ESPEN guidelines on nutritional support for polymorbid internal medicine patients
Open accessAbstract
Background & aims Polymorbidity (also known as multimorbidity) - defined as the co-occurrence of at least two chronic health conditions - is highly prevalent, particularly in the hospitalized population. Nonetheless, clinical guidelines largely address individual diseases and rarely account for polymorbidity. The aim of this project was to develop guidelines on nutritional support for polymorbid patients hospitalized in medical wards. Methods The methodology used for the development of the current project follows the standard operating procedures for ESPEN guidelines. It started with an initial meeting of the Working Group in January 2015, where twelve key clinical questions were developed that encompassed different aspects of nutritional support: indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. Systematic literature searches were conducted in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines), until April 2016. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations, which were followed by submission to Delphi voting rounds. Results From a total of 4532 retrieved abstracts, 38 relevant studies were analyzed and used to generate a guideline draft that proposed 22 recommendations and four statements. The results of the first online voting showed a strong consensus (agreement of >90%) in 68% of recommendations and 75% of statements, and consensus (agreement of >75-90%) in 32% of recommendations and 25% of statements. At the final consensus conference, a consensus greater than 89% was reached for all of the recommendations. Conclusions Despite the methodological difficulties in creating non-disease specific guidelines, the evidence behind several important aspects of nutritional support for polymorbid medical inpatients was reviewed and summarized into practical clinical recommendations. Use of these guidelines offer an evidence-based nutritional approach to the polymorbid medical inpatient and may improve their outcomes.
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For polymorbid medical inpatients at nutritional risk with impaired kidney function (eGFR <30 ml/min/1.73m2) who are not on kidney replacement therapy, a low amount of protein of 0.8 g protein/kg body weight/day should be targeted.
“For polymorbid medical inpatients at nutritional risk with impaired kidney function (eGFR <30 ml/min/1.73m 2 ) who are not on kidney replacement therapy, a low amount of protein of 0.8 g protein/kg body weight/day should be targeted.”
From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [1]
The Accepted Manuscript (p. 32) reports that renal-patient guidelines recommend 0.8–1 g/kg/day for at-risk or malnourished inpatients with renal failure who are not receiving renal replacement therapy. It does not specify an eGFR threshold or a fixed 0.8 g/kg/day target; it explicitly says a protein-intake recommendation cannot be made for polymorbid inpatients with a renal condition. (LLM, conf=0.88)
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Self-citationMalnutrition in Older Adults—Recent Advances and Remaining Challenges
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Self-citationESPEN guideline on home enteral nutrition
Bischoff, S. C., Austin, P. D., Boeykens, K., Chourdakis, M., Cuerda, C., Jonkers‐Schuitema, C. F., Lichota, M., Nyulasi, I. B., Schneider, S. M., Stanga, Z. G., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2019.04.022 · Cited by 437 · see citing works
Self-citationManagement of disease-related malnutrition for patients being treated in hospital
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Self-citationSurviving sepsis campaign: research priorities for sepsis and septic shock
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ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease
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Self-citationESPEN guideline on hospital nutrition
Thibault, R., Abbasoglu, O., Ioannou, E., Meija, L., Ottens-Oussoren, K., Pichard, C., Rothenberg, E., Rubin, D., Siljamäki-Ojansuu, U., Vaillant, M.-F., et al. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.09.039 · Cited by 259 · see citing works
Self-citationCaccialanza, R., Laviano, A., Lobascio, F., Montagna, E., Bruno, R., Ludovisi, S., Corsico, A. G., Sabatino, A. D., Belliato, M., Calvi, M., et al. (2020) · Nutrition · doi:10.1016/j.nut.2020.110835 · Cited by 257 · see citing works
Self-citationBellanti, F., Buglio, A. L., Quiete, S., & Vendemiale, G. (2022) · Nutrients · doi:10.3390/nu14040910 · Cited by 228 · see citing works
Hersberger, L., Bargetzi, L., Bargetzi, A., Tribolet, P., Fehr, R., Baechli, V., Geiser, M., Deiss, M., Gomes, F., Kutz, A., et al. (2019) · Clinical Nutrition · doi:10.1016/j.clnu.2019.11.041 · Cited by 226 · see citing works
Self-citationMahmoodpoor, A., Shadvar, K., Saghaleini, S. H., Dehghan, K., & Ostadi, Z. (2018) · Indian Journal of Critical Care Medicine · doi:10.4103/ijccm.ijccm_277_17 · Cited by 217 · see citing works
The Underappreciated Role of Low Muscle Mass in the Management of Malnutrition
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Self-citationdi Filippo, L., LORENZO, R. D., D’Amico, M., Sofia, V. M., Roveri, L., Mele, R., Saibene, A., Rovere, P. Q., & Conte, C. (2020) · Clinical Nutrition · doi:10.1016/j.clnu.2020.10.043 · Cited by 190 · see citing works
Friedli, N., Stanga, Z., Culkin, A., Crook, M., Laviano, A., Sobotka, L., Kressig, R. W., Kondrup, J., Mueller, B., & Schuetz, P. (2018) · Nutrition · doi:10.1016/j.nut.2017.09.007 · Cited by 169 · see citing works
Self-citationESPEN practical guideline: Home enteral nutrition
Bischoff, S. C., Austin, P. D., Boeykens, K., Chourdakis, M., Cuerda, C., Jonkers‐Schuitema, C. F., Lichota, M., Nyulasi, I. B., Schneider, S. M., Stanga, Z. G., et al. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.10.018 · Cited by 155 · see citing works
Self-citationTagliaferri, S., Lauretani, F., Pelà, G. M., Meschi, T., & Maggio, M. G. (2018) · Clinical Nutrition · doi:10.1016/j.clnu.2018.11.022 · Cited by 143 · see citing works
Evaluation of Nutritional Support and In-Hospital Mortality in Patients With Malnutrition
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Self-citationSurviving Sepsis Campaign: Research Priorities for Sepsis and Septic Shock
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Arvanitakis, M., Gkolfakis, P., Despott, E. J., Ballarin, A., ten Beyna, T., Boeykens, K., Elbe, P., Gisbertz, I. A. M., Hoyois, A., Moșteanu, O., et al. (2020) · Endoscopy · doi:10.1055/a-1303-7449 · Cited by 117 · see citing works
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ESPEN guideline on nutritional support for polymorbid medical inpatients
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“The present guideline represents an update of the original guideline on polymorbid patients from 2018 [1] and follows the Standard Operating Procedures (SOP) from European Society for Clinical Nutrition and Metabolism (ESPEN) [2].”
