Supportive interventions for enhancing dietary intake in malnourished or nutritionally at‐risk adults

Malnutrition is both a cause and consequence of ill health and its aetiology is complex. It predisposes to illness but is also a consequence of illness , creating a vicious, self‐perpetuating cycle of malnutrition and infection . People who are undernourished on admission to hospital, who do not receive adequate nutritional care, experience decline in their nutritional status . While in hospital, the reasons for further poor intakes and subsequent weight loss may include temporary starvation for medical procedures, difficulty in feeding, lack of nursing supervision during mealtimes, depression, unpalatable foods and disease‐ or drug‐induced anorexia . At home, in addition to the effects of illness and its management, sub‐optimal nutritional status may be due to practical challenges, such as lack of transport, difficulties in grocery shopping, or difficulties utilising cooking facilities, resulting in diets of poor nutritional quality. Social and psychological issues also have a significant impact. The factors that contribute to malnutrition in hospital and community patients have been described extensively elsewhere .

The strategies most frequently used to treat malnutrition in individuals requiring nutritional support aim to increase energy and nutrient intake by means of the following.

Nutritional Supplements

  • Dietary counselling – provision of nutritional advice to increase nutrient intake, requiring an individual to understand and act upon instructions given. This approach may include providing advice on food fortification, to increase the energy density of foods without increasing quantity, or dietary fortification, to increase the energy density of the diet by adding extra snacks or drinks between meals.
  • Oral nutritional supplements – available in either liquid or solid forms. These usually provide a mixture of macro‐ and micronutrients and may be nutritionally complete in a specified volume and are often available in the form of commercial supplement products.
  • Artificial nutrition support ‐ includes enteral tube feeds and parenteral nutrition that are used when oral intake is not possible. Weekes et al,,( 2016) Cochrane Database Syst Rev. 12.

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