19 When oral food and ONS are impossible or inadequate, nutrition can be given as enteral tube feeds. When the gastrointestinal tract is so compromised that calorie and protein requirements cannot be fully Small Molecule Compound Library met by enteral feeding, parenteral nutrition can be used either alone or in combination with enteral nutrition. Guidelines support prompt intervention, that is, individualized nutrition therapy within 24 to 48 hours of admission.7, 16, 17 and 88 As a notable exception, a patient

near the end of life can be kept comfortable without provision of food or oral/enteral nutrition, if this strategy is mutually agreeable to patient/family and caregivers.89 Many hospitalized individuals are able to eat food, but their appetite is limited by illness. In such cases, experts recommend foods with energy-rich additives (eg maltodextrin, protein fortification), eating smaller but more frequent meals or high-energy snacks between meals, or using ONS.7 Standard commercially prepared enteral formulas are complete and balanced and contain an energy level of 1.0 kcal/mL, thus meeting the needs of many sick or injured patients who cannot

get adequate nutrition with a diet of regular food.90 Specialized commercially prepared formulas meet basic needs but also meet disease- or condition-specific needs, including 1.0 to 2.0 kcal/mL; some are formulated and flavored for use as ONS or enteral tube feeds, and others are intended only for enteral tube feeds.91 Nutrition care PD-0332991 price does not end when a patient is released from the hospital or other care center. The final step of the Nutrition Care Pathway is to supervene below and follow-up, with continuing attention to meeting nutrition needs. In fact, poor nutritional status on discharge predicts hospital readmission within 30 days.92 New focus on postdischarge nutrition planning18 is expected to help lower costly hospital readmissions,20

improve quality of life for patients,53 and 55 and in some cases even reduce risk of death.25 Effective nutrition care necessitates a postdischarge nutrition plan, and use of follow-up measures to ensure that the plan is implemented. Results of a systematic review of 6 RCTs (surgical and medical patients of older age) showed that postdischarge nutrition care with use of ONS had a positive effect on nutritional intake (energy) and nutritional status (weight) in all trials.93 The feedM.E. Global Group thus recommends continued efforts to prevent and treat malnutrition for patients who have been discharged from the hospital into long-term care centers or into the community. Attention to nutrition is fundamental to good clinical practice. Nutrition care improves patient outcomes and reduces health care costs. We, the members of the feedM.E. Global Group on Nutrition in Healthcare, call health care providers worldwide to action with “screen, intervene, and supervene.