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Nutrition in Clinical Practice
http://ncp.sagepub.com/
Advocacy and Public Policy Special Report: Disease-Related Malnutrition and Enteral Nutrition Therapy:
A Significant Problem With a Cost-Effective Solution
SAGE Publications
Nutr Clin Pract published online 27 August 2010
DOI: 10.1177/0884533610378524
The online version of this article can be found at:
http://ncp.sagepub.com/content/early/2010/08/26/0884533610378524.citation
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Nutr Clin Pract OnlineFirst, published on August 27, 2010 as doi:10.1177/0884533610378524
Adocacy and Pulic Policy Special Report Nutrition in Clinical Practice
Volume XX Number X
Month XXXX 1-7
Disease-Related Malnutrition and © 2010 American Society for
Parenteral and Enteral Nutrition
1011770 1072
Enteral Nutrition Therapy: httncaeubcom
hoted at
A Significant Prole ith a httonlineaeubcom
Cost-Effectie Solution
National Alliance for
nfuion heray and the American
Society for Parenteral and Enteral Nutrition Public Policy
ommittee and oard of irector
he National Alliance for
nfuion heray NA
eamined nutrition erice and deoted reource to
and the American Society for Parenteral and elorin the benefit of nutrition theray for certain di-
2
Enteral Nutrition ASPEN Public Policy eae in the Medicare oulation
n 200 a a reult of
ommittee and oard of irector hae deeloed the a reuirement et forth in the Medicare Medicaid and
folloin hite aer to roide leilator reulator S
P enefit
mroement and Protection Act
PA
and other taeholder ith a baic undertandin of of 2000 the Secretary of ealth and uman Serice
dieae-related malnutrition and it imact on outcome ubmitted a reort to onre on the ue of medical
a ell a an oerie of enteral nutrition theray and it nutrition theray for ecific dieae
articular imact on outcome and cot hi or i not An emhai on nutrition health i arranted a there
a comrehenie reie of the literature but rather a are eriou coneuence of malnutrition Malnutrition
baic oerie of thi imortant area may reult in increaed morbidity uch a hiher infec-
ieae-related malnutrition i realent in S ho- tion rate increaed mortality loner lenth of hoital
ital in lon-term care facilitie and in atient ith tay hiher leel of intitutionaliation and increaed
chronic medical condition liin at home oneuence cot EN i a nutrition uort modality ued in certain
of thi malnutrition include increaed morbidity mortal- atient to increae nutrition intae thereby maintain-
ity and healthcare cot Enteral nutrition EN theray in or imroin nutrition health EN reduce the nea-
i feedin roided throuh the atrointetinal tract ia tie imact of malnutrition imroe atient outcome
a tube catheter or toma that delier nutrient dital to and reult in cot ain
the oral caity EN i a enerally afe and cot-effectie
theray for atient ho are malnourihed or ho are at
ri for malnutrition hi hite aer decribe 1 di- Disease-Related Malnutrition
eae-related malnutrition 2 the coneuence of mal-
nutrition the atient oulation uin EN itorically there ere a ariety of definition of malnu-
imroed outcome reultin from EN and cot-a- trition in the literature leadin to confuion and lac of
in attributable to EN conenu on the meanin of the term oeer recently
an
nternational uideline ommittee a contituted to
deelo a conenu aroach to definin malnutrition
Introduction yndrome for adult in the clinical ettin he ommittee
deeloed three term to decribe malnutrition yn-
he S federal oernment ha reconied the imor- drome taration-related malnutrition chronic dieae-
tance of nutrition he S eartment of ealth and related malnutrition and acute dieae or inury-related
uman Serice S often incororate nutrition oli- malnutrition
cie and rioritie hen etablihin national health A the recently etablihed term decribin malnu-
1
obectie A a reult of a tudy reuired by the alanced trition yndrome uet malnutrition i commonly
udet Act of 17 the
ntitute of Medicine
M aociated ith both acute and chronic dieae and
1
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2 Nutrition in Clinical Practice Vol XX No X Month XXXX
Tale Malnutrition Prealence tay reater ri of hoital readmiion and intitution-
in a Variety of ondition aliation and hiher cot of care
¡ate of Morbidity and Mortality
ieae or ondition Malnutrition
