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Cited by 571Dysphagia Assessment and ManagementClinical Nutrition and GastroenterologyNutrition and Health in Aging

ESPEN guideline clinical nutrition in neurology

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Burgos, Rosa, Bretón, Irene, Cereda, Emanuele, Desport, Jean Claude, Dziewas, Rainer, Genton, Laurence, Gomes, Filomena, Jésus, Pierre +8 more·2018·Clinical Nutrition
DOI 10.1016/j.clnu.2017.09.003
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Abstract

Neurological diseases are frequently associated with swallowing disorders and malnutrition. Moreover, patients with neurological diseases are at increased risk of micronutrient deficiency and dehydration. On the other hand, nutritional factors may be involved in the pathogenesis of neurological diseases. Multiple causes for the development of malnutrition in patients with neurological diseases are known including oropharyngeal dysphagia, impaired consciousness, perception deficits, cognitive dysfunction, and increased needs. The present evidence- and consensus-based guideline addresses clinical questions on best medical nutrition therapy in patients with neurological diseases. Among them, management of oropharyngeal dysphagia plays a pivotal role. The guideline has been written by a multidisciplinary team and offers 88 recommendations for use in clinical practice for amyotrophic lateral sclerosis, Parkinson's disease, stroke and multiple sclerosis.

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  • In people following stroke, thickened fluids alongside access to free water compared to thickened liquids alone was effective at protecting against aspiration and increasing fluid intake.

    “A recent systematic review and guidelines report RCTs showing that in people following stroke, thickened fluids alongside access to free water (no other drinks) compared to thickened liquids alone was effective at protecting against aspiration and increasing fluid intake.”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [110]

    In the Recommendation 61 commentary (page unavailable), the guideline describes stroke trials comparing thickened liquids plus free water with thickened liquids alone, and reports no pneumonia in either group. But the reported RCT found identical mean total beverage intake in both groups; the guideline does not establish that free water increased intake or protected against aspiration compared with thickened liquids alone. (LLM, conf=0.87)

    Experimental — accuracy not yet measured

  • Many guidelines and studies recommend that in initial stages of dysphagia, adequate nutrition intake may be achieved through dietary modification to include soft, semisolid, or semi-liquid consistencies, partnered with appropriate swallowing techniques.

    “In initial stages of dysphagia, adequate”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [15]

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

  • The use of pre-thickened drinks rather than drinks thickened with powder at the point of use was better at supporting fluid intake post-stroke.

    “The use of pre-thickened drinks rather than drinks thickened with powder at the point of use was also better at supporting fluid intake post-stroke (110).”

    From ESPEN practical guideline: Clinical nutrition and hydration in geriatrics (2022) · cites this paper as [110]

  • There is a lack of evidence on the positive and adverse effects of texture-modified diets in stroke patients with dysphagia.

    “evidence on the positives well as on the adverse effects of texture-modified diets in stroke”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [15]

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Authors
Burgos, R., Bretón, I., Cereda, E., Desport, J. C., Dziewas, R., Genton, L., Gomes, F., Jésus, P., Leischker, A., Muscaritoli, M., Poulia, K.-A., Preiser, J. C., Van der Marck, M., Wirth, R., Singer, P., & Bischoff, S. C.
Affiliations
  • Vall d'Hebron Hospital Universitari (ES)
  • Policlinico San Matteo Fondazione (IT)
  • Centre Hospitalier Universitaire de Limoges (FR)
  • University Hospital Münster (DE)
  • University Hospital of Geneva (CH)
  • Cereneo (CH)
  • Sapienza University of Rome (IT)
  • Laiko General Hospital of Athens (GR)
  • Université Libre de Bruxelles (BE)
  • Universitätsklinik Marien Hospital Herne (DE)
  • Tel Aviv University (IL)
  • University of Hohenheim (DE)
Corresponding author
Burgos, Rosa
ORCID
Venue
Clinical Nutrition
Publisher
Elsevier BV
Published
2018-02
Volume
37
Issue
1
Pages
354-396
ISSN
0261-5614 (ISSN-L)
DOI
10.1016/j.clnu.2017.09.003
OpenAlex
W2756752218
Cited by
571
References
8
Citations by year
2026: 77 · 2025: 82 · 2024: 86 · 2023: 73 · 2022: 79 · 2021: 70 · 2020: 44 · 2019: 40 · 2018: 18 · 2017: 1
FWCI
55.52
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Clinical Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • Archive ouverte UNIGE (University of Geneva) (acceptedVersion, other-oa)
  • Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
  • HAL (submittedVersion)
  • IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
  • Archive ouverte UNIGE (University of Geneva) (submittedVersion, cc-by)
Funders
  • VAST
  • ESPEN
Topics
  • Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
Keywords
neurological disorders, malnutrition, oropharyngeal dysphagia, dysphagia, medical nutrition therapy, micronutrient deficiency, dehydration, amyotrophic lateral sclerosis, Parkinson's disease, stroke, multiple sclerosis, dietary management
MeSH terms
Deglutition Disorders, Humans, Nervous System Diseases, Nutritional Status, Prognosis, Nutrition Policy, Stroke

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