Cover
Title Page
Preface
Foreword
Editor biographies
Contributors
Abbreviations
SECTION: 1 Background to undernutrition
1. Chapter 1.1: Definitions and prevalence of undernutrition
  1. 1.1.1 Undernutrition: definition and diagnostic criteria
  2. 1.1.2 Prevalence of undernutrition
  3. References
2. Chapter 1.2: Physiological causes of undernutrition
  1. 1.2.1 Altered metabolism
  2. 1.2.2 Reduced oral intake
  3. 1.2.3 Reduced absorption
  4. References
3. Chapter 1.3: Socioeconomic causes of undernutrition
  1. 1.3.1 Introduction
  2. 1.3.2 Socioeconomic differences in diet and nutrition
  3. 1.3.3 Food insecurity
  4. 1.3.4 Food security and socioeconomic factors
  5. 1.3.5 Psychology of undernutrition
  6. 1.3.6 Summary
  7. References
4. Chapter 1.4: Institutional causes of undernutrition
  1. 1.4.1 Introduction
  2. 1.4.2 Identification and consequences of institutional undernutrition
  3. 1.4.3 Determinants of institutional undernutrition
  4. 1.4.4 Causes of undernutrition in long‐term care
  5. References
5. Chapter 1.5: Consequences of undernutrition
  1. 1.5.1 Introduction and background
  2. 1.5.2 Physical consequences of undernutrition
  3. 1.5.3 Psychological consequences of undernutrition
  4. 1.5.4 Economic consequences of undernutrition
  5. 1.5.5 Summary
  6. References
SECTION: 2 Identification of undernutrition
1. Chapter 2.1: Nutritional screening
  1. 2.1.1 Introduction
  2. 2.1.2 Purpose of screening
  3. 2.1.3 Screening methods
  4. 2.1.4 Process following screening
  5. 2.1.5 Implementing screening in healthcare settings
  6. 2.1.6 Conclusion
  7. References
2. Chapter 2.2: Nutritional assessment
  1. 2.2.1 Background
  2. 2.2.2 Process of nutrition assessment
  3. 2.2.3 Summary
  4. References
3. Chapter 2.3: Anthropometric assessment of undernutrition
  1. 2.3.1 Introduction
  2. 2.3.2 Weight
  3. 2.3.3 Height
  4. 2.3.4 Body mass index
  5. 2.3.5 Mid‐upper arm circumference
  6. 2.3.6 Triceps skinfold
  7. 2.3.7 Mid‐arm muscle circumference
  8. 2.3.8 Calf circumference
  9. 2.3.9 Bioelectrical impedance analysis
  10. References
4. Chapter 2.4: Biochemical assessment in undernutrition
  1. 2.4.1 Introduction
  2. 2.4.2 Baseline biochemical tests
  3. 2.4.3 Biochemical interpretation and application
  4. 2.4.4 Summary
  5. References
5. Chapter 2.5: Clinical assessment of undernutrition
  1. 2.5.1 Introduction
  2. 2.5.2 Functional assessment of nutritional status
  3. 2.5.3 Clinical status
  4. 2.5.4 Conclusion
  5. References
6. Chapter 2.6: Dietary assessment in undernutrition
  1. 2.6.1 Introduction
  2. 2.6.2 Determining the ‘ideal’ dietary assessment tool
  3. 2.6.3 The utility of traditional dietary assessment methods
  4. 2.6.4 Retrospective methods of dietary assessment
  5. 2.6.5 Prospective methods of dietary assessment
  6. 2.6.6 Summary
  7. References
7. Chapter 2.7: Advanced imaging techniques for assessment of undernutrition
  1. 2.7.1 Introduction
  2. 2.7.2 Advances in imaging techniques
  3. 2.7.3 Summary
  4. References
SECTION: 3 Nutritional requirements in nutrition support
1. Chapter 3.1: Fluid requirements and assessment in nutrition support
  1. 3.1.1 Hydration status: physiopathology
  2. 3.1.2 Assessment of hydration status
  3. 3.1.3 Summary
  4. References
2. Chapter 3.2: Energy requirements in nutrition support
  1. 3.2.1 Introduction
  2. 3.2.2 Measurement of energy expenditure
  3. 3.2.3 Estimation of total energy requirements
  4. 3.2.4 Summary
  5. References
3. Chapter 3.3: Protein requirements in nutrition support
  1. 3.3.1 Metabolic requirement for protein
  2. 3.3.2 Assessment of protein requirements
  3. 3.3.3 Amino acid requirements
  4. 3.3.4 Protein requirements of older adults
  5. 3.3.5 Protein requirements in acute illness
  6. References
4. Chapter 3.4: Water‐soluble vitamins in nutrition support
  1. 3.4.1 Introduction
  2. 3.4.2 Vitamin recommendations
  3. 3.4.3 Water‐soluble vitamins
  4. 3.4.4 Summary
  5. References
5. Chapter 3.5: Fat‐soluble vitamins in nutrition support
  1. 3.5.1 Introduction
  2. 3.5.2 The normal diet
  3. 3.5.3 Effects of disease on absorption and metabolism of fat‐soluble vitamins
  4. 3.5.4 Undernutrition and acute illness
  5. 3.5.5 Vitamin A
  6. 3.5.6 Vitamin D
  7. 3.5.7 Vitamin E
  8. 3.5.8 Vitamin K
  9. 3.5.9 Summary
  10. References
6. Chapter 3.6: Minerals in nutrition support
  1. 3.6.1 Introduction
  2. 3.6.2 Electrolytes
  3. 3.6.3 Trace elements
  4. 3.6.4 Other trace elements