Pancreatic cancer Malnutrition increae the ri of neatie health out-
7 a 1
¢un cancer 1-0 come and comlication or intance malnutrition
a ha a neatie effect on the ulmonary function of
ead and nec cancer 2-
1011 a
atrointetinal cancer -0 atient ith chronic obtructie ulmonary dieae
121 a
erebroacular accident troe 1 - P Malnourihed atient ith P eerience
1
hronic obtructie ulmonary dieae 2 orened reiratory mucle trenth decreaed entila-
aVarie deendin on ecific oulation tudied and adance- tory drie and reone to hyoia and altered immune
1
ment of dieae function A another eamle malnutrition i a redic-
tor of oor health outcome for atient dianoed ith
cerebral acular accident VA or troe ne tudy
inury ertain dieae may caue a eron to be unable illutrated that malnourihed troe atient eerienced
to inet or aborb nutrient reult in increaed enery hiher tre reaction durin the firt ee of hoital-
need or caue undernutrition due to inificant dietary iation hiher rate of reiratory and urinary infection
retriction imoed durin the treatment of the dieae2 and reure ulcer loner lenth of tay in the hoital
he actual realence of malnutrition i unnon 1
and increaed mortality Malnutrition ha alo been
becaue of the ue of different criteria to define the identified a a oible ri factor for troe in atient
realence of malnutrition the abence of a thorouh 20
ith end-tae renal dieae
comarion of malnutrition realence in different di- ih-ri malnourihed atient are 21 time more
eae condition uin uniform criteria the characteritic liely to deelo reure ulcer than ell-nourihed
of the atient tudied the atient’ healthcare ettin 21
atient
n addition roloned inadeuate rotein
and meaure ued to determine malnutrition able 1 intae may eacerbate ae-related reduced mucle ma
roide eamle of reorted freuencie of malnutrition 22
hich caue reduced mucle trenth Malnourihed
in atient ith different underlyin condition atient alo hae a hiher ri of deeloin neumonia
Malnourihed atient can be found in all healthcare and undernutrition increae the ri of mortality from
ettin includin home care lon-term care and acute 2
neumonia
care ettin ne tudy ublihed in 200 aein the A tudy ublihed in 200 found that malnourihed
method ued to creen for malnutrition in hoital iden- hoitalied atient had a inificantly hiher incidence
tified of the hoitalied tudy oulation a bein of total comlication 27 than ell-nourihed atient
malnourihed uin a tandard nutrition creenae- 1 the total incidence of infectiou comlication
ment rotocol and beteen 1 and of the hoital- and the incidence of ei and intra-abdominal abce
1 2
ied articiant a malnourihed uin other method ere inificantly hiher for malnourihed atient
eite 0 year of nutrition theraeutic reearch thi rate Another tudy of hoitalied atient ublihed in 200
ha chaned little a een hen comared ith the land- demontrated that malnutrition a an indeendent ri
1
mar tudy by itrian et al in the mid-170 hey found factor for deeloin noocomial infection hich are
that the realence of rotein-calorie malnutrition a aociated ith increaed ri of mortality reater time
or reater in hoitalied atient in eneral medical ent in the intenie care unit hiher lielihood of
ard he American ietetic Aociation hihlihted the 2
readmiion to the hoital and increaed cot
eere roblem of malnutrition in the lon-term care et- Malnutrition increae the lielihood of hoital mortal-
tin reortin that the realence of rotein enery under- 2
ity
n addition malnutrition at hoital dichare i
nutrition for reident of lon-term care facilitie a 2
aociated ith othoital mortality in the elderly
beteen 2 and and that u to of reident had
17
unintended eiht lo and undernutrition Length of Stay
Conseuences of Disease-Related Malnutrition alo affect the lenth of hoital tay ne
tudy of hoitalied atient found that the median
Malnutrition lenth of tay for atient at ri for malnutrition a
inificantly loner day than the median lenth of
ieae-related malnutrition i aociated ith increaed 27
tay for atient ho ere not at uch ri day A
morbidity and comlication heihtened ri of deeloin later tudy found that malnourihed atient in a ub-
infection increaed mortality loner hoital lenth of acute care facility tayed at the facility for an aerae of
Downloaded from ncp.sagepub.com by Peggi Guenter on August 31, 2010
ieae-¡elated Malnutrition and EN / National Alliance for Infusion Therapy and A.S.P.E.N.
