American Society for Parenteral and Enteral Nutrition

This review considers enteral nutrition in the context of disease-related malnutrition, provides evidence for the use of enteral nutrition in hospitalized patients, and discusses practice considerations.

The Global Leadership Initiative on Malnutrition (GLIM) approach to malnutrition diagnosis is based on assessment of three phenotypic (weight loss, low body mass index, and reduced skeletal muscle mass) and two etiologic (reduced food intake/assimilation and disease burden/inflammation) criteria, with diagnosis confirmed by fulfillment of any combination of at least one phenotypic and at least one etiologic criterion. The original GLIM description provided limited guidance regarding assessment of inflammation, and this has been a factor impeding further implementation of the GLIM criteria. We now seek to provide practical guidance for assessment of inflammation. A GLIM-constituted working group with 36 participants developed consensus-based guidance through a modified Delphi review. A multiround review and revision process served to develop seven guidance statements. The final round of review was highly favorable, with 99% overall "agree" or "strongly agree" responses. The presence of acute or chronic disease, infection, or injury that is usually associated with inflammatory activity may be used to fulfill the GLIM disease burden/inflammation criterion, without the need for laboratory confirmation. However, we recommend that recognition of underlying medical conditions commonly associated with inflammation be supported by C-reactive protein (CRP) measurements when the contribution of inflammatory components is uncertain. Interpretation of CRP requires that consideration be given to the method, reference values, and units (milligrams per deciliter or milligram per liter) for the clinical laboratory that is being used. Confirmation of inflammation should be guided by clinical judgment based on underlying diagnosis or condition, clinical signs, or CRP.

Este artículo cuenta la historia de la evolución de la Asociación Americana de Nutrición Enteral y Parenteral (ASPEN) como la principal sociedad interprofesional dedicada a la nutrición parenteral y enteral y el metabolismo. La creación de la ASPEN Rhoads Research Foundation por parte de la Asociación es fundamental para su misión de mejorar la atención del paciente mediante el avance de la ciencia y la práctica de la nutrición clínica y el metabolismo. El artículo describe la misión, visión y los valores fundamentales de la Fundación a través de su soporte económico a la investigación e innovación en nutrición. Se destaca el alcance de los proyectos financiados por la Fundación, así como la distribución cuidadosa de los beneficiarios de las ayudas. Explicamos cómo años de financiación han impactado las carreras de investigación y liderazgo de muchos investigadores jóvenes, así como el desarrollo de la investigación y la práctica del soporte nutricional. Por último, aconsejamos a los profesionales en nutrición y otros profesionales de la salud sobre cómo iniciarse en la investigación nutricional y laimportancia de buscar tutores.

American Society for Parenteral and Enteral Nutrition (ASPEN) Board of Directors:; Cresci, Gail A. M. PhD, RD, LD1; Hurt, Ryan MD, PhD2; Rice, Todd W. MD, MSc3; Mogensen, Kris MS, RD-AP, LDN, CNSC4; Ayers, George PharmD, BCNSP, FMSHP, FASHP5; Gura, Kathleen PharmD, BCNSP, FASHP, FPPA, FASPEN, FMSHP6; Hamilton, Cindy MS, RD, LD, FAND1; Hardy, Gil PhD, Cchem, FRSC, FASPEN7; Jain, Ajay MD, DNB8; Mager, Diana PhD, MSc, RD9; McMahon, M. Molly MD, FASPEN10; Worthington, Pat RN, MSN, CNSC11; Johnson, Wanda BS, CMP, CAE12 Author Information

This consensus represents the collaboration among three professional organizations focused on nutrition: Brazilian Society of Nephrology (SBN), Brazilian Association of Nutrition (ASBRAN), Brazilian Society of Parenteral and Enteral Nutrition (Braspen/SBNPE), in order to identify the terminology and internationally standardized instruments for the nutrition care process. The focus is to facilitate the conduct of training for nutritionists who work with adult patients with acute kidney injury (AKI). Eleven questions were raised related to screening, the care process and the management of results in nutrition. The recommendations were based on international guidelines and electronic databases such as PubMed, EMBASE, CINHAL, Web of Science and Cochrane. From the submission of lists of internationally standardized terms, 20 specialist nutritionists selected those they considered very clear and relevant to clinical practice with patients with AKI. The Content Validity Index (CVI) was calculated, with 80% agreement in the responses, and then the kappa multirater free coefficient (kfree) was calculated. Kfree results above zero indicate agreement among experts, and below zero, zero agreement. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to assign strength of evidence to the recommendations. 37 terms of Assessment and Reassessment (kfree 0.46), 13 of Diagnosis (kfree 0.60), 6 of Intervention (kfree 0.44) and 37 of Monitoring and Measurement in Nutrition (kfree 0.46) were selected. The list of selected terms and identification of instruments will help in planning training and implementing standardized terminology in nutrition in Brazil, for nutritionists who work with patients with AKI.

