Türkiye’deki Klinik Nütrisyon Uygulamalarının ve ESPEN Rehberlerine Uyumunun Değerlendirilmesi

Yıl 2023, Cilt: 8 Sayı: 2, 355 - 363, 21.06.2023

Sema Çalapkorur , Hilal Toklu

Öz

Amaç: Bu çalışma, Türkiye’deki klinik beslenme uygulamalarının ve ESPEN rehberlerine uyumun değerlendirilmesi amacıyla planlanıp yürütülmüştür.

Gereç ve Yöntem: Çalışma, Türkiye'nin farklı illerinde beslenme destek ekibinde (BDE) yer alan 60 diyetisyen ile online platformda gerçekleştirilmiştir. Çevrimiçi form beslenme destek ekibinin özellikleri ve hastalıklara özgü beslenme uygulamalarının değerlendirilmesine yönelik bölümlerden oluşmuştur.

Bulgular: Diyetisyenlerin %60’ı kurumlarındaki BDE’nin klinik nütrisyona yönelik eğitimi olduğunu belirtmiştir. Bireylerin tamamı beslenme durumunun taranmasında Nütrisyonel Risk Skoru (NRS-2002)’nin kullanıldığını belirtirken, katılımcıların %50’si kurumlarında antropometrik ölçüm uygulamalarının düzenli olarak yapılmadığını ifade etmiştir. İlk 3 gün içinde ağızdan tam doz nütrisyona başlaması beklenmeyen yoğun bakım hastalarına enteral nütrisyon başlandığını ifade eden diyetisyenlerin oranı %71,7’dir. Cerrahi öncesi hastalara preoperatif açlık uygulamayan diyetisyenlerin oranı %3,4, postoperatif dönemde beslemeye devam ettiklerini belirten diyetisyenlerin oranı ise %10,5’tir. Bakımsız ve bağırsaklarında inflamatuar steanoz gelişen olgularda kombine terapi kullanılma oranı %23,3, bağırsaktaki inflamasyonun devamı halinde oral nutrisyon desteği yapılma oranı ise %46,6 olarak belirlenmiştir. Karaciğer hastalarında tam protein içeren formüllerin kullanım oranı %77, hepatik ensefalopati gelişen hastalarda dallı zincirli aminoasit (DZAA) lerden zengin formüllerin kullanılma oranı ise %51,9’dur.

Sonuç: Beslenme destek ekibi profesyonelleri klinik beslenme eğitimine odaklanmalı ve kılavuz önerileri konusunda farkındalıklarını artırmalıdır.

Anahtar Kelimeler

Klinik beslenme, kılavuzlar, beslenme destek ekibi, beslenme uygulamaları, ESPEN.

Evaluation of Compliance of Clinical Nutrition Practices in with ESPEN Guidelines in Turkey

Öz

Objective: This study was planned to assess clinical nutrition practices and compliance with ESPEN guidelines in Turkey.

Material and Method: The study was conducted on the online platform with 60 dieticians who were in the nutritional support team in different provinces of Turkey. The online form consists of sections on the particulars of the nutritional support team and an assessment of disease-specific nutrition practices.

Results: Dietitians’ 60% stated that NST (Nutritional Support Team) in their institution had training in clinical nutrition. While all the participants stated that the Nutritional Risk Score (NRS-2002) was used in screening the nutritional status, 50% of the participants reported that anthropometric measurement practices were not carried out regularly. The rate of dietitians who stated that enteral nutrition was started in intensive care patients who were not expected to start full oral nutrition in the first 3 days was 71.7%. The rate of dietitians who stated that preoperative fasting was not applied in patients before surgery was 3.4%, while continued to be fed in the post-operative period was 10.5%. The rate of using combined therapy was 23.3% in patients who were neglected and who developed inflammatory stenosis in the intestines, applying for oral nutritional support in case of continued inflammation in the intestines was determined as 46.6%. The rate of using formulas containing whole protein in liver patients was 77%, and using formulas rich in branched-chain amino acids in patients with hepatic encephalopathy was 51.9%.

Conclusion: Nutritional support team professionals should focus on clinical nutrition education and increase their awareness of guideline recommendations.

Anahtar Kelimeler

Clinical nutrition, nutritional support team, guidelines, nutrition practices, ESPEN.

Kaynakça

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