Title: Parenteral nutrition in adults with a functional gastrointestinal tract
Abstract: Contrary to the title, parenteral nutrition is for when nutrition cannot be safely delivered into the gastrointestinal tract. Gary Zaloga (April 1, p 1101)1Zaloga GP Parenteral nutrition in adult inpatients with functioning gastrointestinal tracts: assessment of outcomes.Lancet. 2006; 367: 1101-1111Summary Full Text Full Text PDF PubMed Scopus (138) Google Scholar points out that for most patients this is not the case. I suggest that his Review has a perspective that reflects his home country, where parenteral nutrition is overused, and that it is its misuse that is the problem rather than parenteral nutrition per se. Decision-making in nutrition support requires recognition of the malnourished or soon to be and follows an escalating pathway of care from oral food to enteral nutrition and only finally to parenteral nutrition if needed.In response to Zaloga's concluding paragraph about the need to develop evidence-based guidelines, the UK's National Institute for Health and Clinical Excellence (NICE) has just published some.2National Institute for Health and Clinical ExcellenceNutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition. Clinical guideline no 32. NICE, London2006http://www.nice.org.uk/CG032Google Scholar The working group that developed these guidelines recognised the fallacy of studies that have compared parenteral nutrition with enteral nutrition since only patients assured to have a functional gastrointestinal tract are recruited. Furthermore, the considerable change in the practice, nature, and content of parenteral nutrition has meant that historical studies have perhaps little to contribute to this debate.I was a member of the National Collaborating Centre for Acute Care working group that developed the guidelines for NICE, but these are my own personal views. I have received lecture honoraria from several nutrition companies over the years but have no direct commercial association or connections. Contrary to the title, parenteral nutrition is for when nutrition cannot be safely delivered into the gastrointestinal tract. Gary Zaloga (April 1, p 1101)1Zaloga GP Parenteral nutrition in adult inpatients with functioning gastrointestinal tracts: assessment of outcomes.Lancet. 2006; 367: 1101-1111Summary Full Text Full Text PDF PubMed Scopus (138) Google Scholar points out that for most patients this is not the case. I suggest that his Review has a perspective that reflects his home country, where parenteral nutrition is overused, and that it is its misuse that is the problem rather than parenteral nutrition per se. Decision-making in nutrition support requires recognition of the malnourished or soon to be and follows an escalating pathway of care from oral food to enteral nutrition and only finally to parenteral nutrition if needed. In response to Zaloga's concluding paragraph about the need to develop evidence-based guidelines, the UK's National Institute for Health and Clinical Excellence (NICE) has just published some.2National Institute for Health and Clinical ExcellenceNutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition. Clinical guideline no 32. NICE, London2006http://www.nice.org.uk/CG032Google Scholar The working group that developed these guidelines recognised the fallacy of studies that have compared parenteral nutrition with enteral nutrition since only patients assured to have a functional gastrointestinal tract are recruited. Furthermore, the considerable change in the practice, nature, and content of parenteral nutrition has meant that historical studies have perhaps little to contribute to this debate. I was a member of the National Collaborating Centre for Acute Care working group that developed the guidelines for NICE, but these are my own personal views. I have received lecture honoraria from several nutrition companies over the years but have no direct commercial association or connections.
Publication Year: 2006
Publication Date: 2006-11-01
Language: en
Type: letter
Indexed In: ['crossref', 'pubmed']
Access and Citation
Cited By Count: 4
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