Summary of guidelines
In the past years, several Dutch guidelines have been developed on malnutrition.
The guideline Malnutrition, recognising, diagnosing and treating malnutrition in adults, gives an overview of current perspectives on the early recognition and treatment of malnutrition in Dutch healthcare. It concerns adults in all health care settings.
A multidisciplinary guideline for the screening and treatment of malnutrition in the community was drafted by a working group of the Dutch College of General Practitioners, Dutch Nurses’ Association and the Dutch Dietetic Association. The guideline is designed to achieve better primary care for adults with or at risk of malnutrition by creating closer cooperation between GPs, nurses and dietitians. This requires tasks and responsibilities regarding detection, diagnosis, treatment and support to be divided. The goal is to have the most suitable care provider(s) provide the right care at the right time and to safeguard continuity of care for the patient.
Malnutrition constitutes an important threat to the independence and quality of life of older people. Its prevalence among hospitalized geriatric patients is high, ranging from 20 to 60%.
This guideline ‘Assessment and treatment of malnutrition in geriatric practice’ was developed early recognition and treatment of malnutrition in Dutch healthcare. This practice-based guideline was based on the consensus in a panel of experts with the use of a Delphi technique.
The potential fatal consequences of the refeeding syndrome are commonly acknowledged. Many aspects of the syndrome such as the direct cause, incidence, symptoms, prevention and treatment are unknown because of the lack of data from large patients series. Although the refeeding syndrome is univocally presented, patients present themselves with many different symptoms. In some patients deviations of many electrolytes are present and in others only the serum phosphate level is reduced. Some patients have mild symptoms, other have severe to lethal symptoms. Moreover, there is no unequivocal evidence on the best strategy for prevention and treatment of the refeeding symptoms. Because of these reasons it is not possible to tie the refeeding syndrome to a protocol. This consensus statement gives guidance to the definition, prevention, recognition and treatment of refeeding.
Malnutrition is associated with adverse outcomes in surgical patients. The guideline ‘Perioprative Nutrition’ contains recommendations on both pre- and postoperative nutrition in patients undergoing surgery.
Cancer patients, like everybody else, need a well-composed, sufficient and attractive diet, to keep their nutritional status in balance. Disease and treatment have an negative influence on nutritional status and body composition and cause a negative effect on treatment response and quality of life. In illness and treatment the capacity of a cancer patient to eat well is limited which can lead to moderate of severe malnourishment. Nutritional and dietary treatment is therefore an important supportive therapy to achieve cure or good palliative care.
The guideline ‘General Nutrition and Dietary Treatment in Oncology’ aims to give insight into the current knowledge of nutrition, nutritional symptoms and the nutritional care process in cancer.
Since 1997, ESPEN publishes guidelines and position papers on a regulatory basis in Clinical Nutrition.