Nutrition in Internal Medicine

Abstract

Nutritional support has become a part of patient treatment. The nutritional content varies depending on the underlying disease in each patient. Malnutrition is defined as a condition that arises due to inadequate or excessive nutrition. Malnutrition is a major contributor to both morbidity and mortality, with its risk significantly heightened in hospitalized patients. Early assessment of a patient's nutritional status and timely appropriate treatment initiation can effectively reduce morbidity and mortality rates. As malnutrition is preventable, identifying at-risk patients and providing adequate nutritional support are essential components in optimizing clinical outcomes. Therefore, this review summarizes the nutritional approach to some common diseases in internal medicine practice. Our review's recommendations are based on guidelines from the European Society for Clinical Nutrition and Metabolism (ESPEN).

Keywords

• Malnutrition
• Nutritional approach
• Internal medicine

References

1. Bellanti F, Lo Buglio A, Quiete S, Vendemiale G. Malnutrition in hospitalized old patients: Screening and diagnosis, clinical outcomes, and management. Nutrients. 2022 Feb 21;14(4):910. doi: 10.3390/nu14040910.
2. Fielding RA, Landi F, Smoyer KE, Tarasenko L, Groarke J. Association of anorexia/appetite loss with malnutrition and mortality in older populations: A systematic literature review. J Cachexia Sarcopenia Muscle. 2023 Apr;14(2):706-29. doi: 10.1002/jcsm.13186.
3. Leiva Badosa E, Badia Tahull M, Virgili Casas N, Elguezabal Sangrador G, Faz Méndez C, Herrero Meseguer I, Izquierdo González À, López Urdiales R, Oca Burguete FJ, Tubau Molas M, Vilarasau Farré C, Llop Talaveron JM. Hospital malnutrition screening at admission: malnutrition increases mortality and length of stay. Nutr Hosp. 2017 Jul 28;34(4):907-13. doi: 10.20960/nh.657.
4. Xue J, Li S, Zhang Y, Hong P. Accuracy of predictive resting-metabolic-rate equations in Chinese Mainland adults. Int J Environ Res Public Health. 2019 Aug 1;16(15):2747. doi: 10.3390/ijerph16152747.
5. Kreymann G, Adolph M, Mueller MJ; Working group for developing the guidelines for parenteral nutrition of The German Association for Nutritional Medicine. Energy expenditure and energy intake - Guidelines on Parenteral Nutrition, Chapter 3. Ger Med Sci. 2009 Nov 18;7:Doc25. doi: 10.3205/000084.
6. Wunderle C, Gomes F, Schuetz P, Stumpf F, Austin P, Ballesteros-Pomar MD, Cederholm T, Fletcher J, Laviano A, Norman K, Poulia KA, Schneider SM, Stanga Z, Bischoff SC. ESPEN practical guideline: Nutritional support for polymorbid medical inpatients. Clin Nutr. 2024 Mar;43(3):674-91. doi: 10.1016/j.clnu.2024.01.008.
7. Bischoff SC, Ockenga J, Eshraghian A, Barazzoni R, Busetto L, Campmans-Kuijpers M, Cardinale V, Chermesh I, Kani HT, Khannoussi W, Lacaze L, Léon-Sanz M, Mendive JM, Müller MW, Tacke F, Thorell A, Vranesic Bender D, Weimann A, Cuerda C. Practical guideline on obesity care in patients with gastrointestinal and liver diseases - Joint ESPEN/UEG guideline. Clin Nutr. 2023 Jun;42(6):987-1024. doi: 10.1016/j.clnu.2023.03.021.
8. Fiaccadori E, Sabatino A, Barazzoni R, Carrero JJ, Cupisti A, De Waele E, Jonckheer J, Singer P, Cuerda C. ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease. Clin Nutr. 2021 Apr;40(4):1644-1668. doi: 10.1016/j.clnu.2021.01.028.

9. Arvanitakis M, Ockenga J, Bezmarevic M, Gianotti L, Krznarić Ž, Lobo DN, Löser C, Madl C, Meier R, Phillips M, Rasmussen HH, Van Hooft JE, Bischoff SC. ESPEN practical guideline on clinical nutrition in acute and chronic pancreatitis. Clin Nutr. 2024 Feb;43(2):395-412. doi: 10.1016/j.clnu.2023.12.019.