Today it is a well-established fact that scientifically substantiated, competent and individualized usage of macro-, micro- and pharmaconutrients is capable of optimizing human capacities, increasing muscle contraction strength, general and special endurance in professional, highly skilled athletes. It is quite obvious that balanced nutrition is a key to providing athlete body with the main substances and energy necessary for the high level of motor activity. The paper considers the role, the place, the validity and the efficiency of dietary supplements utilization in the course of athlete preparation on the basis of March 2018 the IOC Consensus statement on dietary supplements usage by elite athletes, which has become the main regulatory document for specialists of sports medicine and nutritiology. The Consensus has formulated the concept of ergogenic nutritiological means that in future will enable to revise the system of sports preparation pharmacological support in European countries, bringing it closer to world standards. The work briefly highlights the development of sports nutritiology as a science and practice of its provisions realization in elite sport. Based on the Consensus provisions, 4 main classes of dietary supplements for sport have been outlined: 1) functional food, food enriched with additional nutrients or components, different from the usual nutrient composition; 2) specially formulated compounds and sports nutrition for providing energy and nutrients in a more convenient form than regular food for nutritional support in sport; 3) individual nutrients and other food components or plant products in isolated or concentrated forms; 4) multi-component products containing various combinations of substances with a certain intended use. In addition, the main, more highly specialized groups of dietary supplements have been classified with indication of their representatives, the fundamental differences between dietary supplements and ergogenic pharmacological preparations have been formulated, thus enabling reasonable nutritional and metabolic support of functional and structural reorganizations in the body of athlete, when it forms the prerequisites for emergence of new own ergogenic characteristics. The article emphasizes that the problem of dietary supplements usage has many unresolved issues of organizational and informational nature, focuses on the formation of holistic algorithm for these ergogenic means utilization, which requires highly qualified specialists – sports nutritionists, above all. The authors present their vision of managing preparation of such specialists in the post-Soviet space, which should become the key to the rational use of dietary supplements in order to increase the competitive process efficiency of members of the national Olympic teams along with preservation of athletes’ health.

Cancer patients undergoing treatment are at risk for COVID-19. These patients are predisposed to greater severity of infection caused by the coronavirus. During the current scenario of this pandemic, nutrition has been cited numerous times by the fact contribute to the treatment in general. Unfortunately, reports of nutritional care for cancer patients are currently scarce. The purpose of this document is to discuss the recommended practices in a compilation of data already published on nutrition and coronavirus, at this specific time.

This article gives an outline of the key groups at risk of malnutrition in the community and the effects and clinical consequences of not identifying and managing these groups. It outlines the potential health and social costs of not identifying and treating malnutrition in the community and advises how malnutrition arises in these 'at-risk' groups. As 93% of those affected by malnutrition are living in our communities, advice is given on how community nurses can play a pivotal role in identifying malnutrition by initiating conversations about dietary intake with patients and integrating screening and nutritional care into pathways of care.

Dear Drs Brandon and McGrath, We would like to comment on a recently published article in the August 2018 issue of Advances in Neonatal Care, “Comparison of Neonatal Nursing Practices for Determining Feeding Tube Insertion Length and Verifying Gastric Placement With Current Best Evidence” by Leslie A. Parker et al.1 We agree with the authors that further research is needed to determine the best method for nasogastric tube (NGT) insertion length. We also agree that further research is needed for NGT placement verification in this population as our study showed that 61% of the pediatric patients requiring an NGT in our prevalence study were in a neonatal intensive care unit (NICU).2 However, until that research is completed and publishes, the use of the nose-ear-mid-umbilicus (NEMU) method for estimating insertion length and the use of pH to verify NGT placement are the best answers we have. We want to recognize that the United Kingdom, Canada, and Australia have used pH for many years as their standard for NGT placement verification.3 While we do not have RCTs validating that this practice in the NICU is effective, we also do not have case reports indicating that the use of pH has been ineffective. While we wait for a large, multicenter RCT to be done, nurses need to stop using methods known to be unreliable—auscultation and/or aspiration with visualization of gastric contents. We acknowledge that in the NICU population, data are lacking in this practice area, which prevents strong practice recommendations but given the serious/horrific outcome of an infant who is inadvertently fed into the lung,4 is it now wise to standardize care toward the use of the NEMU method for estimating insertion length and to pH to verify placement?5,6 Sincerely, Beth Lyman, MSN, RN, CNSC, FASPEN Chair, NOVEL Project Children's Mercy Kansas City, Kansas City, Missouri Peggi Guenter, PhD, RN, FAAN, FASPEN American Society for Parenteral and Enteral Nutrition Silver Spring, Maryland