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      Guía Práctica ESPEN: nutrición enteral domiciliaria Translated title: ESPEN practical guideline: home enteral nutrition

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          Abstract

          Resumen Esta guía práctica de la European Society for Clinical Nutrition and Metabolism (ESPEN) proporciona información a médicos, enfermeras, dietistas, farmacéuticos, cuidadores y otros proveedores de nutrición enteral domiciliaria (NED) de forma concisa, sobre las indicaciones y contraindicaciones de la NED, así como sobre su administración y seguimiento. Esta guía también ofrece información a los pacientes interesados que necesiten NED. La nutrición parenteral domiciliaria no está incluida, pero se abordará en otra guía de la ESPEN. La guía se basa en la guía científica de la ESPEN publicada anteriormente, que consta de 61 recomendaciones (que se han reproducido y renumerado), junto con los comentarios asociados (que se han resumido en relación a la guía científica). Se indican los grados de evidencia y los niveles de consenso. La ESPEN encargó y financió la guía y seleccionó también a los miembros del grupo.

          Translated abstract

          Abstract This ESPEN practical guideline will inform physicians, nurses, dieticians, pharmacists, caregivers and other home enteral nutrition (HEN) providers in a concise way about the indications and contraindications for HEN, as well as its implementation and monitoring. This guideline will also inform interested patients requiring HEN. Home parenteral nutrition is not included but will be addressed in a separate ESPEN guideline. The guideline is based on the ESPEN scientific guideline published before, which consists of 61 recommendations that have been reproduced and renumbered, along with the associated commentaries that have been shorted compared to the scientific guideline. Evidence grades and consensus levels are indicated. The guideline was commissioned and financially supported by ESPEN and the members of the guideline group were selected by ESPEN.

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          Most cited references140

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          ESPEN guidelines on nutrition in cancer patients

          Cancers are among the leading causes of morbidity and mortality worldwide, and the number of new cases is expected to rise significantly over the next decades. At the same time, all types of cancer treatment, such as surgery, radiation therapy, and pharmacological therapies are improving in sophistication, precision and in the power to target specific characteristics of individual cancers. Thus, while many cancers may still not be cured they may be converted to chronic diseases. All of these treatments, however, are impeded or precluded by the frequent development of malnutrition and metabolic derangements in cancer patients, induced by the tumor or by its treatment. These evidence-based guidelines were developed to translate current best evidence and expert opinion into recommendations for multi-disciplinary teams responsible for identification, prevention, and treatment of reversible elements of malnutrition in adult cancer patients. The guidelines were commissioned and financially supported by ESPEN and by the European Partnership for Action Against Cancer (EPAAC), an EU level initiative. Members of the guideline group were selected by ESPEN to include a range of professions and fields of expertise. We searched for meta-analyses, systematic reviews and comparative studies based on clinical questions according to the PICO format. The evidence was evaluated and merged to develop clinical recommendations using the GRADE method. Due to the deficits in the available evidence, relevant still open questions were listed and should be addressed by future studies. Malnutrition and a loss of muscle mass are frequent in cancer patients and have a negative effect on clinical outcome. They may be driven by inadequate food intake, decreased physical activity and catabolic metabolic derangements. To screen for, prevent, assess in detail, monitor and treat malnutrition standard operating procedures, responsibilities and a quality control process should be established at each institution involved in treating cancer patients. All cancer patients should be screened regularly for the risk or the presence of malnutrition. In all patients - with the exception of end of life care - energy and substrate requirements should be met by offering in a step-wise manner nutritional interventions from counseling to parenteral nutrition. However, benefits and risks of nutritional interventions have to be balanced with special consideration in patients with advanced disease. Nutritional care should always be accompanied by exercise training. To counter malnutrition in patients with advanced cancer there are few pharmacological agents and pharmaconutrients with only limited effects. Cancer survivors should engage in regular physical activity and adopt a prudent diet.
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            Nutritional risk screening (NRS 2002): a new method based on an analysis of controlled clinical trials.

            A system for screening of nutritional risk is described. It is based on the concept that nutritional support is indicated in patients who are severely ill with increased nutritional requirements, or who are severely undernourished, or who have certain degrees of severity of disease in combination with certain degrees of undernutrition. Degrees of severity of disease and undernutrition were defined as absent, mild, moderate or severe from data sets in a selected number of randomized controlled trials (RCTs) and converted to a numeric score. After completion, the screening system was validated against all published RCTs known to us of nutritional support vs spontaneous intake to investigate whether the screening system could distinguish between trials with a positive outcome and trials with no effect on outcome. The total number of randomized trials identified was 128. In each trial, the group of patients was classified with respect to nutritional status and severity of disease, and it was determined whether the effect of nutritional intervention on clinical outcome was positive or absent. Among 75 studies of patients classified as being nutritionally at-risk, 43 showed a positive effect of nutritional support on clinical outcome. Among 53 studies of patients not considered to be nutritionally at-risk, 14 showed a positive effect (P=0.0006). This corresponded to a likelihood ratio (true positive/false positive) of 1.7 (95% CI: 2.3-1.2). For 71 studies of parenteral nutrition, the likelihood ratio was 1.4 (1.9-1.0), and for 56 studies of enteral or oral nutrition the likelihood ratio was 2.9 (5.9-1.4). The screening system appears to be able to distinguish between trials with a positive effect vs no effect, and it can therefore probably also identify patients who are likely to benefit from nutritional support.
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              ESPEN expert group recommendations for action against cancer-related malnutrition

