Definition of Malnutrition
      Malnutrition can be defined as “a state resulting from lack of intake or 
     uptake of nutrition that leads to altered body composition (decreased fat 
     free mass) and body cell mass leading to diminished physical and mental 
           function and impaired clinical outcome from disease”
     Cederholm T, et al., ESPEN guidelines on definitions and terminology of clinical nutrition, Clinical Nutrition (2016)
           Etiology of Malnutrition
       The Academy of Nutrition and Dietetics/The American Society for Parenteral and Enteral Nutrition Consensus 
       Malnutrition Characteristics: Application in Practice; Nutr Clin Pract. 2013;28:639-650
    Route of 
   Nutritional 
  Intervention
 ASPEN; 1998
         Indication EN
  • If “under nutrition” already exist  nutritionally 
   problems
  • Unintentional weight loss
  • Insufficient to meet requirement to metabolic 
   demand
  • If it is anticipated that the patient will be unable to 
   eat more than requirement
  • If an inadequate food intake ( < 80 % of estimated 
   energy expenditure) is anticipated for more than 
   requirement
                                                                              Route of Enteral Nutrition
                                        Protein and energy enriched
                        Oral
                                        Sip feeding
                                                        Naso gastric*
                                                       Pharyngostomy
                                        Gastric                                     Percutaneous endoscopic gastromy 
       Enteral                                         Oesophagostomy               (PEG) or G-tube (button)
       Nutrition
                                                       Gastronomy*                  Radiological Inserted gastronomy 
                                                                                    (RIG)*
                                                       Nasoduodenal*                Surgical gastronomy
                         Tube 
                        Feeding        Duodenal
                                                       Extended gastronomy*
                                                       Naso jejunal
                                        Jejunal        Extended gastronomy*
                                                                                    Direct access
                                                       Surgical jejunostomy
                                                                                      Fine needle catheter