Nutritional therapy refers to providing food appropriate to the existing disease and arranged according to nutritional principles. The main objectives are to help treat or alleviate disease symptoms, increase survival chances, reduce hospital stay duration, and prevent malnutrition that may occur during disease treatment.
Who needs nutritional therapy?
- Those with malnutrition or at risk of malnutrition, such as eating less than usual for more than 7 days, unintentional weight loss, body mass index (BMI) below 18.5 or above 25
- Those who cannot eat enough or are expected to eat less than 60% of their body’s needs for more than 7 days, such as after gastrointestinal surgery or during chemotherapy
- Those with stable vital signs
Which route is better?
“If the gastrointestinal tract is still functional, the gastrointestinal route is better.”
- The gastrointestinal route is used when the patient’s gastrointestinal system is functioning normally and there are no contraindications.
- Can eat by mouth but the food is inappropriate, such as lacking nutrients, frequent snacking, or unsuitable for chronic diseases.
Correction by adjusting the type, amount, quality of food, lifestyle, and preferences to suit the disease.
- Can eat by mouth but insufficient amount
Correction by ONS: oral nutritional support or medical nutrition is a supplement drink in addition to regular food, usually nutritionally complete but with different proportions, so it can replace main meals. It often tastes easier to consume orally than blended food.
Selection should be based on chronic diseases, such as regular formula, diabetes formula, cancer formula, kidney disease formula, etc. Currently, many brands are available and can be found in department stores, pharmacies, and online stores. It can be prepared with a concentration of 1 ml : 1 kcal according to the instructions on the can, with a total amount of 200-300 ml, 3-4 times a day, or as recommended by a doctor.
- Can eat by mouth but in small amounts and cannot drink medical nutrition or not enough
Correction by inserting a feeding tube into the gastrointestinal tract and providing medical nutrition or blended food.
Blended food consists of various foods from all five food groups, such as pork, chicken breast, pumpkin, eggs, and vegetables, blended into a liquid form that can pass through the feeding tube into the body. It is mixed according to a formula designed by a dietitian for each individual to provide adequate nutritional value according to the body’s needs.
Consuming bird’s nest, chicken essence soup, canned or boxed milk, fruits, or snacks does not provide complete energy and nutrients and is not considered a main meal. Additionally, they may contain high sugar or sodium, which is unsuitable for some diseases.
There are various types of feeding tubes, and the selection principle is as follows:
- Tube tip in the stomach
- For short-term use less than 4-6 weeks, a nasogastric tube (NG tube) inserted through the nose is recommended.
- For long-term use more than 4-6 weeks, a tube inserted through the abdominal wall, such as PEG or gastrostomy tube, is recommended.
- Tube tip in the small intestine, used only in patients at high risk of aspiration or when the stomach cannot be used, such as stomach cancer or large amounts of retained stomach contents
- For short-term use less than 4-6 weeks, a nasojejunal tube (NJ tube) inserted through the nose is recommended.
- For long-term use more than 4-6 weeks, a tube inserted through the abdominal wall, such as PEG-J or open jejunostomy, is recommended.
Changing to an abdominal wall tube instead of a nasal tube for long-term feeding reduces nasal pressure sores, aspiration, and frequent tube changes. When oral intake improves, the tube can be removed, and the wound will close by itself. This is a minor procedure performed by endoscopy through the mouth, safe at all ages, with a very low risk of infection, using only local anesthesia. It is currently the standard method accepted worldwide.
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- Intravenous route is used when the gastrointestinal tract is not functional, such as intestinal obstruction, gastrointestinal bleeding, post-gastrointestinal surgery, or as a supplement in malnourished patients adjusting to oral feeding. It is more complex and requires more caution.
- Peripheral intravenous route, such as veins in the arms or legs, is used for less than 2 weeks.
- Central intravenous route, such as veins in the neck or chest, is used for more than 2 weeks because the veins are larger, reducing infection risk and the need for frequent line changes.
How much to give?
Generally, people should receive enough energy to meet their body’s needs, depending on age, sex, weight, and activity level. A simple calculation can be done based on weight, with energy requirements of 30-35 kcal/kg/day and protein intake of 1.2 – 1.5 g/kg/day, along with complete nutrients from all five food groups. Adjustments should be made according to chronic diseases, such as reducing sugar and starch in diabetes, reducing fat in hyperlipidemia, and reducing salt in hypertension.
For example, Mrs. Somsri has no chronic diseases, is 160 cm tall, weighs 45 kg, has been eating less for two weeks, and has lost weight.
Calculate Mrs. Somsri’s BMI from weight divided by height squared.
BMI = 45 ÷ 1.6 ÷ 1.6 = 17.5 kg/m2
Energy requirement is 30-35 kcal/kg/day based on current weight without edema per day.
Protein requirement is 1.2 – 1.5 g/kg current weight per day.
Goal protein = 45 x 1.2 to 45 x 1.5 = 54 to 67.5 g
Therefore, Mrs. Somsri should receive about 1400 kcal and 60 g of protein per day. For example, if fed entirely by tube, blended food or medical nutrition with a 1:1 concentration at 350 ml per meal, 4 meals a day, is recommended.
If oral intake is 50%, she may be given 200 ml of supplement food 4 times a day, for example.
Long-term malnutrition affects many organs and often causes electrolyte imbalances. Blood tests and corrections are necessary before and during dietary adjustments. Some patients may need several days for their bodies to adapt to the food until the formula meets their body’s needs. Cooperation from relatives and patients is very important.
Do not hesitate if malnutrition is suspected. Prolonged malnutrition, especially in the elderly, worsens physical condition, causes organ deterioration, muscle wasting, and weight loss. Recovery takes longer after treatment. Some may develop dehydration leading to kidney failure, severe weakness, become bedridden, get infections, or develop pressure ulcers on bony prominences, which can be life-threatening.
If you suspect someone close to you needs additional nutritional care, it is recommended to consult a doctor or nutrition team promptly for appropriate nutritional therapy.
Eat well, be strong, reduce disease, recover when sick, live long, and stay happily with your loved ones.
