Basics of Clinical Nutrition YK Joshi
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1Basics of Clinical Nutrition
2Basics of Clinical Nutrition
Second Edition
Editor YK Joshi MD PhD MAMS Professor Department of Gastroenterology and HNU All India Institute of Medical Sciences Ansari Nagar, New Delhi EDITORIAL ASSISTANT Maneesha Joshi Namrata Singh Jaya Benjamin Tshar Sharma
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Basics of Clinical Nutrition
© 2008, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the editor and the publisher.
First Edition: 2003
Second Edition: 2008
9788184482133
Typeset at JPBMP typesetting unit
Printed at Replica
4Contributors
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6Preface to the Second Edition
The need for nutritional therapy has been emphasized in the patient care, especially for hospitalized patients, where malnutrition related complications are on rise. Malnutrition has been reported in 30–80 percent of hospitalized patients. This prolongs the therapeutic schedule, increases the hospital stay and also leads to high mortality and morbidity. Moreover, there are several systemic and chronic diseases where there is no specific or definite treatment and patients have to be managed by supportive measures, in some instances life long. And provision of adequate amount of nutrition, the way it is accepted by the patient, providing all the ingredients and adequate calories becomes essential to maintain quality of life.
It is essential to understand difference between the consequences of malnutrition in health and diseases in order to understand the need of nutritional supplements. It is also necessary to understand the need and importance of various nutrients and their role in different diseases. One should also know how to assess a patient's nutritional status, nutritional needs, and how to provide it, so that, it is not over done and does not bring any harm to the patient. Many outstanding discoveries and techniques in developed countries have revolutionized nutrition support during the last few decades, which include long term parenteral nutrition, amino acid preparations, intravenous fat supplements, improved vascular and enteral access and devices, early enteral nutrition and immunonutrition. Over the past few decades a new outlook has emerged through a number of studies clearly demonstrating the positive results of nutritional support. Recently some evidence-based guidelines have been developed for nutritional support in acute and chronic diseases. All in all we have ample evidence that lack of nutrition leads to a poorer quality of life, higher morbidity and mortality, increased hospitalization, frequent re-admissions and delayed recovery, that in turn lead to higher hospital costs. Notwithstanding the huge strides made in research and development, clinical nutrition is still in its infancy in India and we have a long way to go to match international standards.
The purpose of this book is to provide a workable knowledge of nutrition support and emphasize its importance in patient care. It is expected that the book will be useful to undergraduate medical and nursing students and also to the physicians. The effort has been made to cover most of the practical aspects of need and provision of nutritional7 support and also nutritional therapy in some of the common systemic diseases, where nutrition support is of importance in reducing mortality and morbidity leading to early recovery.
Four new chapters viz. Nutritional assessment in clinical practice, Immunonutrition, Antioxidants and Probiotics have been added in this edition. The chapters have been written by a distinguished group of physicians, surgeons and dieticians who are actively practicing the nutrition support and also involved in research in this field. I am grateful to all the authors for their valuable contribution.
The most important aim of this book is to help patients. I am sure that it will contribute to improved care of the patient's in need of therapeutic nutrition both in the hospitals and at home. It is hoped that the book will stimulate physicians, dieticians and nurses to put it into practice.
YK Joshi
8Preface to the First Edition
The need of nutritional therapy has been emphasized in the patient care, especially for hospitalized patients, where malnutrition related complications are on rise. Malnutrition has been reported in 30–80 percent of hospitalized patients and more so in surgical patients. This prolongs the therapeutic schedule, increases the hospital stay and also leads to high mortality and morbidity. Though nutritional intervention looks costly, it has been found to be overall cost effective. Moreover, there are several systemic diseases where there is no specific or definite treatment and patients have to be managed by supportive measures and in some instances life long. And provision of adequate amount of nutrition, the way it is accepted by the patient and in adequate quantity providing all the ingredients and calories becomes essential in such conditions.
It is essential to understand difference between the consequences of malnutrition in health and diseases only then one can understand the need of nutritional supplements. This information is poorly provided and not enough emphasized in medical curriculum. It is also necessary to understand the need and importance of various nutrients and their role in different diseases. One should also know how to assess a patient's nutritional needs, and also how to provide it, so that, it is not over done and does not bring any harm to the patient.
Intravenous nutrition known as parenteral nutrition has been well established. There is a rapid accumulation of scientific knowledge and technical advance in nutrition therapy. All the health care workers engaged in patient care must have basic concept of nutritional support.
The purpose of this book is to provide a workable knowledge of nutrition support and emphasize its importance in patient care. It is expected that the book will be useful to undergraduate medical and nursing students and also to the physicians. The effort has been made to cover most of the practical aspects of need and provision of nutritional support and also nutritional therapy in some of the common systemic diseases, where nutrition support is of importance in reducing mortality and early recovery.
The chapters have been written by a distinguished group of physicians, surgeons and dieticians who are actively practicing the nutrition support and also involved in research in this field. I am grateful to all the authors for their valuable contribution.9
The most important aim of this book is to help patients. I am sure that it will contribute to improved care of the patient's in need of therapeutic nutrition both in the hospitals and at home. It is hoped that information contents here will stimulate physicians, dieticians and nurses to put it into practice.
YK Joshi