Cited by 363Clinical Nutrition and GastroenterologyNutrition and Health in AgingDietetics, Nutrition, and Education

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ESPEN guidelines on nutritional support for polymorbid internal medicine patients

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Gomes, Filomena, Schuetz, Philipp, Bounoure, Lisa, Austin, Peter, Ballesteros-Pomar, María, Cederholm, Tommy, Fletcher, Jane, Laviano, Alessandro, Norman, Kristina, Poulia, Kalliopi-Anna, Ravasco, Paula, Schneider, Stephane M., Stanga, Zeno, Weekes, C. Elizabeth, Bischoff, Stephan C.·2018·Clinical Nutrition

DOI 10.1016/j.clnu.2017.06.025

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Abstract

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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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: Gomes, Filomena
Schuetz, Philipp
Austin, Peter
Ballesteros-Pomar, María
Cederholm, Tommy
Fletcher, Jane
Laviano, Alessandro
Norman, Kristina
Poulia, Kalliopi-Anna
Ravasco, Paula
Stanga, Zeno
Weekes, C. Elizabeth
Bischoff, Stephan C.
Venue: Clinical Nutrition
Publisher: Elsevier BV
Published: 2018-02
Volume: 37
Issue: 1
Pages: 336-353
ISSN: 0261-5614 (ISSN-L)
DOI: 10.1016/j.clnu.2017.06.025
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
FWCI: 23.88
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (am, 379 d)
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 (medical) › Nutrition and Health in Aging
Health Sciences › Nursing › Nutrition and Dietetics › 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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