10. Charlson ME, Carrozzino D, Guidi J, Patierno C. Charlson Comorbidity Index: A critical review of clinimetric properties. Psychother Psychosom. 2022;91(1):8-35. doi: 10.1159/000521288.
11. Deutz NE, Matheson EM, Matarese LE, Luo M, Baggs GE, Nelson JL, Hegazi RA, Tappenden KA, Ziegler TR; NOURISH Study Group. Readmission and mortality in malnourished, older, hospitalized adults treated with a specialized oral nutritional supplement: A randomized clinical trial. Clin Nutr. 2016 Feb;35(1):18-26. doi: 10.1016/j.clnu.2015.12.010.
12. Jie B, Jiang ZM, Nolan MT, Efron DT, Zhu SN, Yu K, Kondrup J. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals. Nutrition. 2010 Nov-Dec;26(11-12):1088-93. doi: 10.1016/j.nut.2009.08.027.
13. Schuetz P, Fehr R, Baechli V, Geiser M, Deiss M, Gomes F, Kutz A, Tribolet P, Bregenzer T, Braun N, Hoess C, Pavlicek V, Schmid S, Bilz S, Sigrist S, Brändle M, Benz C, Henzen C, Mattmann S, Thomann R, Brand C, Rutishauser J, Aujesky D, Rodondi N, Donzé J, Stanga Z, Mueller B. Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial. Lancet. 2019 Jun 8;393(10188):2312-2321. doi: 10.1016/S0140-6736(18)32776-4.
14. Schuetz P, Seres D, Lobo DN, Gomes F, Kaegi-Braun N, Stanga Z. Management of disease-related malnutrition for patients being treated in hospital. Lancet. 2021 Nov 20;398(10314):1927-1938. doi: 10.1016/S0140-6736(21)01451-3.
15. Merker M, Felder M, Gueissaz L, Bolliger R, Tribolet P, Kägi-Braun N, Gomes F, Hoess C, Pavlicek V, Bilz S, Sigrist S, Brändle M, Henzen C, Thomann R, Rutishauser J, Aujesky D, Rodondi N, Donzé J, Stanga Z, Mueller B, Schuetz P. Association of baseline inflammation with effectiveness of nutritional support among patients with disease-related malnutrition: A secondary analysis of a randomized clinical trial. JAMA Netw Open. 2020 Mar 2;3(3):e200663. doi: 10.1001/jamanetworkopen.2020.0663.
16. Kaegi-Braun N, Tribolet P, Gomes F, Fehr R, Baechli V, Geiser M, Deiss M, Kutz A, Bregenzer T, Hoess C, Pavlicek V, Schmid S, Bilz S, Sigrist S, Brändle M, Benz C, Henzen C, Mattmann S, Thomann R, Rutishauser J, Aujesky D, Rodondi N, Donzé J, Stanga Z, Mueller B, Schuetz P. Six-month outcomes after individualized nutritional support during the hospital stay in medical patients at nutritional risk: Secondary analysis of a prospective randomized trial. Clin Nutr. 2021 Mar;40(3):812-9. doi: 10.1016/j.clnu.2020.08.019.
17. Schuetz P, Sulo S, Walzer S, Vollmer L, Stanga Z, Gomes F, Rueda R, Mueller B, Partridge J; EFFORT trial collaborators. Economic evaluation of individualized nutritional support in medical inpatients: Secondary analysis of the EFFORT trial. Clin Nutr. 2020 Nov;39(11):3361-3368. doi: 10.1016/j.clnu.2020.02.023.
18. Wong A, Chew A, Wang CM, Ong L, Zhang SH, Young S. The use of a specialised amino acid mixture for pressure ulcers: a placebo-controlled trial. J Wound Care. 2014 May;23(5):259-60, 262-4, 266-9. doi: 10.12968/jowc.2014.23.5.259.
19. Jie B, Jiang ZM, Nolan MT, Efron DT, Zhu SN, Yu K, Kondrup J. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals. Nutrition. 2010 Nov-Dec;26(11-12):1088-1093. doi: 10.1016/j.nut.2009.08.027.
