Journal List > Korean J Gastroenterol > v.65(6) > 1007379

Chang and Song: Understanding Nutritional Support in Digestive Diseases

Abstract

The prevalence of hospital malnutrition is still high in patients with digestive diseases, especially for those suffering from cancer and bowel diseases which cause malabsorption. It is well known that malnutrition is associated with delayed wound healing, impaired immunity, infection, increased complication, and poor convalenscence. Recently, nutrition screening and assessment by nutrition support team has become essential for nutrition management, and gastroenterologists comprise a dominant member of the nutrition support team. In critically ill patients and older people with chronic disease, nutritional support with enteral feeding and early feeding contributes to recovery and rehabilitation of patients. Securing enteral feeding routes, such as feeding tube insertion and placement of percutaneous endoscopic gastrostomy/jejunostomy, is an essential part of nutrition care that should be accomplished by gastroenterologists without much difficulty. It will also be necessary to recommend nutrition care as one of the clinical routines in gastrointestinal clinical practices. Therefore, education on nutrition care is strongly required as a part of gastroenterologist's training.

References

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Fig. 1.
Prognostic impact of disease-related malnutrition. Cited from the study of Norman et al.1 (Clin Nutr 2008;27:5–15) with the permission of original copyright holder.
kjg-65-333f1.tif
Fig. 2.
Nutrition care algorithm. Cited from the study of Mueller et al.2 (JPEN J Parenteral Enteral Nutr 2011;35: 16–24).
kjg-65-333f2.tif
Table 1.
Parameters in Nutrition Assessment Tools
1. Case history and physical examination: history taking, inspection, palpation
2. Antrhropometry: weight and height, weight change, triceps skinfold, arm muscle circumference, BMI
3. Indirect calorimetry
4. Biochemical test: albumin, prealbumin, transferrin, retinol binding protein, CRP, interleukin-6, creatinine height index
5. Immunologic test: total lymphocyte count, delayed hypersensitivity skin testing
6. Physical function examination: handgrip strength, respiratory function
Table 2.
The Gastroenterology Core Curriculum
Goals of training in nutrition
Level 1
 I. Basic nutrition principles
 II. Nutrition assessment
 III. Malnutrition
 IV. Stress states
 V. Specific gastrointestinal disease states
 VI. Nutrition support
Level 2
 I. Nutrient requirements throughout life cycle
 II. Outpatient and inpatient nutrition management
 III. Nutrition in health promotion and disease prevention
 IV. Assessment of energy expenditure and body composition
 V. Nutrition support services
 VI. Home enteral and parenteral nutrition
 VII. Liver and intestinal transplantation
 VIII. Nutrition education
TOOLS
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