  5. 3.6.5 Mineral requirements for enteral and parenteral nutrition
  6. References
SECTION: 4 Nutritional interventions to prevent and treat undernutrition
1. Chapter 4.1: Population and community interventions to prevent and treat undernutrition
  1. 4.1.1 Introduction
  2. 4.1.2 Current policy on undernutrition
  3. 4.1.3 Community interventions to tackle undernutrition
  4. 4.1.4 Conclusions, challenges and the future
  5. References
2. Chapter 4.2: Institutional interventions to prevent and treat undernutrition
  1. 4.2.1 Introduction
  2. 4.2.2 Creating a culture of nutrition support within institutions
  3. 4.2.3 Improving food services
  4. 4.2.4 Creating positive mealtime environments
  5. 4.2.5 System‐level nutrition processes: how to implement change into practice
  6. 4.2.6 Summary
  7. References
3. Chapter 4.3: Oral nutrition support to prevent and treat undernutrition
  1. 4.3.1 Introduction
  2. 4.3.2 Outcomes appropriate for the assessment of effectiveness of oral nutrition support
  3. 4.3.3 Oral nutrition support options
  4. 4.3.4 Evidence for food‐based options
  5. 4.3.5 Oral nutrition supplements
  6. 4.3.6 Food‐based interventions combined with oral nutrition supplements
  7. 4.3.7 Supportive strategies aiming to improve oral nutrition intake
  8. 4.3.8 Summary
  9. References
4. Chapter 4.4: Enteral nutrition to prevent and treat undernutrition
  1. 4.4.1 Introduction
  2. 4.4.2 Enteral nutrition formulas
  3. 4.4.3 Disease‐specific formula
  4. 4.4.4 Administering enteral nutrition
  5. 4.4.5 Outcomes of patients treated with enteral nutrition
  6. References
5. Chapter 4.5: Parenteral nutrition to prevent and treat undernutrition
  1. 4.5.1 Indications for parenteral nutrition
  2. 4.5.2 Routes of parenteral nutrition
  3. 4.5.3 Formulation of parenteral nutrition
  4. 4.5.4 Monitoring
  5. 4.5.5 Complications of parenteral nutrition
  6. 4.5.6 Conclusion
  7. References
SECTION: 5 Undernutrition and nutrition support in clinical specialties
1. Chapter 5.1: Nutrition support in paediatrics
  1. 5.1.1 Introduction
  2. 5.1.2 Definition of undernutrition in paediatrics
  3. 5.1.3 Prevalence of undernutrition in paediatrics
  4. 5.1.4 Common causes of undernutrition in paediatrics
  5. 5.1.5 Pathophysiology of undernutrition in paediatrics
  6. 5.1.6 Consequences of undernutrition in paediatrics
  7. 5.1.7 Identifying undernutrition in paediatrics
  8. 5.1.8 Frequency of monitoring, catch‐up growth and follow‐up in paediatrics
  9. 5.1.9 Nutrient requirements during undernutrition in paediatrics
  10. 5.1.10 Feeding advice as part of the management of undernutrition in paediatrics
  11. 5.1.11 Nutrition intervention for infants and children with faltering growth
  12. References
2. Chapter 5.2: Nutrition support in anorexia nervosa
  1. 5.2.1 Introduction
  2. 5.2.2 Anorexia nervosa
  3. 5.2.3 Nutritional assessment in anorexia nervosa
  4. 5.2.4 Nutritional, psychological and pharmacological intervention in anorexia nervosa
  5. References
3. Chapter 5.3: Nutrition support in older adults
  1. 5.3.1 Introduction
  2. 5.3.2 Prevalence of undernutrition
  3. 5.3.3 Causes of undernutrition in older adults
  4. 5.3.4 Consequences of undernutrition
  5. 5.3.5 Assessment and diagnosis of undernutrition in older adults
  6. 5.3.6 Nutritional interventions
  7. References
4. Chapter 5.4: Nutrition support in neurological disorders
  1. 5.4.1 Introduction
  2. 5.4.2 Undernutrition: prevalence, causes and consequences
  3. 5.4.3 Screening and assessment of nutrition status in neurological disorders
  4. 5.4.4 Nutrition intervention
  5. References
5. Chapter 5.5: Nutrition support in spinal cord injury
  1. 5.5.1 Introduction
  2. 5.5.2 Causes and mechanisms of undernutrition after spinal cord injury
  3. 5.5.3 Nutrition‐related complications in spinal cord injury
  4. 5.5.4 Assessment and diagnosis of undernutrition in spinal cord injury
  5. 5.5.5 Nutrition intervention
  6. 5.5.6 Summary
  7. References
6. Chapter 5.6: Nutrition support in pulmonary and cardiac disease
  1. 5.6.1 Undernutrition in cardiopulmonary disease
  2. 5.6.2 Mechanisms for weight loss and muscle wasting
  3. 5.6.3 Consequences of undernutrition
  4. 5.6.4 Nutritional assessment
  5. 5.6.5 Nutrition management
  6. 5.6.6 Future directions and conclusions
  7. References
7. Chapter 5.7: Nutrition support in diabetes
  1. 5.7.1 Introduction
  2. 5.7.2 Hyperglycaemia in hospitalised patients with diabetes