20. Kok WE, Haverkort EB, Algra YA, Mollema J, Hollaar VRY, Naumann E, de van der Schueren MAE, Jerković-Ćosić K. The association between polypharmacy and malnutrition(risk) in older people: A systematic review. Clin Nutr ESPEN. 2022 Jun;49:163-71. doi: 10.1016/j.clnesp.2022.03.007.
21. Jyrkkä J, Enlund H, Lavikainen P, Sulkava R, Hartikainen S. Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population. Pharmacoepidemiol Drug Saf. 2011 May;20(5):514-22. doi: 10.1002/pds.2116.
22. Pana A, Sourtzi P, Kalokairinou A, Velonaki VS. Sarcopenia and polypharmacy among older adults: A scoping review of the literature. Arch Gerontol Geriatr. 2022 Jan-Feb;98:104520. doi: 10.1016/j.archger.2021.104520.
23. Castera L, Friedrich-Rust M, Loomba R. Noninvasive assessment of liver disease in patients with nonalcoholic fatty liver disease. Gastroenterology. 2019 Apr;156(5):1264-1281.e4. doi: 10.1053/j.gastro.2018.12.036.
24. Chalasani N, Younossi Z, Lavine JE, Charlton M, Cusi K, Rinella M. The diagnosis and management of nonalcoholic fatty liver disease: Practice guidance from the American Association for the Study of Liver Diseases. Clin Liver Dis (Hoboken). 2018 Apr 20;11(4):81. doi: 10.1002/cld.722.
25. De Fré CH, De Fré MA, Kwanten WJ, Op de Beeck BJ, Van Gaal LF, Francque SM. Sarcopenia in patients with non-alcoholic fatty liver disease: is it a clinically significant entity? Obes Rev. 2019 Feb;20(2):353-63. doi: 10.1111/obr.12776.
26. Gan D, Wang L, Jia M, Ru Y, Ma Y, Zheng W, Zhao X, Yang F, Wang T, Mu Y, Zhu S. Low muscle mass and low muscle strength associate with nonalcoholic fatty liver disease. Clin Nutr. 2020 Apr;39(4):1124-1130. doi: 10.1016/j.clnu.2019.04.023.
27. Hong HC, Hwang SY, Choi HY, Yoo HJ, Seo JA, Kim SG, Kim NH, Baik SH, Choi DS, Choi KM. Relationship between sarcopenia and nonalcoholic fatty liver disease: the Korean Sarcopenic Obesity Study. Hepatology. 2014 May;59(5):1772-1778. doi: 10.1002/hep.26716.
28. Tovo CV, Fernandes SA, Buss C, de Mattos AA. Sarcopenia and non-alcoholic fatty liver disease: Is there a relationship? A systematic review. World J Hepatol. 2017 Feb 28;9(6):326-32. doi: 10.4254/wjh.v9.i6.326.
29. Kien CL, Ugrasbul F. Prediction of daily energy expenditure during a feeding trial using measurements of resting energy expenditure, fat-free mass, or Harris-Benedict equations. Am J Clin Nutr. 2004 Oct;80(4):876-80. doi: 10.1093/ajcn/80.4.876.
30. Kittah NE, Vella A. Management of endocrine disease: Pathogenesis and management of hypoglycemia. Eur J Endocrinol. 2017 Jul;177(1):R37-R47. doi: 10.1530/EJE-16-1062.
31. Bischoff SC, Boirie Y, Cederholm T, Chourdakis M, Cuerda C, Delzenne NM, Deutz NE, Fouque D, Genton L, Gil C, Koletzko B, Leon-Sanz M, Shamir R, Singer J, Singer P, Stroebele-Benschop N, Thorell A, Weimann A, Barazzoni R. Towards a multidisciplinary approach to understand and manage obesity and related diseases. Clin Nutr. 2017 Aug;36(4):917-38. doi: 10.1016/j.clnu.2016.11.007.
