Nutrition Support Therapy

  • Lesser, Mary N. R. PhD, RD
  • Lesser, Lenard I. MD, MSHS

  • 1 University of California, Berkeley, California; Children's Hospital Oakland Research Institute, Oakland, California; UCSF Benioff Children's Hospital, Oakland, California

    2 One Medical, San Francisco, California; University of California, San Francisco, California

MARY N. R. LESSER, PhD, RD, is a continuing lecturer at the University of California, Berkeley, and a pediatric registered dietitian and researcher at the Children's Hospital Oakland (Calif.) Research Institute and UCSF Benioff Children's Hospital, Oakland.

LENARD I. LESSER, MD, MSHS, is the medical director of population health and family physician at One Medical, San Francisco, Calif., and an assistant volunteer clinical instructor in the Department of Family and Community Medicine at the University of California, San Francisco.

Address correspondence to Lenard I. Lesser, MD, MSHS, One Medical, 1 Embarcadero Center, Ste. 1900, San Francisco, CA 94111 (email:[email protected]). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

American Family Physician 104(6):p 580-588, December 2021.

Nutrition support therapy is the delivery of formulated enteral or parenteral nutrients to maintain or restore nutrition status. Family physicians can provide nutrition support therapy to patients at risk of malnutrition when it would improve clinical outcomes or quality of life. Physicians should initiate a thorough nutrition screening and assessment to determine an individual's nutrition status and the potential need for nutrition support therapy.

Nutrition support therapy is the delivery of formulated enteral or parenteral nutrients to restore nutritional status. Family physicians can provide nutrition support therapy to patients at risk of malnutrition when it would improve quality of life. The evidence for when to use nutrition support therapy is inconsistent and based mostly on low-quality studies. Family physicians should work with registered dietitian nutritionists to complete a comprehensive nutritional assessment for patients with acute or chronic conditions that put them at risk of malnutrition. When nutrition support therapy is required, enteral nutrition is preferred for a patient with a functioning gastrointestinal tract, even in patients who are critically ill. Parenteral nutrition has an increased risk of complications and should be administered only when enteral nutrition is contraindicated. Family physicians can use the Mifflin-St Jeor equation to calculate the resting metabolic rate, and they should consult with a registered dietitian nutritionist to determine total energy needs and select a nutritional formula. Patients receiving nutrition support therapy should be monitored for complications, including refeeding syndrome. Nutrition support therapy does not improve quality of life in patients with dementia. Clinicians should engage in shared decision-making with patients and caregivers about nutrition support in palliative and end-of-life care. (Am Fam Physician. 2021;104(6):580-588. Copyright © 2021 American Academy of Family Physicians.)

Copyright © 2021 American Academy of Family Physicians. All rights Reserved.
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