11 day loner than atient labeled nutritionally-at- or §7 in ece total chare er atient
n addition
2
ri A tudy of hoitalied atient found that lenth atient ith a lielihood of malnutrition ere time
of hoital tay for eerely malnourihed atient a more liely to hae a maor comlication ei ound
inificantly reater 10 ± 2 day than the lenth of dehicence neumonia renal failure reiratory failure
tay for moderately malnourihed atient ± 2 fitula myocardial infarction reoeration or death
2
day or ell-nourihed atient ± 7 day Patient ith maor comlication had §21 in ece
Similarly reult from a tudy of 70 atient from 2 cot and §1 2 in ece chare comared ith
hoital indicate that the median lenth of tay for mal- atient ithout comlication Patient ith a lielihood
nourihed atient day a loner than the median of malnutrition and maor comlication had §0 in
2
lenth of tay for ell-nourihed atient day ece cot and §107 in ece chare er hoitali-
ation comared ith the atient ith maor comlica-
Readmission and Institutionalization tion and no lielihood of malnutrition Patient ith a
lielihood of malnutrition alo ere 2 time more liely
Malnutrition increae the lielihood that a atient ill to hae a minor comlication bacteremia ound infec-
be readmitted to a healthcare facility or ill reuire ono- tion in oeratie ite or other localied infection atelecta-
in healthcare erice Malnourihed atient often i otoeratie ulmonary edema or urinary tract
reuire readmiion to a healthcare facility after bein infection hich reulted in aroimately §2100 in
2
dichared oitalied atient at ri for malnutri- incremental cot and §00 in incremental chare er
tion are more liely to be dichared to another facility hoitaliation Een in atient ithout comlication
than atient not at ri for malnutrition Similarly thoe ith a lielihood of malnutrition had §01 in ece
atient at ri for malnutrition ho ere dichared cot and §10 in ece chare a comared ith
from the hoital to home are more liely to ue home atient ithout a lielihood of malnutrition
health erice than atient ho are not at ri for mal- he cot aociated ith treatin the health comli-
27
nutrition cation aociated ith malnutrition are inificant
Malnourihed atient are at increaed ri for deelo-
Cost of Malnutrition in neumonia hi infection i a common caue of
morbidity mortality and hoitaliation for nurin home
ieae-related malnutrition alo lead to hiher health- reident he aerae cot to treat neumonia in a
care eenditure he ritih Aociation for Parenteral nurin home reident ho receie ome treatment in
and Enteral Nutrition etimated that in 200 more than the emerency deartment i §1 A 1 tudy cal-
£7 billion euialent to 10 billion S dollar uin culated that the median lenth of hoital tay for elderly
the 2010 echane rate a ent on dieae-related indiidual ith a rimary dianoi of neumonia a
malnutrition annually rereentin aroimately 10 of day ith a median cot of §100 he median lenth of
0
total healthcare eenditure A tudy from 17 illu- tay for indiidual ith a econdary dianoi of neu-
2
trated that healthcare eenditure in the nited State monia a 12 day at a median cot of §10100
ere hiher for undereiht and oereiht indiidual Preure ulcer are aociated ith malnutrition and
1
increain a eiht diered from “ideal eiht” can be uite cotly to treat A 200 tatitical brief ub-
Malnutrition i aociated ith eleated hoital lihed by the Aency for ealthcare ¡eearch and ¨uality
cot indin from a tudy ublihed in 17 illutrate A¡¨ documented that the mean lenth of hoital
that the hoital cot for atient at ri for malnutrition tay for atient ith reure ulcer in 200 a aro-
§ 1 ere inificantly hiher than the cot for imately 1 day and the aerae chare a aroi-
27
atient not at ri for malnutrition § Another mately §700 er atient Malnutrition a a
economic tudy reorted a mean daily eene of §22 concomitant condition in 17 of hoital tay hich
er atient for malnourihed atient comared ith a ere rimarily for reure ulcer Ecet here noted
mean daily eene of §1 er atient for ell-nour- the monetary amount reorted in thi ubection are
2
ihed atient A tudy from the year 2000 illutrated baed on the date of reearch ublication
that deite nutrition tatu uon hoital admiion
atient ho eerienced decline in their nutrition ta-
tu durin their hoital tay had hiher mean hoital Patient Populations sing Enteral Nutrition
chare §7 2 than atient ho remained nourihed
2
durin their hoitaliation §2 1 EN theray commonly non a tube feedin i defined
A tudy ublihed in 1 found that a atient’ a “feedin roided throuh the atrointetinal tract ia
nutrition tatu a related to the cot of care he a tube catheter or toma that delier nutrient dital to
tudy’ reult indicated that lielihood of malnutrition the oral caity”
t i ued to mitiate the neatie
a aociated ith §17 in ece direct ariable cot imact of malnutrition by yieldin benefit uch a
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