Nutritional management: when and how should we become involved?

Abstract

The subject of ‘Clinical Nutrition’ received little attention in the undergraduate curricula of many medical schools until recently, and neither did it commonly feature in post-graduate medical education. Evidence of lack of knowledge in the subject of nutrition amongst doctors and nurses is not surprising (1–3). Thus, nutritional depletion was often ignored until patients became severely malnourished when tissue wasting was obvious and frequently severe. In many centers this problem continues (4–6). Patients who are developing disease-associated malnutrition need to have their nutritional needs recognized so that they can receive appropriate treatment before severe malnutrition develops. Those who are at risk of developing malnutrition also need to be monitored, where possible before any malnutrition occurs, permitting safer and less expensive potential management. This is important especially because of changing clinical practice in which the length of Hospital stay is reduced with new surgical developments, and an increase in the demands on patient beds in the hospitals of many countries. The reduced duration of the patient stay within hospital is another reason why clinicians can no longer focus nutritional management exclusively in the hospital setting. Against this background, consideration must be given to nutritional management before, during, and after hospital treatment. There is a further issue that may require addressing in the future. The rapid increase in the elderly population, particularly those over the age of 75 years, has been identified (7). Recent information emphasizes the reduced cell mass for given body mass index in this group. Thus, such subjects may be at risk of developing disease, for example falls and infection (8). Under these circumstances, identifying potential malnutrition depletion out with the current accepted ranges and recognition, and certainly before illness develops and illness occurs is another area that needs to be addressed.