Edited by
Series Editor
This edition first published 2018 © 2018 by John Wiley & Sons Ltd
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.
The right of Mary Hickson and Sara Smith to be identified as the authors of the editorial in this work has been asserted in accordance with law.
Registered Office(s)
John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA
John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
Editorial Office
9600 Garsington Road, Oxford, OX4 2DQ, UK
For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com.
Wiley also publishes its books in a variety of electronic formats and by print‐on‐demand. Some content that appears in standard print versions of this book may not be available in other formats.
Limit of Liability/Disclaimer of Warranty
The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging‐in‐Publication data applied for
9781118993859
Cover design: Wiley
Nutritional interventions need to be based on solid evidence, but where can you find this information? The British Dietetic Association and the publishers of the Manual of Dietetic Practice present an essential and authoritative reference series on the evidence base relating to advanced aspects of nutrition and dietetics in selected clinical areas. Each book provides a comprehensive and critical review of key literature in the area. Each covers established areas of understanding, current controversies and areas of future development and investigation, and aims to address key themes, including:
Trustworthy, international in scope and accessible, Advanced Nutrition and Dietetics is a vital resource for a range of practitioners, researchers and educators in nutrition and dietetics, including dietitians, nutritionists, doctors and specialist nurses.
Undernutrition is a serious condition that occurs when a person’s diet does not contain sufficient energy or nutrients for a healthy and active life. In the past it has been termed malnutrition, but with the rise of obesity and conditions related to overnutrition, it is important to make a clear distinction between the two extremes. This book focuses particularly on undernutrition in economically developed regions of the world, and as such does not cover in any detail undernutrition relating to famine, conflict and long‐term food insecurity prevalent in developing countries.
Undernutrition can result from inadequate consumption of nutrients, failure to absorb nutrients, impaired metabolism, excessive loss of nutrients or increased requirements. It generally develops gradually but rapid deterioration in nutritional status can occur in acute disease or starvation. The first changes are to nutrient concentrations in blood and tissues, followed by intracellular changes in biochemical functions and structure. Later, overt symptoms and signs appear, enabling diagnosis by history, physical examination, body composition and dietary analysis, and laboratory tests. The causes of undernutrition can be complex and may involve several interacting factors including physiological, psychological, socioeconomic and institutional. The consequences can be far reaching and affect the optimal functioning of individuals, as well as exacerbating and precipitating disease. Undernutrition commonly occurs concurrently with disease and particular life stages make people more vulnerable to it: childhood, during pregnancy and lactation, and during older age.
Advanced Nutrition and Dietetics in Nutrition Support aims to provide an essential and authoritative reference and review of the evidence base relating to undernutrition. It draws on the experience and expertise of recognised authorities from around the world to bring together the information needed by practitioners, researchers and educators in the area of nutrition and diet. Specialist dietitians and nutritionists will find this to be an essential text, but it will also be valuable for doctors, nurses and other health professionals with a specialist interest in nutrition.
The chapters provide a comprehensive and critical review of the key literature and are split into five sections.
The authors have focused on established areas of understanding, current controversies and areas of future development and investigation, and drawn extensively upon the research literature, particularly systematic reviews and meta‐analyses. Efforts have been made to highlight the gaps in the literature and specific issues relating to the quality of the evidence in a given specialty. Importantly, the authors have sought to discuss the implications of research findings for practice and the issues to consider when translating research into practice.
This book is the fourth title in a series commissioned as part of a major initiative between the British Dietetic Association and the publishers Wiley. Each book in the series provides a comprehensive and critical review of the key literature in a clinical area. Each book is edited by one or more experts who have themselves undertaken extensive research and published widely in the relevant topic area. Chapters are written by experts drawn from an international audience and from a variety of disciplines as required of the relevant chapter (e.g. dietetics, medicine, biomedical sciences).
The editors and I are proud to present this title: Advanced Nutrition and Dietetics in Nutrition Support. Undernutrition can have profound impacts on a range of outcomes, including clinical (e.g. mortality, morbidity, complications), patient‐centred (e.g. quality of life, patient experience) and economic outcomes (e.g. length of stay, readmission rates, costs). Approaches are needed to both screen and assess undernutrition and to appropriately prevent and manage it, using interventions ranging from public health approaches to parenteral nutrition. We hope that this book will improve health professionals’ understanding and application of nutrition and dietetics in these areas and improve outcomes for the patients affected.
I am delighted to present the foreword for Advanced Nutrition and Dietetics in Nutrition Support, edited by two eminent British dietitians and clinical nutritionists, Professor Mary Hickson and Dr Sara Smith. Both of the authors have the advantage of considerable clinical and research experience in actually providing nutrition support as well as a gift for communicating their knowledge of the science and art to others. Together with the experts writing each chapter, they nicely define and set out the problem of undernutrition, the tools for deciding what needs to be done and then what to do, all in a single volume.
This is a book that I, and many other practitioners throughout the world, will welcome as an addition to their core reference libraries that they will turn to repeatedly in their daily work because it manages to convey the essentials succinctly and authoritatively. The information it provides is useful not only in Europe but globally since the comprehensive and critical review of the key literature in nutrition support covers not only basic concepts but current controversies and likely directions for future developments in the field.
