The initial energy (non-target requirement) of malnutrition patients is generally 20~25kcal/(kg? D) (The weight here is the actual weight of non-obese patients, the same below). The more serious malnutrition is and the longer it lasts, the lower the initial energy is, such as 10~ 15kcal/(kg? D) prevention of refeeding syndrome.
The basic requirements of malnutrition treatment are to meet the four standards of 90% liquid target demand, ≥70%(70%~90%) energy target demand, 100% protein target demand and 100% micronutrient target demand.
Diet plus nutrition education is the first choice for all malnourished patients (except those who can't take food orally). This is an economical, practical and effective measure, which is the basis of all malnutrition treatments. (1) Assess the severity of malnutrition. (2) To judge the type of malnutrition reaction. (3) Analyze the causes of malnutrition. (4) Provide personalized dietary guidance. (5) Discuss or deal with the non-dietary causes of malnutrition.
Diet +ONS? As the name implies, oral nutritional supplements supplement the deficiency of daily diet through oral food for special medical purposes (FSMP). It is found that only when the energy provided by ONS is above 400~600kcal per day can the function of ONS be better played.
Ten means that all nutrition is provided by enteral nutrition preparation (FSMP), and there is no need to eat at all. TEN is an ideal choice when diet +ONS can't meet the target requirements or can't be eaten at all in some cases, such as complete obstruction of esophageal cancer, dysphagia, severe gastroparesis, etc.
When TEN can't meet the target requirements, PEN+PPN should be selected, or parenteral nutrition should be supplemented on the basis of enteral nutrition. Although total diet or total enteral nutrition is an ideal method, PEN+PPN is a realistic choice in clinic, especially for tumor patients [1 1]. Because of anorexia, early satiety, tumor-related gastrointestinal diseases and adverse reactions to treatment, patients don't want to eat, eat much and can't digest. At this time, PPN or supplementary nutrition (SPN) is particularly important.
TPN？ TPN is the only source of nutrition to maintain the survival of patients when the intestines are completely unusable.
Pointer: the study suggests that when choosing TPN to treat patients, we should not only consider the above indications, but also observe SGA score and albumin level, SGA or albumin with severe malnutrition
Generally speaking, we should follow the principle of gradual progress, from bottom to top; However, the steps are not insurmountable. Patients may skip the previous step and go directly to the previous step, often adopting different steps at the same time, such as diet+nutrition education +ONS+PPN. In the practice of clinical nutrition work, individualized nutrition therapy should be carried out according to the specific situation of patients.