Research demonstrates that MNT can reduce risk factors for heart disease, such as LDL bad cholesterol, triglycerides, and high blood pressure 14 , A dietician may recommend that you adhere to a diet low in saturated fat, cholesterol, sodium, and inflammatory foods Emphasis may be placed on increasing fruits and vegetables and following a more plant-based diet.
As obesity is a risk factor for heart disease, an RDN may also encourage lifestyle changes to achieve and maintain a healthy weight, including increasing physical activity and getting adequate sleep Cancer is a disease in which abnormal cells start to divide uncontrollably. It can affect any part of your body, such as your blood, bones, or organs One of the primary reasons that a dietician may be involved in cancer treatment is to help individuals with poor appetite, which is a common symptom of chemotherapy or cancer medications Radiation therapy may also damage the gastrointestinal lining and make it painful to eat or difficult to digest foods.
As such, many people with cancer struggle to eat enough and are at risk of malnutrition. An RDN may recommend high calorie nutritional shakes or other fat- and protein-rich foods that are easy to consume and digest These digestive ailments can lead to poor nutrient absorption, malnutrition, weight loss, a buildup of toxins in the colon, and inflammation A dietician can develop a tailored MNT plan to fit the needs of a specific digestive condition , reduce symptoms, and improve quality of life.
For example, someone with inflammatory bowel disease IBD may benefit from a supervised elimination diet , in which certain foods are excluded and slowly added back to their diet to identify those that trigger symptoms 21 , Untreated kidney disease, in which your blood is not filtered normally, can lead to complications like high levels of calcium and potassium in the blood, low iron levels, poor bone health , and kidney failure 23 , MNT is useful because most people with kidney disease may need to adjust their diet.
For example, some should limit their intake of nutrients like protein, potassium, phosphorus, and sodium, while others may need to adhere to certain fluid restrictions. These needs vary widely depending on the stage or severity of the disease Treating high blood pressure is often central to MNT for someone with kidney issues, as high blood pressure can increase your risk of this disease MNT can be used to treat numerous medical conditions, such as heart disease, diabetes, cancer, kidney disease, and digestive issues.
MNT is prescribed after an in-depth evaluation by an RDN determines that you have a medical condition that can be improved by adhering to this method. For example, someone admitted to the hospital for a procedure who is determined to be eating well , adequately nourished, and not at risk of malnutrition may not require MNT. In general, a doctor orders a nutritional assessment from an RDN when a patient is admitted to the hospital. In an outpatient setting, an RDN may be consulted if a doctor suspects a nutrition-related concern.
MNT is determined to be appropriate only after a thorough nutritional evaluation by a dietician in a hospital or outpatient setting. MNT is a well-established, nutritional approach to alleviating, managing, and even treating certain medical conditions.
Tests also measure the function of vital organs such as kidneys and liver. Those who suffer from alcohol and substance use disorders are often malnourished. Substance abuse can affect nutritional status and body composition by resulting in inadequate nutrient intake, absorption, and changes to metabolism. Once the body is no longer receiving and absorbing nutrients correctly, a slew of health problems may appear. Clients start the journey to total health, wellness, and awareness right here.
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However, they are not implemented despite the strong recommendation of nutritional therapy in the management of critical illness. The aim of this study is to map evidence on nutritional therapy guidelines and their implementation in critically ill adult patients. We will follow a predetermined criterion to map literature and additional articles will be searched from the reference lists of included studies.
Quality assessment of included studies determines the overall quality of the resultant review. We hope to find studies on the implementation of nutritional therapy practice guidelines in adult critically ill patients and its impact on nutritional practices, patient outcomes, and health care costs.
The results of this review will be disseminated through presentations in research seminars, conferences, and congresses and will also be available electronically and in print. Peer Review reports. Modern medicine has increased the chances of survival for many patients, which has increased the rate of critical illness [ 1 ].
Critical illness can be defined as a life-threatening multisystem process preceded by a period of increased catabolism and physiological deterioration [ 2 ].
