Tailoring Parenteral Nutrition
Aiming to Meet Each Patient’s Nutritional Requirements
When it comes to disease-related malnutrition, every patient’s requirements will be different. Once parenteral nutrition (PN) is indicated, health care professionals can calculate nutrient requirements to optimize clinical nutrition therapy to the specific needs of the patient.
To meet each patient’s energy and protein requirements, it is important to consider the complete clinical picture. Energy intake during PN must be adjusted to the:1
- Actual energy expenditure
- Clinical situation of the patient
- Nutritional goals based on nutritional status
Actual Energy Expenditure
Several equations are available to predict energy consumption. In clinical practice, the Harris and Benedict equation is the most commonly used to calculate resting energy expenditure (REE). Using this equation, height, body weight, gender and age are used to estimate an individual’s resting metabolic rate.2
Clinical Situation of the Patient
The patient’s clinical condition, e.g. activity or trauma factors, such as large bone fractures, sepsis, burns, severe infection, chronic renal failure and cancer, must be assessed to adjust PN. These conditions account for increased energy and protein requirements due to the physical activity and metabolic stress related to the underlying disease.
Nutritional Goals Established with Regard to Nutritional Status
When calculating a patient’s energy and protein requirements, the established objectives of the nutrition therapy must be considered, including:1
- Provision of energy and protein to prevent body wasting during acute illness
- Recovery of muscle and energy stores during re-convalescence
- Catch-up growth in children
- Nutritional status/body mass index (BMI) in severe malnutrition or cachexia
Using these parameters, carefully tailored PN can support the clinical nutrition needs of patients, thereby fighting disease-related malnutrition.