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Cited by 1,505Nutrition and Health in AgingClinical Nutrition and GastroenterologyDysphagia Assessment and Management

ESPEN guideline on clinical nutrition and hydration in geriatrics

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Volkert, Dorothee, Beck, Anne Marie, Cederholm, Tommy, Cruz-Jentoft, Alfonso, Goisser, Sabine, Hooper, Lee, Kiesswetter, Eva, Maggio, Marcello +6 more·2019·Clinical Nutrition
DOI 10.1016/j.clnu.2018.05.024
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Abstract

Background Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats. Aim To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons. Methods This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process. Results We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counseling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach. Conclusion A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.

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  • The effects of snacks were not analyzed separately, so no specific conclusions were possible.

    “However, the effects of snacks were not 430 analyzed separately and thus no specific conclusions were possible in this regard.”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [16]

  • Food fortification by natural foods or specific nutrient preparations can increase energy and protein density of meals and beverages and thus enable an increased intake by eating similar amounts of food.

    “food fortification by natural foods or specific nutrient preparations 425 can increase energy and protein density of meals and beverages and thus enable an increased 426 intake by eating similar amounts of food [16]”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [16]

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Authors
Volkert, D., Beck, A. M., Cederholm, T., Cruz-Jentoft, A., Goisser, S., Hooper, L., Kiesswetter, E., Maggio, M., Raynaud-Simon, A., Sieber, C. C., Sobotka, L., van Asselt, D., Wirth, R., & Bischoff, S. C.
Affiliations
  • Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
  • Herlev Hospital (DK)
  • Uppsala University (SE)
  • Instituto Ramón y Cajal de Investigación Sanitaria (ES)
  • Heidelberg University (DE)
  • University of East Anglia (GB)
  • University of Parma (IT)
  • Assistance Publique – Hôpitaux de Paris (FR)
  • Charles University (CZ)
  • Universitätsklinik Marien Hospital Herne (DE)
  • University of Hohenheim (DE)
Corresponding author
Volkert, Dorothee
ORCID
Venue
Clinical Nutrition
Publisher
Elsevier BV
Published
2019-02
Volume
38
Issue
1
Pages
10-47
ISSN
0261-5614 (ISSN-L)
DOI
10.1016/j.clnu.2018.05.024
OpenAlex
W2809202362
Cited by
1,505
References
62
Citations by year
2026: 226 · 2025: 194 · 2024: 189 · 2023: 203 · 2022: 216 · 2021: 224 · 2020: 170 · 2019: 81 · 2018: 1
FWCI
79.10
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Nutrition (publishedVersion)
  • PubMed (publishedVersion)
  • UEA Digital Repository (University of East Anglia) (acceptedVersion)
  • University of Regensburg Publication Server (University of Regensburg) (submittedVersion)
  • Radboud Repository (Radboud University) (submittedVersion)
Funders
III
Topics
  • Health Sciences › Medicine › Physiology › Nutrition and Health in Aging
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Health Professions › Speech and Hearing › Dysphagia Assessment and Management
Keywords
hydration, malnutrition, dehydration, obesity in older adults, weight loss diet, malnutrition screening, enteral nutrition, parenteral nutrition, oral nutritional supplements, nutrition counseling, dietary restriction, physical activity, multidisciplinary care
MeSH terms
Aged, Aged, 80 and over, Dehydration, Enteral Nutrition, Europe, Geriatrics, Humans, Parenteral Nutrition, Societies, Medical, Malnutrition, Overweight

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