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Self-citationESPEN practical guideline: Nutritional support for polymorbid medical inpatients
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Self-citationThomas, S. E., Alexander, C., & Cassady, B. A. (2021) · Clinical Nutrition ESPEN · doi:10.1016/j.clnesp.2021.06.002 · Cited by 40 · see citing works
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Self-citationConceptualising comorbidity and multimorbidity in dementia: A scoping review and syndemic framework
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Weight trajectories and abdominal adiposity in COVID-19 survivors with overweight/obesity
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Self-citationHoyois, A., Ballarin, A., Thomas, J., Lheureux, O., Preiser, J., Coppens, E., Pérez-Bogerd, S., Taton, O., Farine, S., Ouytsel, P. V., et al. (2021) · Journal of Parenteral and Enteral Nutrition · doi:10.1002/jpen.2101 · Cited by 36 · see citing works
Impact of COVID-19 on nutritional status during the first wave of the pandemic
Ramos, A., Joaquín, C., Ros, M., Martin, M., Cachero, M., Sospedra, M., Martínez, E., Sánchez-Migallón, J. M., Madroño, M. J. S., Soldevila, B., et al. (2021) · Clinical Nutrition · doi:10.1016/j.clnu.2021.05.001 · Cited by 35 · see citing works
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Self-citationComorbidity, multimorbidity, dual diagnosis — synonyms or different terms?
Drapkina, O. M., Шутов, А. М., & Ефремова, Е. В. (2019) · CARDIOVASCULAR THERAPY AND PREVENTION · doi:10.15829/1728-8800-2019-2-65-69 · Cited by 33 · see citing works
Beta-hydroxy-beta-methylbutyrate and sarcopenia
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Metabolic and nutritional aspects in continuous renal replacement therapy
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Clinical Nutrition of Critically Ill Patients in the Context of the Latest ESPEN Guidelines
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- Authors
- Gomes, F., Schuetz, P., Bounoure, L., Austin, P., Ballesteros-Pomar, M., Cederholm, T., Fletcher, J., Laviano, A., Norman, K., Poulia, K.-A., Ravasco, P., Schneider, S. M., Stanga, Z., Weekes, C. E., & Bischoff, S. C.
- Affiliations
- University of Basel (CH)
- Complejo Asistencial Universitario de León (ES)
- Uppsala University (SE)
- Queen Elizabeth Hospital Birmingham (GB)
- Sapienza University of Rome (IT)
- Charité – Universitätsmedizin Berlin (DE)
- Laiko General Hospital of Athens (GR)
- University of Lisbon (PT)
- University of Bern (CH)
- King's College London (GB)
- University of Hohenheim (DE)
- ORCID
- Venue
- Clinical Nutrition
- Publisher
- Elsevier BV
- Published
- 2018-02
- Volume
- 37
- Issue
- 1
- Pages
- 336-353
- ISSN
- 0261-5614 (ISSN-L)
- OpenAlex
- W2738062702
- Cited by
- 363
- References
- 105
- Citations by year
- 2026: 24 · 2025: 33 · 2024: 41 · 2023: 46 · 2022: 57 · 2021: 57 · 2020: 51 · 2019: 35 · 2018: 15 · 2017: 4
- FWCI
- 23.88
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Clinical Nutrition (acceptedVersion)
- PubMed (publishedVersion)
- Bern Open Repository and Information System (University of Bern) (submittedVersion)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Funders
- ESPEN society
- SNF Swiss National Science Foundation (PP00 P3_150531/1)
- Research Council of the Kantonsspital Aarau, Switzerland (1410.000.044)
- Nestlé and Fresenius
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
- Health Sciences › Health Professions › Health Information Management › Dietetics, Nutrition, and Education
- Keywords
- multimorbidity, nutritional support, internal medicine, energy and protein requirements, micronutrient requirements, Delphi consensus, ESPEN
- MeSH terms
- Hospitalization, Humans, Comorbidity, Practice Guidelines as Topic, Nutrition Therapy
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