The book is well suited to both beginners and master practitioners. Early sections provide a succinct background on undernutrition and how to identify it, followed by a section describing nutritional requirements. In addition to artificial nutrition support (e.g. parenteral, enteral), a welcome addition is a chapter on population and community interventions to prevent and treat undernutrition. The various routes that can be used to provide nutritional support have an entire section of their own. A particularly valuable section of the book is its coverage of over a dozen of the most common diseases and conditions requiring nutrition support. They are tackled in sufficient detail to provide the practitioner with the specific considerations to adequately deal with the patient’s problem. Paediatric as well as older adults are considered. In addition to the diseases involving various organ systems and metabolic disease, special and rarely covered problems such as anorexia nervosa, HIV, burns, orthopaedics and spinal cord injury are discussed. The special issues arising in delivering nutrition support in critical care and palliative care are also covered.
I look forward to reading and using this book, and congratulate the authors on a job well done.
Mary Hickson
Mary Hickson is Professor of Dietetics at the University of Plymouth, UK, and leads the Dietetics, Human Nutrition and Health Research group in the Institute of Health and Community. Her research interests include sarcopenia and frailty, hospital nutritional care, and nutrition in older people. Professor Hickson is on the editorial board of the Journal of Human Nutrition and Dietetics.
Sara Smith
Sara Smith is a Senior Lecturer in Dietetics and Nutrition at Queen Margaret University in Edinburgh, Scotland, UK. She is particularly interested in nutritional assessment, undernutrition and the effects of treatment interventions on nutritional status. Her own PhD explored the effects of an intradialytic exercise programme on quality of life, functional and nutritional status of individuals receiving haemodialysis therapy. Dr Smith works with the National Health Service in a number of capacities and is actively engaged in the work of the British Dietetic Association. She won the BDA IBEX award in 2016 in recognition of her significant contribution to the dietetic profession.
Kevin Whelan
Kevin Whelan is the Professor of Dietetics and Head of Department of Nutritional Sciences at King’s College London. He is a Principal Investigator leading a research programme exploring the interaction between the gut microbiota, diet in health, disease and in patients receiving artificial nutrition support. In 2012 he was awarded the Nutrition Society Cuthbertson Medal for research in clinical nutrition and in 2017 was appointed a Fellow of the British Dietetic Association. Professor Whelan is on the editorial boards of Alimentary Pharmacology and Therapeutics and the Journal of Human Nutrition and Dietetics.
Christine Baldwin PhD RD
Lecturer in Nutrition and Dietetics
King’s College London
London, UK
Stephanie Baron PharmD PhD
European Hospital Georges‐Pompidou
Paris, France
Danielle Bear MRes RD
HEE/NIHR Clinical Doctoral Research Fellow
Guy’s and St Thomas’ NHS Foundation Trust
London, UK
Jack J. Bell PhD AdvAPD
Senior Dietitian and Research Fellow
Prince Charles Hospital
Brisbane, Australia
Timothy Bowling MD FRCP
Consultant in Gastroenterology and Clinical Nutrition
Nottingham University Hospitals NHS Trust
Nottingham, UK
Katrina Campbell PhD AdvAPD
Associate Professor of Nutrition and Dietetics
Bond University
Robina, Australia
Stefan G.J.A. Camps PhD
Research Fellow
National University of Singapore
Singapore
Peter F. Collins PhD APD
Senior Lecturer in Nutrition and Dietetics
Queensland University of Technology
Brisbane, Australia
Avril Collinson PhD RD
Associate Professor in Dietetics
Plymouth University
Plymouth, UK
Kevin Conlon MD FRCSI
Professor of Surgery
Trinity College Dublin
Dublin, Ireland
Clare Corish PhD RD FINDI
Associate Professor
University College Dublin
Dubin, Ireland
Marie Courbebaisse MD PhD
Associate Professor
European Hospital Georges‐Pompidou
Paris, France
Alison Culkin PhD RD
Research Dietitian
St Mark’s Hospital
Harrow, UK
Ronit Das MBBS MRCP
Gastroenterology Registrar
Royal Derby Hospital
Derby, UK
Sinead N. Duggan PhD
Postdoctoral Research Dietitian
Trinity College Dublin
Dublin, Ireland
Alastair Duncan PhD RD
Principal Dietitian and Lecturer in Nutrition
Guy’s and St Thomas’ NHS Foundation Trust and King’s College London
London, UK
Sarah A. Elliott PhD