  3. 5.7.3 Undernutrition in diabetes
  4. 5.7.4 Oral nutrition support in diabetes
  5. 5.7.5 Enteral nutrition in diabetes
  6. 5.7.6 Parenteral nutrition in diabetes
  7. 5.7.7 Conclusion
  8. References
8. Chapter 5.8: Nutrition support in pancreatitis
  1. 5.8.1 Acute pancreatitis
  2. 5.8.2 Chronic pancreatitis
  3. 5.8.3 Nutritional assessment in chronic pancreatitis
  4. 5.8.4 Nutritional requirements
  5. 5.8.5 Nutrition intervention in chronic pancreatitis
  6. 5.8.6 Monitoring
  7. References
9. Chapter 5.9: Nutrition support in inflammatory bowel disease
  1. 5.9.1 Undernutrition in inflammatory bowel disease
  2. 5.9.2 Assessment and diagnosis of undernutrition
  3. 5.9.3 Dietary management
  4. 5.9.4 Long‐term impact
  5. References
10. Chapter 5.10: Nutrition support in intestinal failure
  1. 5.10.1 Introduction
  2. 5.10.2 Nutrition interventions
  3. 5.10.3 Intestinal transplantation
  4. 5.10.4 Future interventions
  5. References
11. Chapter 5.11: Nutrition support in liver disease
  1. 5.11.1 Liver disease
  2. 5.11.2 Causes and consequences of undernutrition in liver disease
  3. 5.11.3 Nutritional assessment of patients with liver disease
  4. 5.11.4 Nutrition support in liver disease
  5. 5.11.5 Specific aspects of nutritional management in liver disease
  6. 5.11.6 Lessons for practice
  7. References
12. Chapter 5.12: Nutrition support in kidney disease
  1. 5.12.1 Introduction
  2. 5.12.2 Undernutrition in kidney disease
  3. 5.12.3 Aetiology of undernutrition in kidney disease
  4. 5.12.4 Consequences of undernutrition in kidney disease
  5. 5.12.5 Assessment of undernutrition in kidney disease
  6. 5.12.6 Nutritional management of undernutrition in kidney disease
  7. 5.12.7 Conclusions
  8. References
13. Chapter 5.13: Nutrition support in critical care
  1. 5.13.1 Overview of undernutrition in critical illness
  2. 5.13.2 Mechanisms of undernutrition in critical illness
  3. 5.13.3 Metabolic and nutritional consequences of critical illness
  4. 5.13.4 Assessment and diagnosis of undernutrition in critical illness
  5. 5.13.5 Nutritional management and interventions in critical illness
  6. 5.13.6 Summary
  7. References
14. Chapter 5.14: Nutrition support in burn injury
  1. 5.14.1 Incidence and severity of burn
  2. 5.14.2 Pathophysiology and impact of undernutrition
  3. 5.14.3 Nutrition assessment and monitoring
  4. 5.14.4 Route and timing of nutrition support
  5. 5.14.5 Energy and nutrient requirements
  6. 5.14.6 Immuno‐nutrition
  7. 5.14.7 Non‐nutritional management of hypermetabolism
  8. 5.14.8 Summary
  9. References
15. Chapter 5.15: Nutrition support in orthopaedics
  1. 5.15.1 Introduction
  2. 5.15.2 Undernutrition in orthopaedic inpatient populations
  3. 5.15.3 Nutrition screening in orthopaedic settings
  4. 5.15.4 Nutrition assessment and nutritional diagnosis
  5. 5.15.5 Estimating requirements for orthopaedic conditions
  6. 5.15.6 Approaches to the management of undernutrition in orthopaedic patients
  7. 5.15.7 Monitoring and evaluation in orthopaedic patients
  8. References
16. Chapter 5.16: Nutrition support in HIV infection
  1. 5.16.1 Background and prevalence of undernutrition in HIV
  2. 5.16.2 Causes of undernutrition in HIV
  3. 5.16.3 Consequences of undernutrition in HIV
  4. 5.16.4 Nutritional assessment and diagnosis of undernutrition in HIV
  5. 5.16.5 Clinical and nutritional management of undernutrition in HIV
  6. 5.16.6 Future research needs
  7. 5.16.7 Resources
  8. References
17. Chapter 5.17: Nutrition support in oncology
  1. 5.17.1 Introduction
  2. 5.17.2 Background to undernutrition in cancer
  3. 5.17.3 Causes and mechanisms of undernutrition during cancer treatment
  4. 5.17.4 Consequences of undernutrition in cancer
  5. 5.17.5 Assessment and diagnosis of undernutrition in cancer
  6. 5.17.6 Interventions for nutrition support in cancer
  7. 5.17.7 Undernutrition and living with and beyond cancer
  8. 5.17.8 Palliative care
  9. 5.17.9 Summary
  10. References
18. Chapter 5.18: Nutrition support in palliative care
  1. 5.18.1 Introduction
  2. 5.18.2 Undernutrition in palliative care
  3. 5.18.3 Nutrition support in palliative care
  4. 5.18.4 Palliative care and nutrition support decision making
  5. 5.18.5 Food and hydration at the end of life
  6. 5.18.6 Decision‐making tools and options for nutrition interventions
  7. 5.18.7 Early communication and application to nutrition practice
  8. References
Index
End User License Agreement