32. Marsk R, Jonas E, Rasmussen F, Näslund E. Nationwide cohort study of post-gastric bypass hypoglycaemia including 5,040 patients undergoing surgery for obesity in 1986-2006 in Sweden. Diabetologia. 2010 Nov;53(11):2307-2311. doi: 10.1007/s00125-010-1798-5.
33. Lee CJ, Brown TT, Schweitzer M, Magnuson T, Clark JM. The incidence and risk factors associated with developing symptoms of hypoglycemia after bariatric surgery. Surg Obes Relat Dis. 2018 Jun;14(6):797-802. doi: 10.1016/j.soard.2018.01.028.
34. Guo XF, Yang B, Tang J, Li D. Fatty acid and non-alcoholic fatty liver disease: Meta-analyses of case-control and randomized controlled trials. Clin Nutr. 2018 Feb;37(1):113-22. doi: 10.1016/j.clnu.2017.01.003.
35. Musa-Veloso K, Venditti C, Lee HY, Darch M, Floyd S, West S, Simon R. Systematic review and meta-analysis of controlled intervention studies on the effectiveness of long-chain omega-3 fatty acids in patients with nonalcoholic fatty liver disease. Nutr Rev. 2018 Aug 1;76(8):581-602. doi: 10.1093/nutrit/nuy022.
36. Yan JH, Guan BJ, Gao HY, Peng XE. Omega-3 polyunsaturated fatty acid supplementation and non-alcoholic fatty liver disease: A meta-analysis of randomized controlled trials. Medicine (Baltimore). 2018 Sep;97(37):e12271. doi: 10.1097/MD.0000000000012271.
37. Sanyal AJ, Abdelmalek MF, Suzuki A, Cummings OW, Chojkier M; EPE-A Study Group. No significant effects of ethyl-eicosapentanoic acid on histologic features of nonalcoholic steatohepatitis in a phase 2 trial. Gastroenterology. 2014 Aug;147(2):377-84.e1. doi: 10.1053/j.gastro.2014.04.046.
38. Fiaccadori E, Regolisti G, Maggiore U. Specialized nutritional support interventions in critically ill patients on renal replacement therapy. Curr Opin Clin Nutr Metab Care. 2013 Mar;16(2):217-24. doi: 10.1097/MCO.0b013e32835c20b0.
39. MacLaughlin HL, Friedman AN, Ikizler TA. Nutrition in Kidney Disease: Core Curriculum 2022. Am J Kidney Dis. 2022 Mar;79(3):437-49. doi: 10.1053/j.ajkd.2021.05.024.
40. Jie B, Jiang ZM, Nolan MT, Efron DT, Zhu SN, Yu K, Kondrup J. Impact of nutritional support on clinical outcome in patients at nutritional risk: a multicenter, prospective cohort study in Baltimore and Beijing teaching hospitals. Nutrition. 2010 Nov-Dec;26(11-12):1088-1093. doi: 10.1016/j.nut.2009.08.027.
41. Picolo MF, Lago AF, Menegueti MG, Nicolini EA, Basile-Filho A, Nunes AA, Martins-Filho OA, Auxiliadora-Martins M. Harris-Benedict equation and resting energy expenditure estimates in critically Ill ventilator patients. Am J Crit Care. 2016 Jan;25(1):e21-9. doi: 10.4037/ajcc2016758.
42. Hellerman M, Sabatino A, Theilla M, Kagan I, Fiaccadori E, Singer P. Carbohydrate and lipid prescription, administration, and oxidation in critically Ill patients with acute kidney injury: A post hoc analysis. J Ren Nutr. 2019 Jul;29(4):289-94. doi: 10.1053/j.jrn.2018.09.002.
43. Hanna RM, Ghobry L, Wassef O, Rhee CM, Kalantar-Zadeh K. A practical approach to nutrition, protein-energy wasting, sarcopenia, and cachexia in patients with chronic kidney disease. Blood Purif. 2020;49(1-2):202-11. doi: 10.1159/000504240.
44. Lion RP, Vega MR, Smith EO, Devaraj S, Braun MC, Bryan NS, Desai MS, Coss-Bu JA, Ikizler TA, Akcan Arikan A. The effect of continuous venovenous hemodiafiltration on amino acid delivery, clearance, and removal in children. Pediatr Nephrol. 2022 Feb;37(2):433-41. doi: 10.1007/s00467-021-05162-0.
