Weight loss is one of the most important signs of change in nutritional status. A weight loss of more than 10% over the past 6 months or more than 5% over the last 3 months is a significant and serious weight loss. If the weight loss occurs in combination with low BMI (body mass index) (< 20 kg/m2 for adults) and/or a food intake of less than 60% of the calculated requirement over the past 10 days, the patient will be malnourished or be at nutritional risk.
Calculation of nutrition and fluid requirements
Ambulatory patients: 30-35 kcal/kg/day
Bed-ridden patients: 25-30 kcal/kg/day
Elderly above 70 years: Recommended amount is reduced by 10%
Fluid requirement: 30-35 ml/kg/day
Actions include offerring the patient a diet that is appropriate for their symptoms and nutritional status. The patient should be offered nutritionally-rich food, snacks, nutritional beverages, tube feeding, and intravenous nutrition.
Small, frequent meals
Patients must often have food of softer consistency and milder in taste. This requires the food to be as rich in nutrition as possible. These patients will need 6-8 small meals per day to meet their energy need.
Enrichment of food and beverages
The most effective way to enrich food and drink is to use ordinary foods such as cream, oil, butter, sour cream, mayonaise, etc.
Enrichment of food and drink is done to increase the energy content of the meal without increasing the volume. This is done for patients who eat too little and therefore need energy-rich food.
- are not supplemented with vitamins, minerals, or trace elements
- are supplemented usually with only fat, carbohydrates, or protein (sometimes a combination of fat and carbohydrates).
Some powders are nutritionally complete, that is, a given amount includes everything the body needs of energy and vitamins and minerals. There are also powders neutral in taste which do not affect the taste or consistency of food.
Nutritional beverages may be used as a meal in itself or between meals. Nutritional drinks can be a more valuable snack than "normal" food, because it is often easier for the patient to drink than to eat. It has been shown that if nutritional drinks are introduced as snacks, it does not affect the energy intake during the main meals.
There are a number of ready-made nutritional drinks on the market. Some of the products are of nutritionally complete. They contain carbohydrates, protein and fat and are supplemented with all the necessary vitamins, minerals and trace minerals and possibly fiber. Some of these products can be used as the sole source of nutrition. The energy content varies from 85-200 kcal/100 ml and some products have a high protein content.
The products are also adapted for age, and the dose is determined individually by a clinical dietician/doctor.
Many patients prefer homemade nutritional drinks based on full fat milk, cream, ice cream, fruit and possibly flavor supplements. These are free of additives and have a fresher taste. The energy and protein content is close to the commercial products and at the same time they are more sensibly priced.
Tube feeding is preferable to total parenteral nutrition (TPN) when the digestive system is working. Nutrition supply to the intestine is more physiological. It protects against bacterial growth, maintains the intestine's mucous membrane structure and function, and promotes motility. Tube feeding involves less risk of metabolic complications.
Tube feeding is used in the event of
insufficient food intake (less than 60% of energy requirements) over the past 5-7 days despite oral intake
weight loss >2 % over the past week, >5 % over the past month or >10 % over the past 6 months
danger of weight loss due to planned treatment
low albumin values (under 35 g/l, lower limit for normal area)
stenosis with feeding obstacles in pharynx/gullet
Tube feeding must not be used for the following conditions.
Paralysis or ileus of the alimentary tract
Short bowel syndrome
Serious acute pancreatitis
Obstruction of the intestine
Serious fluid problems
Tube feeding solutions
The tube feeding solution must be nutritionally complete because they are used as the sole source of nourishment. The most frequently used are standard (1 kcal/ml), or energy-rich (1.5 kcal/ml) solutions with or without fiber. There are also tube feeding solutions adapted for patients with digestion and absorption problems, patients with diabetes or lactose allergy, and intensive care and cancer patients.
Parenteral nutrition should only be used if food by mouth or tube feeding cannot be maintained. Parenteral nutrition can also be used as a supplement to tube feeding or ordinary food if the patient's nutrional needs are not met by this alone.
Precautions must be taken for the following conditions:
- Renal failure
- Heart failure
- Lung failure
- Large fluid or electrolyte loss
- Diabetes mellitus
- Liver failure