Increased catabolism and drug-induced adverse effects, which accompany critical illness, reduce appetite, or increase nausea and vomiting making patients unable to achieve nutritional requirements by oral intake [ 3 ]. In addition, the intensive care unit ICU routine may also interrupt patient feeding, which warrants consideration of other methods to deliver nutritional requirements including enteral nutritional therapy EN , parenteral nutritional therapy PN , or a combination of both [ 3 ].
Failure to provide adequate nutritional therapy leads to malnutrition characterized by loss of lean body mass; lack of adequate physical activity and, ultimately, weakness and inability to mobilize; long periods of stay in the ICU; infectious complications; and high morbidity and mortality [ 4 ].
Therefore, means to monitor the prevalence and the indicators of critical illness-related malnutrition, emphasizing the role of nutritional therapy and the effects of nutritional therapy practice guidelines, are warranted.
Thirty to fifty percent of hospitalized patients are malnourished, and the incidence is estimated to be higher in critically ill patients [ 1 , 5 ]. Consequently, malnutrition leads to high readmission rates, which impact negatively on the economic outcomes for both patients and the healthcare system [ 9 ]. The prevalence of malnutrition in critically ill patients emphasizes the need for adequate nutritional therapy and implementation of related practice guidelines [ 10 ].
Nutritional therapy has been proven to promote an improved nutritional status, early recovery, improved immune status, and improved quality of life following critical illness [ 11 , 12 ]. It helps reduce the metabolic response to critical illness, prevent oxidative cellular injury, and favorably modulate immune response [ 13 ].
Nutrition therapy practice guidelines for critically ill patients are designed to help clinicians prevent malnutrition and improve patient outcomes [ 12 , 16 , 17 ]. However, despite the highlighted benefits, a number of barriers to effective implementation of nutritional therapy guidelines exist [ 18 ].
In many clinical settings, decisions made by healthcare providers involved in the nutrition care of critically ill patients are found not to be based on scientific evidence, leading to varied nutritional practices in many ICUs, even within a single hospital [ 19 , 20 ]. Evidence-based guidelines provide recommendations based on the available evidence to address areas of ambiguity in terms of treatment options.
They help clinicians make decisions regarding the feeding of critically ill patients that will contribute to the prevention of malnutrition [ 21 ]. The development of feeding protocols, which are standard operating procedures based on complex guidelines, is usually guided by these research-founded documents [ 22 ].
Guidelines are also considered as a reference to harmonize practices and enhance communication among healthcare professionals in a particular institution or setting. Adherence to such documents with institution-tailored strategies increases the efficiency of patient care among healthcare professionals with varying levels of experience and competency in nutrition therapy [ 22 ].
The poor or non-implementation of nutritional therapy practice guidelines leads to variations in nutrition therapy practices, inadequate nutrition delivery malnutrition, and resultant mortality [ 23 ]. In a case study on the practical implementation of revised nutritional therapy guidelines in the adult critically ill patient, a mention was made of some recommendations remaining unchanged due to a lack of new evidence on the topic [ 24 ].
Further, systematic reviews of the evidence are necessary to address critical outcomes for decision-making to balance risks and benefits [ 25 ]. It is hoped that the proposed review will contribute to the limited evidence on nutritional therapy practice guidelines implementation in critically ill adults and act as a baseline for future research on the topic. It also has a potential to positively influence nutritional practices and combat critical illness-related malnutrition.
Therefore, this review aims to map literature on nutritional therapy guidelines in critically ill adults in order to identify gaps and provide a baseline for further research. The framework has five stages that include 1 identifying the review question, 2 searching for relevant studies, 3 selecting eligible studies, 4 extracting data, and 5 collating, summarizing, and reporting of the results.
However, in our review, we will identify both the research question and the eligibility criteria for the selection of studies in stage 1, as technically, the same framework that is used to identify the research question is conceived for guiding and reporting inclusion and exclusion criteria.
The population-concept-context PCC framework will be used to identify the main concepts of the review question and will inform the search strategy [ 28 ]. Furthermore, breaking down the review question according to PCC elements allows the reviewers to check for any potentially missed inclusion and exclusion criteria in the protocol [ 30 ].
Based on the research question and the population-concept-context PCC framework, eligibility criteria for the selection of studies were determined to ascertain that only studies with the relevant information will be included in this review. The inclusion and exclusion criteria are shown in Table 1. Keywords and MeSH terms that include critically ill patients, nutritional therapy, guidelines, and implementation will be used to search for relevant studies.
