Elsevier

Clinical Nutrition

Volume 25, Issue 2, April 2006, Pages 311-318
Clinical Nutrition

ESPEN GUIDELINES
ESPEN Guidelines on Enteral Nutrition: Cardiology and Pulmonology

https://doi.org/10.1016/j.clnu.2006.01.017Get rights and content

Summary

These guidelines are intended to give evidence-based recommendations for the use of enteral nutrition (EN) in patients with chronic heart failure (CHF) and chronic obstructive pulmonary disease (COPD). They were developed by an interdisciplinary expert group in accordance with officially accepted standards and are based on all relevant publications since 1985. They have been discussed and accepted in a consensus conference.

EN by means of oral nutritional supplements (ONS) or tube feeding (TF) enables nutritional intake to be maintained or increased when normal oral intake is inadequate.

No data are yet available concerning the effects of EN on cachexia in CHF patients. However, EN is recommended to stop or reverse weight loss on the basis of physiological plausibility. In COPD patients, EN in combination with exercise and anabolic pharmacotherapy has the potential to improve nutritional status and function. Frequent small amounts of ONS are preferred in order to avoid postprandial dyspnoea and satiety as well as to improve compliance.

The full version of this article is available at: www.espen.org.

Section snippets

Chronic heart failure (CHF)

Introduction: Approximately 1% of the population suffers from CHF,1 from which the average 5-year-survival-rate is approximately 50%.1 Over the next few years, the general increase in life expectancy, better treatment of acute cardiac events, and improvements in diagnostic and therapeutic management of CHF itself will lead to better survival and therefore an increased prevalence of this disease among the elderly particularly in its advanced form. Since cardiac cachexia will be more common in

Chronic obstructive pulmonary disease (COPD)

2.1. Does COPD have an influence on nutritional state, energy and substrate metabolism?

Between 25% and 40% of patients with advanced COPD are malnourished.

Comment: Clinically relevant weight loss (5% of actual weight within three months or 10% within 6 months) is found in 25–40% of all cases when lung function is severely impaired (FEV1<50%). Muscle wasting, defined as fat-free mass index (FFMI) <16 kg/m2 (in males) and <15 kg/m2 (in females), is found in 25% of patients with GOLD stages 2 and 3

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    For further information on methodology see Schütz et al.68 For further information on definition of terms see Lochs et al.69

    ☆☆

    The authors of the DGEM (German Society for Nutritional Medicine) guidelines on enteral nutrition in cardiology are acknowledged for their contribution to this article.

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