Nutritional Therapy Plan
Four Steps in Developing Optimal Nutritional Therapy
The overarching goal of nutrition therapy is to stabilize or to increase the weight of the patient and to improve their nutritional status. This means ensuring that the patient’s total nutrient intake provides sufficient energy, proteins, micronutrients and fluid to meet the individual patient’s needs.1
Further objectives of nutritional therapy include maintaining immune functions and preventing metabolic complications.2
An effective plan typically follows four critical steps:
- Define the nutritional goals for the patient
- Define the patient’s individual nutritional requirements
- Define the nutritional support and implement a nutritional therapy plan
- Define the route(s) of nutrition
Define the Nutritional Goals for the Patient
The first step in a nutritional therapy plan is defining the nutritional goal for the patient. For some patients this may mean stabilizing body weight, for others it may mean increasing body weight. A target weight and a target body mass index (BMI) should be determined.
Define the Patient’s Individual Nutritional Requirements
The second step is to define the patient’s specific nutritional requirements. Energy requirements, protein intake and fluid intake should all be calculated.
Define Nutritional Support and Implement Nutritional Therapy Plan
The third step is to evaluate the nutritional intake of the patient and compare it to clinically established requirements. A range of strategies may be used to manage disease-related malnutrition. Such strategies may involve food fortification or the use of enteral or parenteral nutrition.
According to the ESPEN Enteral Nutrition Guidelines3, the term “enteral nutrition” is used to describe all forms of nutritional support that involve the use of ‘‘dietary foods for special medical purposes’’ independent of the route of administration. Enteral Nutrition, therefore, includes oral nutritional supplements (ONS) and enteral tube feeding via nasoenteral or percutaneous tubes. The term “parenteral nutrition” (also known as intravenous nutrition) is used to describe the intravenous infusion of nutrients directly into the systemic circulation, bypassing the gastrointestinal (GI) tract.2
Define the Route(s) of Nutrition
The fourth step is to determine the best route or routes of nutrition.1,4 The general rule of thumb is – “if the gut works, use it.” However, supplemental or total parenteral nutrition via a central or peripherally-placed line is suggested when nutritional requirements cannot be met via oral or enteral feeding.
To read more about indications for clinical nutrition, click here.
- 1. a. b. National Collaborating Centre for Acute Care (UK). Nutrition Support for Adults Oral Nutrition Support, Enteral Tube Feeding and Parenteral Nutrition. NICE Clinical Guidelines, No. 32 London 2006.
- 2. a. b. American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Board of Directors. Clinical Guidelines for the Use of Parenteral and Enteral Nutrition in Adult and Pediatric Patients. JPEN 2009;33(3):255-259.
- 3. Lochs H, Allison SP, Meier R et al. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, definitions and general topics. Clin Nutr 2006;25(2):180-186.
- 4. Carpentier Y, Sobotka L. Energy. In: Sobotka L, editor. Basics in Clinical Nutrition. Prague: Galen 2011:247-251.