Topic of the Month

The Who, What and Why of Medical Nutrition

Julia Bird

October 24, 2018

We all know that what we eat has an impact on our health. Likewise, our health can also affect our individual need for nutrients. Medical Nutrition takes this concept one step further by providing specialized nutrition to help treat medical conditions. Used exclusively under a doctor’s supervision, Medical Nutrition can help support patients with a range of diseases, disorders and conditions. Medical Nutrition helps address nutrient inadequacies that are unable to be met by the normal diet. 

In the coming decades, Medical Nutrition will help support the aging population, and people with acute and chronic conditions that require a specific diet or nutrition-related therapy. Medical Nutrition is effective, cost-effective, and also improves quality of life for patients [1]. 

Who Should Use Medical Nutrition?

Medical Nutrition is intended for patients who would benefit from short- or long-term nutritional support under advice from a doctor. Anyone who is having difficulty obtaining enough nutrients from the food they eat due to a health conditions can benefit, especially:

  • Frail elderly patients
  • People with problems swallowing foods
  • Before and after surgery, especially surgery involving the digestive tract
  • People with chronic diseases such as diabetes and chronic kidney disease 
  • Patients with digestive tract disorders such as Crohn’s Disease
  • Cancer patients with poor appetite or difficulties eating or digesting food
  • Hospitalized patients

What Forms Do Medical Nutrition Products Come In? 

Oral Nutrition Supplements

Patients who still have a good appetite and can eat properly can use oral nutrition supplements. These may be in the form of a powder that can be mixed into a drink, or it may be a sterile liquid such as a milkshake, soup or shot, or a semi-solid food such as dairy-based dessert or jelly. Oral nutrition supplements can be used to increase total energy intakes, or it can help increase intakes of macronutrients, particularly protein, or vitamins and minerals. The liquid or semi-solid forms are easy to eat and do not suppress appetite because they are absorbed easily by the body [1]. 

Typically, patients that need extra help to meet nutrient requirements will benefit most from oral nutrition supplements. Think of frail elderly patients, hospitalized patients who need to put on weight before surgery, and cancer patients having trouble getting enough calories. High protein supplements can help older adults meet their protein requirements, particularly if they undergo a period of bedrest [2]. Patients using oral nutrition supplements have been shown to have a lower mortality and risk of complications compared to normal standard-of-care patients in many reviews and meta-analyses [1,3]. In one clinical study, colorectal cancer patients taking a milkshake-style nutritional supplement before surgery reported less weight loss and a lower risk of infection [4]. In another, malnourished adults in nursing homes given access to a variety of oral nutrition supplements reported a better quality of life and higher nutrient intakes than residents receiving dietary advice [5]. These results show that oral nutrition supplements can help patients with a range of different conditions. 

Enteral Nutrition

For patients who are unable to eat but still have a functioning gastrointestinal tract, enteral nutrition allows them to obtain nutrients without having to chew or swallow. Commonly called “tube feeding,” this form of nutrition requires a tube to be placed in the stomach or small intestine. A feeding tube can be inserted via the nose or mouth, or alternatively via a surgical procedure in which the tube is inserted through a small incision in the abdomen. Enteral nutrition is often used in the short-term such as directly before and after surgery, or to quickly address malnutrition, however long-term use is also possible. 

Foods used for tube feeding must be in liquid form and able to flow easily through a tube. Both commercial formulas and “blended foods” – that is, normal foods that have been liquidized through a blender – can be used. Commercial formulas are sterile liquids that are a specially formulated mixture containing complete nutrition: proteins, fats, carbohydrates and micronutrients. Different formulas are available for different types of patients. Examples are formulas containing peptides and amino acids to improve digestion of protein building blocks, or formulas intended for patients with chronic kidney disease [6].  

Blended foods are an option for enteral nutrition. Normal table foods can be used to make up blended foods, or other prepared foods such as baby foods can also be suitable for direct use in place of formula. Commercial formulas can also be used as a base for blended foods, and to make them more liquid. Care must be taken with blended foods that they meet patients’ dietary requirements [7].  

