Interviewed by Dr Yossi Sammy, Global Medical Affairs, Nestle Health Science.
Yossi: New ESPEN guidelines 2018 – what are the key highlights what are the gaps/controversies?
Prf Singer:Well thank you for this question. The new ESPEN guidelines that have been release in 2018, give new inside in nutrition in report to the many studies that have been published in 2000.
The first point is that any patient at is… let’s say more 48h in an ICU is at risk of malnutrition and we have to consider nutrition for them.
The second point which is very important is the fact that we have to evaluate the needs of calories and proteins the patient is acquiring. How to do that? We say in the ESPEN guidelines that we should not use anymore the predictive equations because they are so much inaccurate, and we encourage the patients to be measured by indirect calorimetry to create a target for calories. This is a very important point in these guidelines.
The second point is to know what to do with these measurements? And we suggest that in the first 3 days, because of the huge substrate under production we should not give too much calories and only reach 70% at day 3 of the measurements and then continue to progress to 80 to 100 % in the next days. The route has to be determined according to the GI function, preferably using the enteral route but sometimes if it is not available use parenteral.
The second important points is the protein recommendation. This is a difficult issue since there are only few prospective randomized studies giving us a clear message. Therefore, the message of the ESPEN society is to give 1.3 gm per kilo per day. However, it is an expert recommendation it is not based on solid evidence and we hope that we will have better evidence to suggest for the next guidelines. Of course, we have also to recommend a certain amount of carbohydrates and fat to this critically patients not forget the minerals and not miss a hypophosphatemia that can endanger the patient.
Other patient with vitamin D, taking care specific diseases, post-trauma, sepsis- dysphagia patient but read the clinical nutrition ESPEN guidelines you will know everything about it.