Keywords will be combined using Boolean search. The search results will be exported to an Endnote library that will be created for this study. An initial search was undertaken in PubMed to pilot the search strategy that has been developed for this study and the results are shown in Table 2.
Two independent reviewers, the principal investigator and a research assistant, who have been trained as a reviewer, will engage in a rigorous three-phased process to select studies for inclusion in this review using predetermined eligibility criteria. All duplicates will be removed before screening commences.
The first phase will involve title screening following the piloted search strategy. The screening of abstracts will then follow and articles agreed upon by the two reviewers will be included or excluded based on the inclusion and exclusion criteria. Any disagreements between the two reviewers will be resolved by discussion, and a third reviewer project supervisor will be invited for reconciliation of discrepancies where necessary.
In the third stage, the full article screening will be conducted in the similar manner and reference lists of articles will also be screened for non-identified articles.
Additionally, in order to maximize the search process, the authors will be consulted for full-text articles that are not available during the electronic search. The reviewers will collectively develop a data charting form to determine which variables to extract to appropriately address the research question. They will use the data charting form to extract data from the first five studies independently, after which they will meet to determine if the extracted information is consistent with the overall aim of the study and to familiarize themselves with the form.
The data charting form will be modified and revised as necessary during the process of extracting data from each included study. Additionally, the authors of articles will be contacted to request missing or additional data where required. Table 3 illustrates a draft of the data charting table. This stage will involve a descriptive summary and thematic analysis of the results of included studies, identification, and interpretation of emerging themes related to the main aim of the review and making recommendations for future research, practice, and policymaking.
The reviewers will numerically summarize information regarding the authors and publication dates, full journal details, source or country of origin, area of care ICU, home, clinic , aim of the study, and study design. The last step will be interpreting the emerging themes in relation to the review question and discussion of implications for future research, practice, and policymaking. Previously, scoping reviews did not include an assessment of the methodological quality of included studies, however, that has changed; current recommendations state that the absence of quality assessment makes the results of scoping studies more difficult to interpret and limit the translation of scoping study findings into policy and practice [ 33 , 34 ].
The quality of qualitative studies will be assessed using section one of the MMAT tool. For quantitative studies, sections two, three, and four will be used for randomized controlled, non-randomized, and descriptive studies, respectively. For mixed methods studies, section one we will be used for assessing the qualitative component, while sections two, three, or four will be used for the appropriate quantitative component of a study.
Section five will be used to assess quality of the mixed methods components of the included studies. Further, studies will be rated as low, moderate, and high [ 34 ]. Assessment of the methodological quality of the included studies will help to determine the overall quality of the resultant review. The high incidence of critical illness, advances in critical care, and improvements in patient selection have led to an increased survival of critically ill patients with high nutritional demands and resultant malnutrition [ 35 ].
Combating this double burden of malnutrition DBM has become a significant global health challenge in many healthcare settings [ 36 ]. DBM is characterized by the coexistence of undernutrition along with obesity or diet-related noncommunicable disease and is associated with poor outcomes and increased cost of hospitalization [ 20 , 36 ].
Literature has shown that nutritional therapy, both enteral and parenteral, is the most cost-effective intervention in managing malnutrition in critical illness before ICU admission and after discharge, including the rehabilitation period [ 37 , 38 , 39 ]. However, nutritional practices in critically ill patients remain widely varied.
This has become an indication of the need for the development and implementation of nutritional therapy practice guidelines in the form of feeding protocols as a strategy to optimize adequate delivery of nutritional therapy [ 40 ].
Guidelines provide basic recommendations that are supported by reviews and analyses of the current literature, to standardize and improve nutritional practices [ 17 ]. In a study by Barr et al. Other studies emphasize monitoring of nutrition therapy, however, do not state how this can be achieved [ 6 , 44 ].
Sharada and Vadivelan and Seoung-Hyun et al. Notwithstanding the volumes of research on nutrition guidelines development, evidence on nutritional therapy guidelines in critically ill adults is lacking, hence the need for this study.
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