This is a Myth

Malnourished patients represent a significant part of healthcare systems in highly developed countries across the world¹.

Malnutrition can take many forms and represents a large-scale complex problem across the world².

Whilst the UK is a highly developed country, malnutrition is still prevalent across its population as 45% of all adults screened across health and care settings were found to be at risk of disease-related malnutrition³.

References

1. Hébuterne X. et al. Prevalence of malnutrition and current use of nutrition support in patient s with cancer. JPEN. 2014; 38(2):196-204
2. Fanzo J., Hawkes C., Udomkesmalee E., et al. Global Nutrition Report: Shining a Light to Spur Action on Nutrition. Geneva, Switzerland: WHO; 2018.
3. BAPEN (2024). What is the scale of malnutrition in the UK? [Online]. BAPEN. Last Updated: 2024. Available at: https://www.bapen.org.uk/malnutrition/introduction-to-malnutrition/what-is-the-scale-of-malnutrition-in-the-uk/ [Accessed 25 August 2024]

This is a Fact.

When oral nutrition is not an option, clinical nutrition is able to fully cover nutritional requirements.^1,2

Parenteral nutrition can be divided into:

• Total parenteral nutrition – all nutrient needs are provided intravenously without any supplementary oral or enteral intake.²
• Supplementary parenteral nutrition – a portion of the patient’s nutrient needs is provided via the gastrointestinal tract, and the remainder is infused parenterally in a sufficient amount to meet optimal nutrition.²

References

1. Lochs H. et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, Definitions and General Topics. Clin Nutr. 2006; 25: 180–186.
2. Sobotka L. (Editor in Chief). Basics in clinical nutrition. Fourth edition. GALEN, page 401.

This is a Myth

Starving the patient during active treatment against cancer means caloric restriction, which can lead to a deficiency of macro and micronutrients, resulting in weight loss and malnutrition. These two parameters influence cancer patients negatively.²

The results of an analysis of 240 patients with non-Hodgkin's lymphoma showed a statistically significant correlation between "poor" nutritional status (depressed nutritional indices) and "high" labelling index (increased tumoural growth).¹

References

1. Bozzetti F. et al. Relationship between nutritional status and tumour growth in humans. Tumori. 1995; 81(1): 1-6.
2. Arends J. et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2017; 36(1): 11-48.
   

This is a Fact.

Optimal wound healing requires adequate nutrition with all the required macro and micronutrients.¹ 
Nutrition deficiencies interfere with the normal process of wound healing through all the stages.¹ Malnutrition has also been related to decreased wound tensile strength and increased infection rates.¹

Optimal nutritional care for wound healing includes:

• A sufficient energy amount, as energy is necessary for anabolism, protein synthesis, collagen formation, and wound healing.¹
• The optimal protein content is necessary for the synthesis of the enzymes involved in wound healing, the proliferation of cells and collagen, and the formation of connective tissue. The amino acids arginine and glutamine have been studied extensively in this field.¹
• Essential fatty acids are essential for wound healing.¹
• Ensuring adequate water intake is mandatory for perfusion and oxygenation healing as well as for healthy tissues.¹
• Standard multivitamins with minerals are recommended for patients with wounds in the event that deficiencies occur. A special role is played by vitamin A, vitamin C and zinc.¹

Optimal nutrition and hydration play an important role in general wound healing and preserving skin supporting tissue repair for ulcer healing.²

References

1. Stechmiller J.K. Understanding the Role of Nutrition and Wound Healing. Nutr Clin Pract. 2010; 25: 61-68.
2. Posthauer M.E. et al. The Role of Nutrition for Pressure Ulcer Management: National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel, and Pan Pacific Pressure Injury Alliance White Paper. Advances in Skin & Wound Care. 2015; 28(4): 175-188.

This is a Myth

Parenteral nutrition at home is a life-saving therapy for patients with irreversible intestinal failure^1,2 requiring long term treatment.

Intestinal failure occurs when the intestines are unable to digest food and absorb macro and micronutrients, and fluids that are essential for life. Intestinal failure is often caused by short bowel syndrome or digestive disorders like Crohn's Disease.¹

For the treatment of chronic intestinal failure (CIF) in patients with a benign disease, a source of macro- (protein, carbohydrates and fats) and micro- (electrolytes, vitamins and trace elements) nutrients are administered intravenously – this is parenteral nutrition.

The relatively low morbidity and mortality associated with home parenteral nutrition (HPN) as a part of clinical nutrition has encouraged its widespread use in western countries for this special patient group.²

A prospective survey from ESPEN about patients with CIF due to a benign disease found out that these patients on HPN have a good probability of long-term survival (about 80% in adults and 90% in children at 5 years).³

References

1. Allan P. and Simon S. Intestinal failure: a review. F1000 Res. 2018; 7: 85.
2. Staun M. et al. ESPEN Guidelines on Parenteral Nutrition: Home Parenteral Nutrition (HPN) in adult patients. Clin Nutr. 2009; 28: 467–479.
3. Pironi L. et al. Outcome on home parenteral nutrition for benign intestinal failure: a review of the literature and benchmarking with the European prospective survey of ESPEN. Clin Nutr. 2012; 31: 831-45.