List of Tables

Chapter 1.2
1. Table 1.2.1 Key hormones involved in appetite regulation with sites of release and modes of action
2. Table 1.2.2 Summary of the main causes of malabsorption by region of the gastrointestinal (GI) tract
3. Table 1.2.3 Drug‐induced malabsorption by mechanism of action
Chapter 2.3
1. Table 2.3.1 Estimated contribution of fluid to body weight in patients with alcoholic hepatitis and ascites [6] and with oedema [7]
2. Table 2.3.2 Adjustment of body weight following amputation or with an immoveable cast
Chapter 2.4
1. Table 2.4.1 Other biochemical parameters used in the assessment of a patient for nutrition support [1]
2. Table 2.4.2 Definition of systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock [24]
Chapter 2.5
1. Table 2.5.1 Summary of common quality of life and functional measurement tools
2. Table 2.5.2 Summary of selected clinical scoring tools
Chapter 2.6
1. Table 2.6.1 Steps for consideration of the utility of dietary assessment methods for appraisal of undernourished patients
2. Table 2.6.2 Basic review of the likely capacity of undernourished individuals to complete traditional dietary assessment methods
Chapter 2.7
1. Table 2.7.1 Overview of available body composition techniques and relevance for clinical practice
Chapter 3.1
1. Table 3.1.1 Recommendations for adequate water intake expressed as volume in litres/day except Belgium (including fluid from food and beverages)
2. Table 3.1.2 Advantages and disadvantages of methods available for assessing hydration status
Chapter 3.2
1. Table 3.2.1 Substrate oxidation variables, VO₂, CO₂ and energy expenditure during fat, protein and carbohydrate oxidation
2. Table 3.2.2 The percentage by which the FAO/WHO/UNU equations overestimate (+) or underestimate (−) BMR in different ethnic groups by sex, all ages 3–60 years
3. Table 3.2.3 Henry prediction equations for BMR based on weight, and weight and height
4. Table 3.2.4 Comparison of BMR prediction equations against the US Dietary Reference Intake (DRI) dataset
5. Table 3.2.5 Revised estimated average requirements (EAR) for infants aged 1–12 months
6. Table 3.2.6 Revised estimated average requirements (EAR) for children aged 1–18 years
7. Table 3.2.7 Stress factors for some clinical conditions
8. Table 3.2.8 Physical activity level (PAL) of hospitalised patients
Chapter 3.3
1. Table 3.3.1 Estimated requirements for essential amino acids in adults
Chapter 3.4
1. Table 3.4.1 UK and SACN recommendations in the healthy population [2]
2. Table 3.4.2 WHO recommendations for the healthy population
3. Table 3.4.3 ESPEN and European recommendations for the healthy population [4,5]
4. Table 3.4.4 US recommendations for dietary reference intakes [7]
5. Table 3.4.5 Comparison of recommendations for folate intake [2,4,5,7,9,12,13]
6. Table 3.4.6 Comparison of recommendations for vitamin C intake [2,4,5,7,23,24]
7. Table 3.4.7 Comparison of recommendations for thiamine intake [2,4,5,7]
Chapter 3.5
1. Table 3.5.1 SACN recommendations (reference nutrient intakes) for fat‐soluble vitamins in the healthy population [1]
2. Table 3.5.2 Population reference intakes for fat‐soluble vitamins published by the Scientific Committee for Food [2]
3. Table 3.5.3 Dietary reference intakes for fat‐soluble vitamins in males [6]
4. Table 3.5.4 Dietary reference intakes for fat‐soluble vitamins in females [6]
5. Table 3.5.5 WHO recommended nutrient intakes for fat‐soluble vitamins [8]
6. Table 3.5.6 Parenteral requirements for fat‐soluble vitamins in infants, children and adults [13,15]
Chapter 3.6
1. Table 3.6.1a Daily oral or enteral requirements for electrolytes in healthy adults
2. Table 3.6.1b Daily oral or enteral requirements for trace elements in healthy adults
3. Table 3.6.2 Recommended Adult Daily Parenteral Trace Element Requirements
4. Table 3.6.3 Trace element content of selected IV trace element solutions
Chapter 4.3
1. Table 4.3.1 Outcomes used in the assessment of oral nutrition interventions
2. Table 4.3.2 Oral nutrition support options available, practical considerations for their use and the influence of patient setting
