournals.org. Retrieved 3 May 2016.
  5. Skipper, Annalynn (2009-10-07). Advanced Medical Nutrition Therapy Practice. Jones & Bartlett Learning. p. 50. ISBN 9780763742898.
  6. "Medical Nutrition Therapy: Definition & Uses". study.com. Retrieved 3 May 2016.
  7. Sikand G, Kashyap ML, Yang I (August 1998). "Medical nutrition therapy lowers serum cholesterol and saves medication costs in men with hypercholesterolemia". J Am Diet Assoc. 98 (8): 889–94, quiz 895–6. doi:10.1016/S0002-8223(98)00204-1. PMID 9710659.CS1 maint: multiple names: authors list (link)
  8. Copperman N, Jacobson MS (February 2003). "Medical nutrition therapy of overweight adolescents". Adolesc Med. 14 (1): 11–21. PMID 12529187.
  9. Novaković B, Grujicić M, Trajković-Pavlović L (2009). "[Medical nutrition prevention and medical nutrition therapy of lipid metabolism disorder]". Med. Pregl. 62 Suppl 3: 95–100. PMID 19702125.CS1 maint: multiple names: authors list (link)
  10. Li C, Norstedt G, Hu ZG, Yu P, Li DQ, Li J, Yu Q, Sederholm M, Yu DM. Effects of a macronutrient preload on type 2 diabetic patients, Frontiers in Endocrinology 6:139, 2015
  11. Morris, Sara F.; Wylie-Rosett, Judith (2010-01-01). "Medical Nutrition Therapy: A Key to Diabetes Management and Prevention". Clinical Diabetes. 28 (1): 12–18. doi:10.2337/diaclin.28.1.12. ISSN 0891-8929.
  12. "Draft Guidance for Industry: Frequently Asked Questions About Medical Foods; Second Edition". fda.gov. Retrieved 3 May 2016.
  13. Joyce Green, Pastors et all. "The Evidence for the Effectiveness of Medical Nutrition Therapy in Diabetes Management". care.diabetesjournals.org. Retrieved 3 May 2016.
  14. "Strategy & Key Figures - Longer, Healthier Lives". danone.com. Archived from the original on 6 February 2018. Retrieved 3 May 2016.
  15. Natalie, Stein (19 August 2015). "What Are the Advantages & Disadvantages of Nutritional Therapy?". livestrong.com. Retrieved 3 May 2016.
  16. "Advertising in The American Journal of Clinical Nutrition". Retrieved June 18, 2009.
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