ESPEN guidelines on nutritional support for polymorbid internal medicine patients
ESPEN guidelines on nutritional support for polymorbid internal medicine patients
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DOI：
10.1016/j.clnu.2017.06.025
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发表时间：
2018-02-01
影响因子：
6.3
通讯作者：
Bischoff, Stephan C.
中科院分区：
文献类型：
--
作者：
Gomes, Filomena;Schuetz, Philipp;Bischoff, Stephan C.
背景与目的：多重发病（也称为多重发病）-定义为至少两种慢性健康状况的同时发生-非常普遍，特别是在住院人群中。尽管如此，临床指南主要针对个体疾病，很少考虑多发性疾病。该项目的目的是为住院病房的多病患者制定营养支持指南。方法：当前项目开发所用的方法学遵循ESPEN指南的标准操作程序。它始于工作组于2015年1月举行的首次会议，会上制定了12个关键临床问题，涵盖营养支持的不同方面：指征、喂养途径、能量和蛋白质需求、微量营养素需求、疾病特异性营养素、时间、监测和干预程序。在三个不同的数据库（Medline、Embase和Cochrane图书馆）以及二手来源（如已发表的指南）中进行了系统的文献检索，直到2016年4月。对检索到的摘要进行筛选，以确定用于制定建议的相关研究，然后提交到德尔菲投票轮。结果：从总共4532篇检索摘要中，分析了38篇相关研究，并用于生成一份指南草案，该草案提出了22条建议和4条陈述。第一次在线投票的结果显示，68%的建议和75%的声明达成了强烈的共识（同意率为90%），32%的建议和25%的声明达成了共识（同意率为75% -90%）。在最后的共识会议上，所有建议达成了超过89%的共识。结论：尽管在制定非疾病特异性指南方面存在方法学上的困难，但对多病住院患者营养支持的几个重要方面的证据进行了审查，并总结为实用的临床建议。这些指南的使用为多病住院患者提供了一种基于证据的营养方法，并可能改善他们的预后。(C) 2017欧洲临床营养与代谢学会。Elsevier Ltd.出版。版权所有。
Background & aims: Polymorbidity (also known as multimorbidity)-defined as the co-occurrence of at least two chronic health conditions - is highly prevalent, particularly in the hospitalized population. Nonetheless, clinical guidelines largely address individual diseases and rarely account for polymorbidity. The aim of this project was to develop guidelines on nutritional support for polymorbid patients hospitalized in medical wards.Methods: The methodology used for the development of the current project follows the standard operating procedures for ESPEN guidelines. It started with an initial meeting of the Working Group in January 2015, where twelve key clinical questions were developed that encompassed different aspects of nutritional support: indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. Systematic literature searches were conducted in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines), until April 2016. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations, which were followed by submission to Delphi voting rounds.Results: From a total of 4532 retrieved abstracts, 38 relevant studies were analyzed and used to generate a guideline draft that proposed 22 recommendations and four statements. The results of the first online voting showed a strong consensus (agreement of >90%) in 68% of recommendations and 75% of statements, and consensus (agreement of >75-90%) in 32% of recommendations and 25% of statements.At the final consensus conference, a consensus greater than 89% was reached for all of the recommendations.Conclusions: Despite the methodological difficulties in creating non-disease specific guidelines, the evidence behind several important aspects of nutritional support for polymorbid medical inpatients was reviewed and summarized into practical clinical recommendations. Use of these guidelines offer an evidence-based nutritional approach to the polymorbid medical inpatient and may improve their outcomes. (C) 2017 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.