3. Table 4.3.3 Summary of findings on nutritional, functional and healthcare outcomes for ONS from individual systematic reviews and meta‐analyses
Chapter 4.4
1. Table 4.4.1 Enteral nutrition formulations
2. Table 4.4.2 Summary of current recommendations for use of fibre in enteral nutrition
3. Table 4.4.3 Improvements in outcome with enteral nutrition in benign and malignant disease
Chapter 4.5
1. Table 4.5.1 Key studies raising concerns over use of parenteral nutrition (PN) lipids in hospitalised patients
2. Table 4.5.2 Monitoring of parenteral nutrition (PN)
3. Table 4.5.3 Monitoring of patients with suspected parenteral nutrition (PN)‐related bone disease
Chapter 5.1
1. Table 5.1.1 Factors and their implications unique to the nutritional management of paediatrics [1,7,8]
2. Table 5.1.2 Hormones and growth factors that affect nutritional status
3. Table 5.1.3 Theoretical energy and protein intake for 5, 10 and 20 g/kg/day catch‐up growth
4. Table 5.1.4 Comparison of energy and protein provided in standard infant formula (SIF) compared to protein energy‐enriched (PEE) infant formula
Chapter 5.2
1. Table 5.2.1 DSM classification of bulimia nervosa and anorexia nervosa
2. Table 5.2.2 Nutritional and clinical markers for risk assessment in AN patients
Chapter 5.3
1. Table 5.3.1 Summary of key micronutrient requirements in older adults
Chapter 5.4
1. Table 5.4.1 Mortality, length of hospital stay and hospitalisation costs in patients following stroke, according to risk of undernutrition as determined by the Malnutrition Universal Screening Tool (MUST)
2. Table 5.4.2 Summary of the International Dysphagia Diet Standardisation Initiative framework
Chapter 5.5
1. Table 5.5.1 Energy, protein, fluid and micronutrient needs for patients with SCI and pressure ulcer
Chapter 5.7
1. Table 5.7.1 Data from a meta‐analysis of diabetes‐specific formulas (DS‐EF) versus standard formulas on glycaemic outcomes. Data represent the favourable effect of DS‐EF over standard formulas, where they exist
Chapter 5.9
1. Table 5.9.1 Nutritional problems and considerations
Chapter 5.10
1. Table 5.10.1 Studies investigating the effect of oral nutrition supplements and enteral formula composition in short bowel intestinal failure
Chapter 5.11
1. Table 5.11.1 Use of late‐evening (nocturnal) feeding in cirrhosis
2. Table 5.11.2 Vegetable versus animal protein in cirrhosis and chronic encephalopathy
3. Table 5.11.3 Calcium and/or vitamin D for liver disease‐associated bone disease
Chapter 5.12
1. Table 5.12.1 Summary of the potential mechanisms contributing to undernutrition in chronic kidney disease
2. Table 5.12.2 Screening and assessment of undernutrition in kidney disease
3. Table 5.12.3 Protein intake recommendations across key guidelines and stages of chronic kidney disease
4. Table 5.12.4 General guidelines for fluid, potassium, phosphate and sodium recommendations on dialysis [35,37]
5. Table 5.12.5 Randomised controlled trials and controlled clinical trials targeting undernutrition via oral nutrition support in chronic kidney disease
Chapter 5.13
1. Table 5.13.1 Hormonal effects on protein metabolism
2. Table 5.13.2 The most influential RCTs in critical care nutrition
Chapter 5.14
1. Table 5.14.1 Summary of recommendations [2,7,8,18]
Chapter 5.15
1. Table 5.15.1 Key monitoring and outcome measures in orthopaedic inpatients [32]
Chapter 5.16
1. Table 5.16.1 Common AIDS‐defining conditions and their nutritional consequences
2. Table 5.16.2 Prevalence of undernutrition in HIV
3. Table 5.16.3 Anthropometry in HIV
Chapter 5.17
1. Table 5.17.1 Prevalence of undernutrition in different diagnostic groups from studies of nutrition screening or nutritional assessment in cancer [4,45]
2. Table 5.17.2 Symptoms affecting food intake in cancer [11,46]
Chapter 5.18
1. Table 5.18.1 Nutrition interventions in palliative care
2. Table 5.18.2 Recommended approach for patients with advanced dementia or near end‐of‐life conditions considering long‐term enteral nutrition access devices

