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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
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