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Cited by 615Clinical Nutrition and GastroenterologyTrace Elements in HealthNutrition and Health Studies

ESPEN micronutrient guideline

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Berger, Mette M., Shenkin, Alan, Schweinlin, Anna, Amrein, Karin, Augsburger, Marc, Biesalski, Hans-Konrad, Bischoff, Stephan C., Casaer, Michael P. +8 more·2022·Clinical Nutrition
DOI 10.1016/j.clnu.2022.02.015
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Abstract

BACKGROUND: Trace elements and vitamins, named together micronutrients (MNs), are essential for human metabolism. Recent research has shown the importance of MNs in common pathologies, with significant deficiencies impacting the outcome. OBJECTIVE: This guideline aims to provide information for daily clinical nutrition practice regarding assessment of MN status, monitoring, and prescription. It proposes a consensus terminology, since many words are used imprecisely, resulting in confusion. This is particularly true for the words "deficiency", "repletion", "complement", and "supplement". METHODS: The expert group attempted to apply the 2015 standard operating procedures (SOP) for ESPEN which focuses on disease. However, this approach could not be applied due to the multiple diseases requiring clinical nutrition resulting in one text for each MN, rather than for diseases. An extensive search of the literature was conducted in the databases Medline, PubMed, Cochrane, Google Scholar, and CINAHL. The search focused on physiological data, historical evidence (published before PubMed release in 1996), and observational and/or randomized trials. For each MN, the main functions, optimal analytical methods, impact of inflammation, potential toxicity, and provision during enteral or parenteral nutrition were addressed. The SOP wording was applied for strength of recommendations. RESULTS: There was a limited number of interventional trials, preventing meta-analysis and leading to a low level of evidence. The recommendations underwent a consensus process, which resulted in a percentage of agreement (%): strong consensus required of >90% of votes. Altogether the guideline proposes sets of recommendations for 26 MNs, resulting in 170 single recommendations. Critical MNs were identified with deficiencies being present in numerous acute and chronic diseases. Monitoring and management strategies are proposed. CONCLUSION: This guideline should enable addressing suboptimal and deficient status of a bundle of MNs in at-risk diseases. In particular, it offers practical advice on MN provision and monitoring during nutritional support.

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Crossref · 10.1016/j.clnu.2022.02.015

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  • The inclusion of renal function and micronutrient biomarkers aligns with ESPEN and ASPEN recommendations that advocate for multidimensional biochemical panels in clinical nutrition practice.

    “The inclusion of renal function and micronutrient biomarkers aligns with current European Society of Clinical Nutrition and Metabolism (ESPEN) [153] and American Society for Parenteral and Enteral Nutrition (ASPEN) [154] recommendations that advocate for multidimensional biochemical panels in clinical nutrition practice.”

    From The Seven Methods for the Evaluation of Nutritional Status—ABCDEFG: Narrative Review (2026) · cites this paper as [153]

    The ESPEN guideline recommends measuring C-reactive protein alongside any micronutrient analysis (Recommendation 3, p. 9), and says albumin is desirable when a series of micronutrients is measured (Comment, p. 9). This supports combining micronutrient biomarkers with contextual biochemical tests, but the cited guideline does not recommend a panel that includes renal-function tests. The separate ASPEN citation is not assessed here. (LLM, conf=0.85)

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  • In polymorbid medical inpatients exclusively fed orally, an adequate intake of micronutrients (vitamins and trace elements) to meet daily estimated requirements should be ensured.

    “In polymorbid medical inpatients exclusively fed orally, an adequate intake of micronutrients (vitamins and trace elements) to meet daily estimated requirements should be ensured.”

    From ESPEN guideline on nutritional support for polymorbid medical inpatients (2023) · cites this paper as [93]

    Recommendation 1 (p. 8) calls for adequate trace elements and vitamins for patients receiving medical nutrition, and Recommendation 2 (p. 8) allows oral supplementation. But the guideline says it focuses primarily on enteral and parenteral nutrition (section 2.4, p. 8); these passages do not specifically establish daily estimated requirements for polymorbid inpatients fed exclusively orally. (LLM, conf=0.86)

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Authors
Berger, M. M., Shenkin, A., Schweinlin, A., Amrein, K., Augsburger, M., Biesalski, H.-K., Bischoff, S. C., Casaer, M. P., Gundogan, K., Lepp, H.-L., de Man, A. M. E., Muscogiuri, G., Pietka, M., Pironi, L., Rezzi, S., & Cuerda, C.
Affiliations
  • Centre Hospitalier Universitaire Vaudois (CH)
  • University of Liverpool (GB)
  • University of Hohenheim (DE)
  • University of Geneva (CH)
  • Erciyes University (TR)
  • North Estonia Medical Centre (EE)
  • UNESCO (FR)
  • Szpital Wielospecjalistyczny im. Stanley Dudricka w Skawinie (PL)
  • University of Bologna (IT)
  • Universidad Complutense de Madrid (ES)
ORCID
Venue
Clinical Nutrition
Publisher
Elsevier BV
Published
2022-06
Volume
41
Issue
6
Pages
1357-1424
ISSN
0261-5614 (ISSN-L)
DOI
10.1016/j.clnu.2022.02.015
OpenAlex
W4214768398
Cited by
615
References
37
Citations by year
2026: 113 · 2025: 151 · 2024: 180 · 2023: 139 · 2022: 31
FWCI
77.41
Type
journal article
Language
en
Update notices
erratum (2024-04-01)
Open access
Licence
Locations
  • Clinical Nutrition (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion, other-oa)
  • SERVAL (Université de Lausanne) (publishedVersion, cc-by-nc-nd)
  • Lirias (KU Leuven) (submittedVersion, cc-by-nc-nd)
  • Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion, cc-by-nc-nd)
  • IRIS (submittedVersion, cc-by-nc-nd)
Funders
European Society for Clinical Nutrition and Metabolism
Topics
  • Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
  • Health Sciences › Nursing › Nutrition and Dietetics › Trace Elements in Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Nutrition and Health Studies
Keywords
micronutrients, trace elements, vitamins, micronutrient deficiency, micronutrient status assessment, micronutrient supplementation, enteral nutrition, parenteral nutrition, nutritional support, micronutrient toxicity, clinical nutrition practice
MeSH terms
Humans, Trace Elements, Vitamin A, Vitamins, Micronutrients, Dietary Supplements

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