T Cederholm1, R Barazzoni2, P Austin3, P Ballmer4, G Biolo5, S C Bischoff6, C Compher7, I Correia8, T Higashiguchi9, M Holst10, G L Jensen11, A Malone12, M Muscaritoli13, I Nyulasi14, M Pirlich15, E Rothenberg16, K Schindler17, S M Schneider18, M A E de van der Schueren19, C Sieber20, L Valentini21, J C Yu22, A Van Gossum23, P Singer24. 1. Departments of Geriatric Medicine, Uppsala University Hospital and Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden. Electronic address: tommy.cederholm@pubcare.uu.se. 2. Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy. Electronic address: barazzon@units.it. 3. Pharmacy Department, Oxford University Hospitals NHS Foundation Trust, United Kingdom; Pharmacy Department, University Hospital Southampton NHS Foundation Trust, United Kingdom. Electronic address: peter.austin@uhs.nhs.uk. 4. Department of Medicine, Kantonsspital Winterthur, Winterthur, Switzerland. Electronic address: peter.ballmer@ksw.ch. 5. Institute of Clinical Medicine, University of Trieste, Trieste, Italy. Electronic address: biolo@units.it. 6. Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany. Electronic address: bischoff.stephan@uni-hohenheim.de. 7. School of Nursing, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: compherc@nursing.upenn.edu. 8. Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil. Electronic address: isabel_correia@uol.com.br. 9. Department of Surgery and Palliative Medicine, Fujita Health University, School of Medicine, Toyoake, Japan. Electronic address: t-gucci30219@herb.ocn.ne.jp. 10. Center for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark. Electronic address: mette.holst@rn.dk. 11. The Dean's Office and Department of Medicine, The University of Vermont College of Medicine, Burlington, VT, USA. Electronic address: gordon.jensen@med.uvm.edu. 12. Pharmacy Department, Mount Carmel West Hospital, Columbus, OH, USA. Electronic address: ainsleym@nutritioncare.org. 13. Department of Clinical Medicine, Sapienza University of Rome, Italy. Electronic address: maurizio.muscaritoli@uniroma1.it. 14. Nutrition and Dietetics, Alfred Health, Melbourne, Australia. Electronic address: i.nyulasi@alfred.org.au. 15. Department of Internal Medicine, Elisabeth Protestant Hospital, Berlin, Germany. Electronic address: matthias.pirlich@pgdiakonie.de. 16. Department of Food and Meal Science, Kristianstad University, Kristianstad, Sweden. Electronic address: elisabet.rothenberg@vgregion.se. 17. Department of Internal Medicine III, Division of Endocrinology and Metabolism, Medical University Vienna, Vienna, Austria. Electronic address: karin.schindler@meduniwien.ac.at. 18. Department of Gastroenterology and Clinical Nutrition, Archet Hospital, University of Nice Sophia Antipolis, Nice, France. Electronic address: stephane.schneider@unice.fr. 19. Department of Nutrition and Dietetics, Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands; Department of Nutrition, Sports and Health, Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, The Netherlands. Electronic address: m.devanderschueren@vumc.nl. 20. Institute for Biomedicine of Ageing, Friedrich-Alexander University Erlangen-Nürnberg, Hospital St. John of Lord, Regensburg, Germany. Electronic address: cornel.sieber@fau.de. 21. Department of Agriculture and Food Sciences, Section of Dietetics, University of Applied Sciences, Neubrandenburg, Germany. Electronic address: valentini@hs-nb.de. 22. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. Electronic address: yu-jch@163.com. 23. Department of Gastroenterology, Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium. Electronic address: Andre.VanGossum@erasme.ulb.ac.be. 24. Department of Critical Care, Institute for Nutrition Research, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva 49100 Israel. Electronic address: pierre.singer@gmail.com.
Abstract
BACKGROUND: A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research. OBJECTIVE: This initiative aimed to reach a consensus for terminology for core nutritional concepts and procedures. METHODS: The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round. RESULTS: Five key areas related to clinical nutrition were identified: concepts; procedures; organisation; delivery; and products. One core concept of clinical nutrition is malnutrition/undernutrition, which includes disease-related malnutrition (DRM) with (eq. cachexia) and without inflammation, and malnutrition/undernutrition without disease, e.g. hunger-related malnutrition. Over-nutrition (overweight and obesity) is another core concept. Sarcopenia and frailty were agreed to be separate conditions often associated with malnutrition. Examples of nutritional procedures identified include screening for subjects at nutritional risk followed by a complete nutritional assessment. Hospital and care facility catering are the basic organizational forms for providing nutrition. Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. enteral tube feeding and parenteral (intravenous) nutrition, becomes the major way of nutrient delivery. CONCLUSION: An agreement of basic nutritional terminology to be used in clinical practice, research, and the ESPEN guideline developments has been established. This terminology consensus may help to support future global consensus efforts and updates of classification systems such as the International Classification of Disease (ICD). The continuous growth of knowledge in all areas addressed in this statement will provide the foundation for future revisions.
BACKGROUND: A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research. OBJECTIVE: This initiative aimed to reach a consensus for terminology for core nutritional concepts and procedures. METHODS: The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round. RESULTS: Five key areas related to clinical nutrition were identified: concepts; procedures; organisation; delivery; and products. One core concept of clinical nutrition is malnutrition/undernutrition, which includes disease-related malnutrition (DRM) with (eq. cachexia) and without inflammation, and malnutrition/undernutrition without disease, e.g. hunger-related malnutrition. Over-nutrition (overweight and obesity) is another core concept. Sarcopenia and frailty were agreed to be separate conditions often associated with malnutrition. Examples of nutritional procedures identified include screening for subjects at nutritional risk followed by a complete nutritional assessment. Hospital and care facility catering are the basic organizational forms for providing nutrition. Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. enteral tube feeding and parenteral (intravenous) nutrition, becomes the major way of nutrient delivery. CONCLUSION: An agreement of basic nutritional terminology to be used in clinical practice, research, and the ESPEN guideline developments has been established. This terminology consensus may help to support future global consensus efforts and updates of classification systems such as the International Classification of Disease (ICD). The continuous growth of knowledge in all areas addressed in this statement will provide the foundation for future revisions.
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Authors: Emanuele Rinninella; Marco Cintoni; Antonino De Lorenzo; Giovanni Addolorato; Gabriele Vassallo; Rossana Moroni; Giacinto Abele Donato Miggiano; Antonio Gasbarrini; Maria Cristina Mele Journal: Intern Emerg Med Date: 2018-05-30 Impact factor: 3.397