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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/1.73m 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]
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Cites
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Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012) · The Lancet · doi:10.1016/s0140-6736(12)60240-2 · Cited by 6,972
Cochrane Handbook for Systematic Reviews of Interventions
Tarsilla, M. (2010) · Journal of MultiDisciplinary Evaluation · doi:10.56645/jmde.v6i14.284 · Cited by 5,232
ESPEN Guidelines for Nutrition Screening 2002
Kondrup, J. (2003) · Clinical Nutrition · doi:10.1016/s0261-5614(03)00098-0 · Cited by 3,159
Aging with multimorbidity: A systematic review of the literature
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ESPEN guidelines on definitions and terminology of clinical nutrition
Cederholm, T., Barazzoni, R., Austin, P., Ballmer, P., Biolo, G., Bischoff, S. C., Compher, C., Correia, I., Higashiguchi, T., Holst, M., et al. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2016.09.004 · Cited by 2,560
Self-citationA new predictive equation for resting energy expenditure in healthy individuals
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“REE measurements were compared with three prediction 541 equations including one specifically for obese individuals [44, 45, 53] and one weight542 based formula recommended by the American College of Chest Physicians (25 kcal/kg 543 body weight).”
MethodA biometric study of human basal metabolism
Harris, J. A., & Benedict, F. G. (1918) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.4.12.370 · Cited by 1,980
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1 of the 105 references couldn’t be matched to a known paper.
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- Crespi-Lofton, 2016, Managing clinically significant drug interactions in patients with HIV and comorbid conditions, Pharm Today, 64
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Schuetz, P., Fehr, R., Baechli, V., Geiser, M., Deiss, M., Gomes, F., Kutz, A., Tribolet, P., Bregenzer, T., Braun, N., et al. (2019) · The Lancet · doi:10.1016/s0140-6736(18)32776-4 · Cited by 910
Self-citationBarazzoni, R., Bischoff, S. C., Breda, J., Wickramasinghe, K. K., Krznarić, Ž., Nitzan, D., Pirlich, M., & Singer, P. (2020) · Clinical Nutrition · doi:10.1016/j.clnu.2020.03.022 · Cited by 910
Self-citationMalnutrition in Older Adults—Recent Advances and Remaining Challenges
Norman, K., Haß, U., & Pirlich, M. (2021) · Nutrients · doi:10.3390/nu13082764 · Cited by 905
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 460
Self-citationManagement of disease-related malnutrition for patients being treated in hospital
Schuetz, P., Seres, D., Lobo, D. N., Gomes, F., Kaegi-Braun, N., & Stanga, Z. (2021) · The Lancet · doi:10.1016/s0140-6736(21)01451-3 · Cited by 355
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Metadata
- 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
- 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 (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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