Ernährungstherapie polymorbider, internistischer Patienten – eine Balance zwischen Energiedefizit- und Refeeding-Syndrom

Zusammenfassung

Mangelernährung ist ein häufiges Problem bei hospitalisierten, internistischen Patienten. Trotz täglicher Konfrontation mit diesem Thema im klinischen Alltag gibt es keine allgemein akzeptierte Richtlinie zur standardisierten und evidenzbasierten Behandlung des polymorbiden, mangelernährten Patienten der Inneren Medizin. Diese Übersichtsarbeit diskutiert wichtige Aspekte des Mangelernährungsmanagements im Spitalalltag – von der Pathophysiologie über das Screening hin zu sinnvollen therapeutischen Ansätzen. Dabei haben klinische Studien Hinweise geliefert, dass die schrittweise, an Eiweiß- und Kalorienzielen angepasste Ernährungstherapie günstige Effekte auf den Krankheitsverlauf von Patienten haben kann. Bei schwer mangelernährten Risikopatienten sollte ein spezielles Augenmerk auf die mögliche Komplikation der zu aggressiven Ernährungstherapie geworfen werden – dem Refeeding-Syndrom. Wir diskutieren sowohl praktische Aspekte als auch bestehende Kontroversen der aktuellen klinischen Studiendatenlage.

Abstract

Malnutrition is a common problem in hospitalized medical patients. Despite the importance of malnutrition in clinical practice, there is a lack of standardized and evidence-based guidelines for nutritional therapy in polymorbid medical inpatients. The aim of this review is to discuss important aspects of malnutrition including pathophysiology, screening and different therapeutic approaches. Recent studies have shown that nutritional therapy targeted to reach nutritional goals may improve disease recovery. In high risk patients with severe malnutrition, particular attention should be given to potential harm resulting from too aggressive feeding leading to refeeding syndrome. We focus on practical aspects and also discuss current controversies of clinical trial data.

Schlüsselwörter

Mangelernährung - Refeeding-Syndrom - Ernährungsalgorithmus - Ernährungstherapie

Keywords

malnutrition - refeeding syndrome - nutritional therapy

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