Medical Nutrition

• Critically ill patients in ICU
• Burns
• Cancer
• Surgical – any patients undergoing surgery requiring wound healing
• Trauma
• Patients on dialysis

Medical nutrition involves the use of specialised nutritional products as part of the management of certain medical conditions. It includes the use of oral nutritional supplements, enteral tube feeding (tube feeding via the nose or the gastrointestinal tract), and parenteral nutrition (intravenous feeding) when a patient is unable to meet their requirements via normal food due to a limited, impaired or disturbed capacity to take, digest, absorb, metabolise or excrete ordinary food or nutrients. Medical nutrition products are used under medical supervision of a registered dietitian or doctor.

Preoperative malnutrition (exacerbated by an underlying condition such as cancer) is common in surgical patients and is often undiagnosed. This means a large number of patients go into theatre malnourished which is associated with higher morbidity and mortality rates, longer length of hospital stay and higher readmission rates. Nutritional supplementation (with immunonutrition- arginine, omega 3 fatty acids and nucleotides) is recommended perioperatively as it is associated with improved outcomes in surgical patients by reducing rate of post operative infections, complications and reducing the length of hospital stay.

Nutrition support is vital as 90% of cancer patients become malnourished or are at risk of malnutrition, due to the disease progression or due to the toxicity of the treatment (chemotherapy or radiotherapy). At this point most cancer patients are unable to meet their nutrition requirements through normal food intake.

The effects from chemotherapy or radiotherapy may cause problems with eating and digestion (maldigestion or malabsorption). When more than one chemotherapy drug is given, each drug may cause different side effects which can be minor or more severe.

Other Side effects include:

• Anorexia and cachexia (loss of skeletal muscle and fat) are common causes of malnutrition in cancer patients.
• Mucositis (sore and inflamed mouth or gut)
• Vomiting
• Mouth sores
• Taste changes
• Sore throat and trouble swallowing
• Diarrhoea (acute or chronic)

Nutrition is vital to keep the body healthy and reduces malnutrition and enhances lean muscle mass.The medical nutrition supplements (oral sip feeds, enteral product or total parenteral IV feeds) can be vital in supporting the body needs as they offer different amounts of nutrients (vitamins, minerals, protein, carbohydrates, fat and water) the body needs. Eating the right amount of protein and calories is important for healing, fighting infection and having enough energy. And thus, support in the form of nutrition is vital for the cancer patient’s journey to recovery.

It is always advisable to speak with your healthcare practitioner before using a medical nutrition product. While certain products can be bought without a prescription/over the counter it is important to note that not all products are the same and may be indicated for specific conditions and not for general use. Products also need to be used in context of any existing medical conditions which is why it is always best to seek advice first.

Ideally the best professionals to seek advice from regarding any nutrition related information and specifically medical nutrition products are registered dietitians as this their specific scope of practice and they are professionally trained in the field of nutrition science and medical nutrition. A registered dietitian will be able to recommend the best suited medical nutrition product after a comprehensive nutrition assessment taking into consideration your needs, preferences, lifestyle, medical diagnosis and nutrition requirements.

This is mostly due to the fact that it is a ready to drink/ready to use – it is more convenient as it is already mixed. These products are all imported and have increased weight resulting in a higher cost. Packaging and convenience could also have an impact on the product pricing.

Medical nutrition can help patients of all ages to address nutritional insufficiencies arising from a disease, disorder, or condition, when they are unable to meet their requirements with normal food.

The benefit of the right nutritional care in a timely manner can:

• Help to reduce medical complications
• Support recovery and independence
• Lower healthcare resource use

It has the main function to build and repair.

Protein delivers the amino acids required by the body’s tissues to support wound healing, immune function and muscle preservation.

After surgery protein is important to repair damaged tissues as well as developing antibodies to remove any infections. Protein further is needed to form collagen which is required for scar formation

Protein in recovery is essential to reduce muscle catabolism.

Omega 3 fats are long-chain polyunsaturated fatty acids which are known to reduce inflammation and in doing so may play a beneficial role in various medical conditions/situations:

In patients with cancer, inflammation inhibits the body’s ability to effectively utilize nutrients. Uncontrolled inflammation may lead to muscle breakdown and contribute to weight loss. Supplementing the diet with omega 3 fatty acids (or with fish oil as a source of omega 3 fatty acids), is currently recommended to improve appetite, oral intake, muscle mass and body weight in patients with cancer. The European Society for Clinical Nutrition and Metabolism (ESPEN), recommends the following: “in patients with advanced cancer undergoing chemotherapy and at risk of weight loss or malnourished, we suggest using supplementation with long-chain omega 3 fatty acids or fish oil to stabilize or improve appetite, food intake, lean body mass and body weight”.

In patients undergoing major surgery, the use of omega 3 fatty acids is recommended (in combination with other immune-modulating nutrients, such as arginine) to enhance recovery and reduce the risk of developing complications after surgery. Recommendation from the North American Surgical Nutrition Summit is to include five to seven days of pre-operative immunonutrition (with omega 3 fats in addition to other nutrients such as arginine), which should be continued well into the postoperative period.