Why Do We Need Medical Nutrition? 

According to the World Health Organization (WHO), the pace of the population aging is much faster than in the past. In fact, between 2015 and 2050, the proportion of the world’s population over 65 years will double from 8 percent to 16 percent [8]. Older adults are at greater risk of malnutrition. Population aging leads to increases in rates of chronic disease and disability in populations [9]. For example, a multi-country study of 12 countries found that one in five adults aged 65 and older were malnourished according to the Mini Nutritional Assessment [10]. Medical Nutrition offers potential to prevent malnutrition and support the treatment of certain diseases. Now is the time to better understand Medical Nutrition and how it can help optimize nutrition levels in people of all ages, especially those who are aging.  

References

  1. Stratton, R.J.; Elia, M. Encouraging appropriate, evidence-based use of oral nutritional supplements. Proc Nutr Soc 2010, 69, 477-487. 10.1017/S0029665110001977.
  2. English, K.L.; Paddon-Jones, D. Protecting muscle mass and function in older adults during bed rest. Curr Opin Clin Nutr Metab Care 2010, 13, 34-39. 10.1097/MCO.0b013e328333aa66.
  3. Cawood, A.L.; Elia, M.; Stratton, R.J. Systematic review and meta-analysis of the effects of high protein oral nutritional supplements. Ageing Res Rev 2012, 11, 278-296. 10.1016/j.arr.2011.12.008.
  4. Burden, S.T.; Gibson, D.J.; Lal, S.; Hill, J.; Pilling, M.; Soop, M.; Ramesh, A.; Todd, C. Pre-operative oral nutritional supplementation with dietary advice versus dietary advice alone in weight-losing patients with colorectal cancer: single-blind randomized controlled trial. J Cachexia Sarcopenia Muscle 2017, 8, 437-446. 10.1002/jcsm.12170.
  5. Parsons, E.L.; Stratton, R.J.; Cawood, A.L.; Smith, T.R.; Elia, M. Oral nutritional supplements in a randomised trial are more effective than dietary advice at improving quality of life in malnourished care home residents. Clin Nutr 2017, 36, 134-142. 10.1016/j.clnu.2016.01.002.
  6. Cano, N.; Fiaccadori, E.; Tesinsky, P.; Toigo, G.; Druml, W.; Dgem; Kuhlmann, M.; Mann, H.; Horl, W.H.; Espen. ESPEN Guidelines on Enteral Nutrition: Adult renal failure. Clin Nutr 2006, 25, 295-310. 10.1016/j.clnu.2006.01.023.
  7. Carter, H.; Johnson, K.; Johnson, T.W.; Spurlock, A. Blended tube feeding prevalence, efficacy, and safety: What does the literature say? J Am Assoc Nurse Pract 2018, 30, 150-157. 10.1097/JXX.0000000000000009.
  8. National Institute on Aging; National Institutes of Health; U.S. Department of Health and Human Services. Global Health and Aging. NIH Publication no. 11-7737; 2011;  http://www.who.int/ageing/publications/global_health.pdf.
  9. Fouweather, T.; Gillies, C.; Wohland, P.; Van Oyen, H.; Nusselder, W.; Robine, J.M.; Cambois, E.; Jagger, C.; Team, J.E. Comparison of socio-economic indicators explaining inequalities in Healthy Life Years at age 50 in Europe: 2005 and 2010. Eur J Public Health 2015, 25, 978-983. 10.1093/eurpub/ckv070.
  10. Kaiser, M.J.; Bauer, J.M.; Ramsch, C.; Uter, W.; Guigoz, Y.; Cederholm, T.; Thomas, D.R.; Anthony, P.S.; Charlton, K.E.; Maggio, M., et al. Frequency of malnutrition in older adults: a multinational perspective using the mini nutritional assessment. J Am Geriatr Soc 2010, 58, 1734-1738. 10.1111/j.1532-5415.2010.03016.x.