Artificial nutrition support in hospital: indications and complications

CME GastroenterologyMalnutrition, both as a cause and consequence of disease, affects 10-50% of patients admitted to hospital.Malnourished patients have higher mortality rates and increased incidence of complications, with delayed recovery from illness during and after hospital stay.The care of malnourished patients should involve a multidisciplinary approach but doctors have the overall responsibility to identify those at nutritional risk, take appropriate action and monitor outcomes.1 Malnutrition remains underrecognised and undertreated and, when it is identified, there is often misunderstanding regarding the specific indications and potential complications of artificial nutrition support. IndicationsNutrition support should be considered in patients:• who are malnourished, as defined as those who have:-body mass index (BMI) below 18.5 kg/m 2 -unintentional weight loss greater than 10% within the last 3-6 months -BMI less than 20 kg/m 2 and unintentional weight loss greater than 5% within the last 3-6 months• at risk of malnutrition, defined as those who have:-eaten or are likely to eat nothing for more than five days -inadequate intake (eg less than half normal intake for 10 days) which is deteriorating or not improving -poor absorptive capacity and/or high nutrient losses and/or increased nutritional needs from causes such as catabolism.