List of Illustrations

Chapter 1.1
1. Figure 1.1.1 Diagnosis tree for undernutrition. COPD, chronic obstructive pulmonary disease.
Chapter 1.3
1. Figure 1.3.1 The social determinants of health.
2. Figure 1.3.2 Range of factors influencing food choice.
Chapter 2.1
1. Figure 2.1.1 Summary of framework to facilitate nutritional screening tool selection
2. Figure 2.1.2 Summary of the factors that can influence rates of nutritional screening
Chapter 2.4
1. Figure 2.4.1 Protocol for the avoidance of the refeeding syndrome in patients on enteral or parenteral nutrition (adults only).
Chapter 2.7
1. Figure 2.7.1 Imaging techniques available for the assessment of body composition. (a) CT/MRI image. (b) Dual‐energy X‐ray absorptiometry (DXA) examination. (d) shows stages in generation of 3D outputs from reconstruction to creation of raw image, and measurement of key body landmarks. Open access images extracted from: Wells JCK, Stocks J, Bonner R, et al. Acceptability, precision and accuracy of 3D photonic scanning for measurement of body shape in a multi‐ethnic sample of children aged 5–11 years: the SLIC Study. PloS One 2015; 10(4): e0124193.
Chapter 3.3
1. Figure 3.3.1 Relationship between nitrogen balance and nitrogen intake. Results of a meta‐analysis of 19 studies involving 235 individuals. Each point represents an individual subject’s observed response to a specific intake.
Chapter 4.4
1. Figure 4.4.1 Gastrointestinal access for enteral nutrition.
Chapter 5.1
1. Figure 5.1.1 Progression of undernutrition with associated short‐term and long‐term consequences.
2. Figure 5.1.2 Timing of growth of body systems during childhood.
Chapter 5.5
1. Figure 5.5.1 International standards for neurological classification of spinal cord injury.
2. Figure 5.5.2 International standards for neurological classification of spinal cord injury.
3. Figure 5.5.3 Spinal Nutrition Screening Tool
Chapter 5.6
1. Figure 5.6.1 Disease‐related undernutrition.
Chapter 5.8
1. Figure 5.8.1 Algorithm for pancreatic enzyme replacement therapy in CP.
2. Figure 5.8.2 Algorithm for the nutritional management of chronic pancreatitis.
Chapter 5.10
1. Figure 5.10.1 Distal feeding algorithm.
Chapter 5.17
1. Figure 5.17.1 Management algorithm for cancer cachexia [6]

Preface

Undernutrition is a serious condition that occurs when a person’s diet does not contain sufficient energy or nutrients for a healthy and active life. In the past it has been termed malnutrition, but with the rise of obesity and conditions related to overnutrition, it is important to make a clear distinction between the two extremes. This book focuses particularly on undernutrition in economically developed regions of the world, and as such does not cover in any detail undernutrition relating to famine, conflict and long‐term food insecurity prevalent in developing countries.

Undernutrition can result from inadequate consumption of nutrients, failure to absorb nutrients, impaired metabolism, excessive loss of nutrients or increased requirements. It generally develops gradually but rapid deterioration in nutritional status can occur in acute disease or starvation. The first changes are to nutrient concentrations in blood and tissues, followed by intracellular changes in biochemical functions and structure. Later, overt symptoms and signs appear, enabling diagnosis by history, physical examination, body composition and dietary analysis, and laboratory tests. The causes of undernutrition can be complex and may involve several interacting factors including physiological, psychological, socioeconomic and institutional. The consequences can be far reaching and affect the optimal functioning of individuals, as well as exacerbating and precipitating disease. Undernutrition commonly occurs concurrently with disease and particular life stages make people more vulnerable to it: childhood, during pregnancy and lactation, and during older age.

Advanced Nutrition and Dietetics in Nutrition Support aims to provide an essential and authoritative reference and review of the evidence base relating to undernutrition. It draws on the experience and expertise of recognised authorities from around the world to bring together the information needed by practitioners, researchers and educators in the area of nutrition and diet. Specialist dietitians and nutritionists will find this to be an essential text, but it will also be valuable for doctors, nurses and other health professionals with a specialist interest in nutrition.

The chapters provide a comprehensive and critical review of the key literature and are split into five sections.

The background to undernutrition, which examines in detail the causes and consequences of undernutrition. Chapters cover how and why physiological, psychological, socioeconomic and institutional factors can all play a role in the development of undernutrition, and the consequences of these.
Identification of undernutrition, which covers the range of methods available for screening and assessing levels of undernutrition, including anthropometric, biochemical, clinical and dietary assessment. This section ends with a look at the cutting‐edge advanced imaging techniques now available to assess undernutrition.
Nutritional requirements in nutrition support, which includes fluid, energy, protein, vitamins and minerals in the context of deficiency or when increased requirements exist.
Nutritional interventions to prevent and treat undernutrition, exploring population‐level, community‐wide and institutional interventions, as well as looking in detail at oral, enteral and parenteral approaches to managing individuals.
Undernutrition and nutrition support in a range of clinical specialties. This section incorporates both life stages and clinical conditions where the risk of undernutrition is increased.