45. Stapel SN, de Boer RJ, Thoral PJ, Vervloet MG, Girbes ARJ, Oudemans-van Straaten HM. Amino acid loss during continuous venovenous hemofiltration in critically Ill patients. Blood Purif. 2019;48(4):321-9. doi: 10.1159/000500998.
46. Ostermann M, Lumlertgul N, Mehta R. Nutritional assessment and support during continuous renal replacement therapy. Semin Dial. 2021 Nov;34(6):449-56. doi: 10.1111/sdi.12973. Epub 2021 Apr 28. PMID: 33909935.
47. Fiaccadori E, Sabatino A, Morabito S, Bozzoli L, Donadio C, Maggiore U, Regolisti G. Hyper/hypoglycemia and acute kidney injury in critically ill patients. Clin Nutr. 2016 Apr;35(2):317-21. doi: 10.1016/j.clnu.2015.04.006.
48. Trikudanathan G, Wolbrink DRJ, van Santvoort HC, Mallery S, Freeman M, Besselink MG. Current concepts in severe acute and necrotizing pancreatitis: An evidence-based approach. Gastroenterology. 2019 May;156(7):1994-2007.e3. doi: 10.1053/j.gastro.2019.01.269.
49. Eckerwall GE, Tingstedt BB, Bergenzaun PE, Andersson RG. Immediate oral feeding in patients with mild acute pancreatitis is safe and may accelerate recovery--a randomized clinical study. Clin Nutr. 2007 Dec;26(6):758-63. doi: 10.1016/j.clnu.2007.04.007.
50. Wu LM, Sankaran SJ, Plank LD, Windsor JA, Petrov MS. Meta-analysis of gut barrier dysfunction in patients with acute pancreatitis. Br J Surg. 2014 Dec;101(13):1644-1656. doi: 10.1002/bjs.9665.
51. Teich N, Aghdassi A, Fischer J, Walz B, Caca K, Wallochny T, von Aretin A, von Boyen G, Göpel S, Ockenga J, Leodolter A, Rüddel J, Weber E, Mayerle J, Lerch MM, Mössner J, Schiefke I. Optimal timing of oral refeeding in mild acute pancreatitis: results of an open randomized multicenter trial. Pancreas. 2010 Oct;39(7):1088-1092. doi: 10.1097/MPA.0b013e3181d3ce05.
52. Marik PE, Zaloga GP. Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis. BMJ. 2004 Jun 12;328(7453):1407. doi: 10.1136/bmj.38118.593900.55.
53. Petrov MS, van Santvoort HC, Besselink MG, van der Heijden GJ, Windsor JA, Gooszen HG. Enteral nutrition and the risk of mortality and infectious complications in patients with severe acute pancreatitis: a meta-analysis of randomized trials. Arch Surg. 2008 Nov;143(11):1111-1117. doi: 10.1001/archsurg.143.11.1111.
54. Wu P, Li L, Sun W. Efficacy comparisons of enteral nutrition and parenteral nutrition in patients with severe acute pancreatitis: a meta-analysis from randomized controlled trials. Biosci Rep. 2018 Nov 15;38(6):BSR20181515. doi: 10.1042/BSR20181515.
55. Chang YS, Fu HQ, Xiao YM, Liu JC. Nasogastric or nasojejunal feeding in predicted severe acute pancreatitis: a meta-analysis. Crit Care. 2013 Jun 20;17(3):R118. doi: 10.1186/cc12790.
56. Zhu Y, Yin H, Zhang R, Ye X, Wei J. Nasogastric nutrition versus nasojejunal nutrition in patients with severe acute pancreatitis: A meta-analysis of randomized controlled trials. Gastroenterol Res Pract. 2016;2016:6430632. doi: 10.1155/2016/6430632.
57. Asrani V, Chang WK, Dong Z, Hardy G, Windsor JA, Petrov MS. Glutamine supplementation in acute pancreatitis: a meta-analysis of randomized controlled trials. Pancreatology. 2013 Sep-Oct;13(5):468-74. doi: 10.1016/j.pan.2013.07.282.