Postdoctoral Research Fellow
University of Alberta
Edmonton, Canada
Peter W. Emery PhD
Professor of Nutrition and Metabolism
King’s College London
London, UK
Lisa Chiara Fellin PhD
Senior Lecturer in Psychology
University of East London
London, UK
Alastair Forbes MD
Professor of Medicine
University of East Anglia
Norwich, UK
Laura Frank PhD RDN
Clinical Dietitian
Multicare Health System
Tacoma, USA
Gérard Friedlander MD PhD
Professor of Physiology
European Hospital Georges‐Pompidou
Paris, France
Maria Gabriella Gentile PhD
Former Director
Eating Disorders Unit
Arese, Italy
Filomena Gomes PhD RD
Nutrition Postdoctoral Researcher
Cereneo AG and Kantonsspital Aarau
Vitznau, Switzerland
Sue M. Green PhD RN
Associate Professor of Nursing
University of Southampton
Southampton, UK
George Grimble PhD
Principal Teaching Fellow
University College London
London, UK
Rosemary Hayhoe RD
Clinical Dietitian
Sunnybrook Health Sciences Centre
Toronto, Canada
C. Jeyakumar Henry PhD
Director of the Clinical Nutrition Research Centre
National University of Singapore
Singapore
Mary Hickson PhD RD
Professor of Dietetics
Plymouth University
Plymouth, UK
Marc Jeschke MD PhD FACS
Professor
University of TorontoSunnybrook Health Sciences Centre
Toronto, Canada
Matthieu Joerger MD
Medical Resident, Nutritional Support Unit
Archet University Hospital
Nice, France
Anna Julian MNutr RD
Research Dietitian
Imperial College London
London, UK
Katie Keetarut MSc RD
Specialist Dietitian for IBD
University College London Hospital
London, UK
Lynne Kennedy PhD RNutr (Public Health)
Professor of Public Health and Nutrition
University of Chester
Chester, UK
Ronald L. Koretz MD
Emeritus Professor of Clinical Medicine
UCLA School of Medicine
Los Angeles, USA
Eve M. Lepicard PhD
Scientific Director
Institute for European Expertise in Physiology
Paris, France
Callum Livingstone PhD FRCPath
Consultant Chemical Pathologist
Royal Surrey County Hospital NHS Trust
Guildford, UK
Miranda Lomer MBE PhD RD
Senior Consultant Dietitian and Reader in Dietetics
Guy’s and St Thomas’ NHS Foundation Trust and King’s College London
London, UK
Angela Madden PhD RD FBDA
Principal Lecturer in Nutrition and Dietetics
University of Hertfordshire
Hatfield, UK
Katelynn Maniatis MHSc RD CNSC
Clinical Dietitian
Sunnybrook Health Sciences Centre
Toronto, Canada
Luise Marino PhD RD
Lead Paediatric Dietitian
University Hospital Southampton Foundation Trust
Southampton, UK
Hilary McCoubrey MSc RD
Specialist Diabetes Dietitian
Birmingham Women’s and Children's Hospital
Birmingham, UK
Rosan Meyer PhD RD
Honorary Senior Lecturer
Imperial College London
London, UK
Joao F. Mota PhD
Adjunct Professor
Federal University of Goiás
Goiânia, Brazil
Paula Murphy PhD RD
Nutrition Support Dietitian
Derriford Hospital
Plymouth, UK
Pinal S. Patel PhD RD
Specialist Dietitian for Intestinal Failure
University College London Hospital
London, UK
Emily Player MBBS
Gastroenterologist
Norfolk and Norwich University Hospital
Norwich, UK
Carla M. Prado PhD FTOS
CAIP Chair in Nutrition, Food and Health
University of Alberta
Edmonton, Canada
Claire E. Robertson PhD RNutr
Senior Lecturer in Nutrition and Public Health
University of Westminster
London, UK
Kathryn Rochette MEd RD
Clinical Dietitian
Sunnybrook Health Sciences Centre
Toronto, Canada
Mary Krystofiak Russell MS RDN FAND
Senior Manager for US Nutrition
Baxter Healthcare Corporation
Deerfield, USA
Stéphane M. Schneider MD PhD FEBGH
Professor of Nutrition
Archet University Hospital
Nice, France
Denise Baird Schwartz MS RD FAND
Nutrition Support Co‐ordinator
Providence Saint Joseph Medical Center
Burbank, USA
Shahriar Shahrokhi MD FRCSC FACS
Assistant Professor
University of TorontoSunnybrook Health Sciences Centre
Toronto, Canada
Clare Shaw PhD RD
Consultant Dietitian
Royal Marsden NHS Foundation Trust
London, UK
Sara Smith PhD RD
Senior Lecturer in Dietetics
Queen Margaret University
Edinburgh, UK
Alan Torrance MSc
Formerly, Head of Newcastle Nutrition
Royal Victoria Infirmary
Newcastle upon Tyne, UK
Liesl Wandrag PhD RD
Principal Critical Care Dietitian
Guy’s and St Thomas’ NHS Foundation Trust
London, UK
Kevin Whelan PhD RD FBDA
Professor of Dietetics
King’s College London
London, UK
Lisa Wilson PhD RPHNutr
Public Health Nutrition Consultant
Middlesex, UK
Samford Wong BSc RD
Lead Dietitian in Spinal Injuries
National Spinal Injuries Centre
Aylesbury, UK
Alison Woodall PhD RD
Senior Lecturer in Nutrition and Dietetics
University of Chester
Chester, UK
Adrienne Young PhD APD
Senior Dietitian
Royal Brisbane and Women’s Hospital
Brisbane, Australia