The authors have focused on established areas of understanding, current controversies and areas of future development and investigation, and drawn extensively upon the research literature, particularly systematic reviews and meta‐analyses. Efforts have been made to highlight the gaps in the literature and specific issues relating to the quality of the evidence in a given specialty. Importantly, the authors have sought to discuss the implications of research findings for practice and the issues to consider when translating research into practice.

Mary Hickson PhD RD
Professor of Dietetics
Plymouth University

Sara Smith PhD RD
Senior Lecturer in Dietetics
Queen Margaret University

Editors
Advanced Nutrition and Dietetics in Nutrition Support

This book is the fourth title in a series commissioned as part of a major initiative between the British Dietetic Association and the publishers Wiley. Each book in the series provides a comprehensive and critical review of the key literature in a clinical area. Each book is edited by one or more experts who have themselves undertaken extensive research and published widely in the relevant topic area. Chapters are written by experts drawn from an international audience and from a variety of disciplines as required of the relevant chapter (e.g. dietetics, medicine, biomedical sciences).

The editors and I are proud to present this title: Advanced Nutrition and Dietetics in Nutrition Support. Undernutrition can have profound impacts on a range of outcomes, including clinical (e.g. mortality, morbidity, complications), patient‐centred (e.g. quality of life, patient experience) and economic outcomes (e.g. length of stay, readmission rates, costs). Approaches are needed to both screen and assess undernutrition and to appropriately prevent and manage it, using interventions ranging from public health approaches to parenteral nutrition. We hope that this book will improve health professionals’ understanding and application of nutrition and dietetics in these areas and improve outcomes for the patients affected.

Kevin Whelan PhD RD FBDA
Professor of Dietetics
King’s College London
Series Editor
Advanced Nutrition and Dietetics Book Series

Contributors

Christine Baldwin PhD RD
Lecturer in Nutrition and Dietetics
King’s College London
London, UK

Stephanie Baron PharmD PhD
European Hospital Georges‐Pompidou
Paris, France

Danielle Bear MRes RD
HEE/NIHR Clinical Doctoral Research Fellow
Guy’s and St Thomas’ NHS Foundation Trust
London, UK

Jack J. Bell PhD AdvAPD
Senior Dietitian and Research Fellow
Prince Charles Hospital
Brisbane, Australia

Timothy Bowling MD FRCP
Consultant in Gastroenterology and Clinical Nutrition
Nottingham University Hospitals NHS Trust
Nottingham, UK

Katrina Campbell PhD AdvAPD
Associate Professor of Nutrition and Dietetics
Bond University
Robina, Australia

Stefan G.J.A. Camps PhD
Research Fellow
National University of Singapore
Singapore

Peter F. Collins PhD APD
Senior Lecturer in Nutrition and Dietetics
Queensland University of Technology
Brisbane, Australia

Avril Collinson PhD RD
Associate Professor in Dietetics
Plymouth University
Plymouth, UK

Kevin Conlon MD FRCSI
Professor of Surgery
Trinity College Dublin
Dublin, Ireland

Clare Corish PhD RD FINDI
Associate Professor
University College Dublin
Dubin, Ireland

Marie Courbebaisse MD PhD
Associate Professor
European Hospital Georges‐Pompidou
Paris, France

Alison Culkin PhD RD
Research Dietitian
St Mark’s Hospital
Harrow, UK

Ronit Das MBBS MRCP
Gastroenterology Registrar
Royal Derby Hospital
Derby, UK

Sinead N. Duggan PhD
Postdoctoral Research Dietitian
Trinity College Dublin
Dublin, Ireland

Alastair Duncan PhD RD
Principal Dietitian and Lecturer in Nutrition
Guy’s and St Thomas’ NHS Foundation Trust and King’s College London
London, UK

Sarah A. Elliott PhD
Postdoctoral Research Fellow
University of Alberta
Edmonton, Canada

Peter W. Emery PhD
Professor of Nutrition and Metabolism
King’s College London
London, UK

Lisa Chiara Fellin PhD
Senior Lecturer in Psychology
University of East London
London, UK

Alastair Forbes MD
Professor of Medicine
University of East Anglia
Norwich, UK

Laura Frank PhD RDN
Clinical Dietitian
Multicare Health System
Tacoma, USA

Gérard Friedlander MD PhD
Professor of Physiology
European Hospital Georges‐Pompidou
Paris, France

