The treatment of malnourished patient requires supportive measures to diet to gain lean body mass. The oral feeding is difficult for anorexic patients or people with eating disorders or absorption. Encourage patients to eat heating or seasoning food not providing preferred or strongly flavored dishes Suggestion for eating smaller portions meal planning help with feeding rich influencing behavior measures: to behave controlling measures that can sometimes improve the food intake, include the following is a nutrition assistance – oral nutrition, nutrition through a feeding tube or parenteral nutrition – indexed, except for dying or severely demented patients. Assessment of the nutritional requirements The nutrient requirements can be calculated in advance, so that interventions can be planned. The demand can be estimated using formulas or measured by indirect calorimetry. Indirect calorimetry requires the use of a metabolic map (closed rebreathing system that determines the energy expenditure based on the total CO2 production), which requires a special expertise and is not always available. However, the total energy consumption (TEE = total energy expenditure), and the protein needs to be determined. The energy conversion TEA obtained based on the body weight, type and extent of the respective metabolic stress (metabolic requirements). The TEA is from 25 kcal / kg / day for persons engaged in sedentary activities and are not exposed to loads up to 40 kcal / kg / day for seriously ill patients. The TEA is the sum of: (rate Resting metabolic, RMR) to the basal metabolism, which is usually about 70% of the TEA, the space occupied by the food metabolic energy (10% of TEA) and the unreacted during physical activity energy (20% of TEA). Clinical calculator: Basal metabolic rate (Harris-Benedict estimate) malnutrition can be up to 20% reduce the amount of basal metabolism. Circumstances such as serious illness, infection, inflammation, trauma or surgery, claiming the metabolism may increase the need for the basal metabolic rate, but the calorie consumption rarely rises to> 50%. The Mifflin-St. Jeor equation calculates the basal metabolic rate more accurately and with fewer errors than the Harris-Benedict equation commonly used, usually to results which are measured within 20% of the respondents by indirect calorimetry. The Mifflin-St. Jeor equation calculates the basal metabolic rate as follows: The TEA can be up to about 40% of the turnover for terminally ill persons absch├Ątzen.Proteinbedarf For healthy people over the addition of about 10% of the turnover for sedentary people is a protein requirement of 0.8 g / kg accepted / day. However, the demand can also be higher for patients with metabolic stress or kidney failure and in the elderly (see table: Estimated daily protein requirement of an adult). Estimated daily protein requirement of an adult Physical condition required (g / kg bw / day at ideal weight) Normal 0.8 Age> 70 years 1.0 renal failure without dialysis (GFR <25 ml / min / 1.73 m2) from 0.6 to 0 , 75 renal failure with dialysis 1,2 Sotffwe chselbelastung (eg. As after a long illness, trauma, burns, surgery) 1.5 Evaluation of response to supportive measures to feed the ideal path, through the reactions can be assess on supportive measures for nutrition, there is not. Doctors often use the following indicators to determine the lean body mass: Body Mass Index (BMI) analysis of the physical constitution body fat distribution (overview of malnutrition: Physical examination and obesity: Physical Constitution) Clinical Calculator: Body Mass Index (Quetelet's index) In addition, the nitrogen balance are evaluated the response to skin antigens muscle strength and indirect calorimetry. Nitrogen balance, which reflects the ratio of protein requirements and protein present, is calculated from the difference between the supplied amount of nitrogen and the loss of nitrogen. A positive balance, in which added more nitrogen than was lost, represents an adequate supply. An accurate measurement is not feasible, but can be estimated via the nitrogen balance, the response to dietary measures: The nitrogen uptake is calculated on the basis of protein intake: nitrogen (g) corresponds Protein (g) / 6.25. The eventual loss of nitrogen resulting from the sum of the excretion in the urine (corresponding to the approximate nitrogen content in the 24-hour urine) in the chair (estimated at 1 g / day, when chair is produced; negligible, if no stool is produced) and further losses do not exactly detected, which are estimated to be 3 g. The reaction to skin antigens with which a delayed hypersensitivity reaction can be observed, normalized often when a patient will respond to supportive measures for nutrition. However, other factors affect this reaction. Muscle strength has indirectly indicate an increase in lean body mass. It can be measured quantitatively by Dynamometry of handshake or electrophysiologically via the stimulation of the ulnar nerve with an electrode. The concentration of acute phase reactants under the serum proteins (particularly short-lived proteins such as prealbumin [transthyretin], retinol-binding protein, and transferrin) correlated sometimes with an improved nutritional status, but correlates better with inflammatory diseases. Important Points behavior-controlling measures can avert the need for nutritional therapy. The forecast of the energy demand of a patient is based on weight, gender, activity and the degree of metabolic stress (eg. As after a long illness, trauma, burns, or recently took gehabter operation). The normal protein requirement is 0.8 mg / kg / day, but this amount should be adjusted accordingly at age> 70 or if the patient is suffering from renal failure or metabolic stress. Response to supportive measures for the diet is based on lean body mass and / or other indicators (eg., Nitrogen balance, reaction to skin antigens, muscle strength, indirect calorimetry) to evaluate.

Health Life Media Team

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