              Patients with cancer are at particularly high risk for malnutrition because both the disease and its treatments threaten their nutritional status. Yet cancer-related nutritional risk is sometimes overlooked or under-treated by clinicians, patients, and their families. The European Society for Clinical Nutrition and Metabolism (ESPEN) recently published evidence-based guidelines for nutritional care in patients with cancer. In further support of these guidelines, an ESPEN oncology expert group met for a Cancer and Nutrition Workshop in Berlin on October 24 and 25, 2016. The group examined the causes and consequences of cancer-related malnutrition, reviewed treatment approaches currently available, and built the rationale and impetus for clinicians involved with care of patients with cancer to take actions that facilitate nutrition support in practice. The content of this position paper is based on presentations and discussions at the Berlin meeting. The expert group emphasized 3 key steps to update nutritional care for people with cancer: (1) screen all patients with cancer for nutritional risk early in the course of their care, regardless of body mass index and weight history; (2) expand nutrition-related assessment practices to include measures of anorexia, body composition, inflammatory biomarkers, resting energy expenditure, and physical function; (3) use multimodal nutritional interventions with individualized plans, including care focused on increasing nutritional intake, lessening inflammation and hypermetabolic stress, and increasing physical activity.
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                Author and article information

                Journal
                nh
                Nutrición Hospitalaria
                Nutr. Hosp.
                Grupo Arán (Madrid, Madrid, Spain )
                0212-1611
                1699-5198
                August 2023
                : 40
                : 4
                : 858-885
                Affiliations
                [1] Stuttgart Baden-Württemberg orgnameUniversität Hohenheim orgdiv1Departamento de Nutrición Clínica Germany
                [4] Sint-Niklaas orgnameHospital AZ Nikolaas orgdiv1Unidad de Soporte Nutricional Bélgica
                [8] Cracovia orgnameAsociación de Pacientes con Fallo Intestinal “Appetite for Life” Polonia
                [14] Bolonia orgnameIRCCS Azienda Ospedaliero-Universitaria di Bologna orgdiv1Unidad de Nutrición Clínica y Metabolismo orgdiv2Centro de Fallo Intestinal Crónico Italia
                [10] Melbourne orgnameUniversidad de Monash orgdiv1Departamento de Medicina Australia
                [11] Niza orgnameUniversité Côte d’Azur orgdiv1Centre Hospitalier Universitaire orgdiv2Gastroenterología y Nutrición Francia
                [3] Londres orgnameUniversity College London orgdiv1School of Pharmacy United Kingdom
                [15] Santiago de Compostela orgnameHospital Clínico Universitario de Santiago de Compostela orgdiv1Servicio de Endocrinología y Nutrición Spain
                [2] Oxford orgnameOxford University Hospitals NHS Foundation Trust orgdiv1Departamento de Farmacia Reino Unido
                [7] Países Bajos orgnameCentro Médico Universitario de Ámsterdam orgdiv1AMC Países Bajos
                [9] Melbourne orgnameUniversidad de La Trobe orgdiv1Departamento de Rehabilitación, Nutrición y Deporte Australia
                [6] Madrid orgnameHospital General Universitario Gregorio Marañón orgdiv1Unidad de Nutrición Spain
                [12] Berna orgnameUniversidad de Berna orgdiv1Hospital Universitario de Berna orgdiv2Servicio de Diabetes, Endocrinología, Nutrición y Metabolismo Suiza
                [13] Bolonia orgnameUniversidad de Bolonia orgdiv1Alma Mater Studiorum orgdiv2Departamento de Medicina y Cirugía Italia
                [5] Tesalónica orgnameUniversidad Aristóteles de Tesalónica orgdiv1Facultad de Ciencias de la Salud orgdiv2Escuela de Medicina Grecia
                Article
                S0212-16112023000500023 S0212-1611(23)04000400023
                10.20960/nh.04796
                99894714-50ca-4727-9843-58b68c5b6f00

                This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

                History
                : 30 May 2023
                : 12 June 2023
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 141, Pages: 28
                Product

                SciELO Spain

                Categories
                Artículo Especial

                Nutrición enteral domiciliaria,Nutrición por sonda,Equipo de soporte nutricional,Fórmula enteral,Seguimiento,Enteral formula,Home enteral nutrition,Monitoring,Nutrition support team,Tube feeding

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