Maria Gabriella Gentile PhD
Former Director
Eating Disorders Unit
Arese, Italy

Filomena Gomes PhD RD
Nutrition Postdoctoral Researcher
Cereneo AG and Kantonsspital Aarau
Vitznau, Switzerland

Sue M. Green PhD RN
Associate Professor of Nursing
University of Southampton
Southampton, UK

George Grimble PhD
Principal Teaching Fellow
University College London
London, UK

Rosemary Hayhoe RD
Clinical Dietitian
Sunnybrook Health Sciences Centre
Toronto, Canada

C. Jeyakumar Henry PhD
Director of the Clinical Nutrition Research Centre
National University of Singapore
Singapore

Mary Hickson PhD RD
Professor of Dietetics
Plymouth University
Plymouth, UK

Marc Jeschke MD PhD FACS
Professor
University of TorontoSunnybrook Health Sciences Centre
Toronto, Canada

Matthieu Joerger MD
Medical Resident, Nutritional Support Unit
Archet University Hospital
Nice, France

Anna Julian MNutr RD
Research Dietitian
Imperial College London
London, UK

Katie Keetarut MSc RD
Specialist Dietitian for IBD
University College London Hospital
London, UK

Lynne Kennedy PhD RNutr (Public Health)
Professor of Public Health and Nutrition
University of Chester
Chester, UK

Ronald L. Koretz MD
Emeritus Professor of Clinical Medicine
UCLA School of Medicine
Los Angeles, USA

Eve M. Lepicard PhD
Scientific Director
Institute for European Expertise in Physiology
Paris, France

Callum Livingstone PhD FRCPath
Consultant Chemical Pathologist
Royal Surrey County Hospital NHS Trust
Guildford, UK

Miranda Lomer MBE PhD RD
Senior Consultant Dietitian and Reader in Dietetics
Guy’s and St Thomas’ NHS Foundation Trust and King’s College London
London, UK

Angela Madden PhD RD FBDA
Principal Lecturer in Nutrition and Dietetics
University of Hertfordshire
Hatfield, UK

Katelynn Maniatis MHSc RD CNSC
Clinical Dietitian
Sunnybrook Health Sciences Centre
Toronto, Canada

Luise Marino PhD RD
Lead Paediatric Dietitian
University Hospital Southampton Foundation Trust
Southampton, UK

Hilary McCoubrey MSc RD
Specialist Diabetes Dietitian
Birmingham Women’s and Children's Hospital
Birmingham, UK

Rosan Meyer PhD RD
Honorary Senior Lecturer
Imperial College London
London, UK

Joao F. Mota PhD
Adjunct Professor
Federal University of Goiás
Goiânia, Brazil

Paula Murphy PhD RD
Nutrition Support Dietitian
Derriford Hospital
Plymouth, UK

Pinal S. Patel PhD RD
Specialist Dietitian for Intestinal Failure
University College London Hospital
London, UK

Emily Player MBBS
Gastroenterologist
Norfolk and Norwich University Hospital
Norwich, UK

Carla M. Prado PhD FTOS
CAIP Chair in Nutrition, Food and Health
University of Alberta
Edmonton, Canada

Claire E. Robertson PhD RNutr
Senior Lecturer in Nutrition and Public Health
University of Westminster
London, UK

Kathryn Rochette MEd RD
Clinical Dietitian
Sunnybrook Health Sciences Centre
Toronto, Canada

Mary Krystofiak Russell MS RDN FAND
Senior Manager for US Nutrition
Baxter Healthcare Corporation
Deerfield, USA

Stéphane M. Schneider MD PhD FEBGH
Professor of Nutrition
Archet University Hospital
Nice, France

Denise Baird Schwartz MS RD FAND
Nutrition Support Co‐ordinator
Providence Saint Joseph Medical Center
Burbank, USA

Shahriar Shahrokhi MD FRCSC FACS
Assistant Professor
University of TorontoSunnybrook Health Sciences Centre
Toronto, Canada

Clare Shaw PhD RD
Consultant Dietitian
Royal Marsden NHS Foundation Trust
London, UK

Sara Smith PhD RD
Senior Lecturer in Dietetics
Queen Margaret University
Edinburgh, UK

Alan Torrance MSc
Formerly, Head of Newcastle Nutrition
Royal Victoria Infirmary
Newcastle upon Tyne, UK

Liesl Wandrag PhD RD
Principal Critical Care Dietitian
Guy’s and St Thomas’ NHS Foundation Trust
London, UK

Kevin Whelan PhD RD FBDA
Professor of Dietetics
King’s College London
London, UK

Lisa Wilson PhD RPHNutr
Public Health Nutrition Consultant
Middlesex, UK

Samford Wong BSc RD
Lead Dietitian in Spinal Injuries
National Spinal Injuries Centre
Aylesbury, UK

Alison Woodall PhD RD
Senior Lecturer in Nutrition and Dietetics
University of Chester
Chester, UK

Adrienne Young PhD APD
Senior Dietitian
Royal Brisbane and Women’s Hospital
Brisbane, Australia