Many people who are undernourished or who are critically ill need additional nutrition (nutritional support). Artificial feeding, which uses commercial nutrient mixtures rather than food, is a common form of nutritional support. Nutritional support is intended to maintain or increase the amount of lean body mass. It usually provides calories as well as vitamins and minerals.
Nutrients are given by mouth whenever possible, ideally as regular food. When people are reluctant to eat, the following strategies can sometimes help them eat more regular food:
Actively encouraging them to eat
Encouraging them to eat small amounts and to eat often
Heating or seasoning foods
Providing favorite or strongly flavored foods
Making meal times a priority when planning the day's activities
Helping them eat if needed
Eating with family and/or friends and making meal times enjoyable
However, these strategies are not enough for some people. For example, these strategies do not help people who cannot eat because of injuries or other physical problems (such as difficulty swallowing) or who have difficulty absorbing nutrients. These people may need nutritional support.
Nutritional support includes the following:
A tube inserted through the nose, mouth, or skin into the stomach or intestine (tube feeding)
A catheter inserted in a vein (intravenous feeding)
With tube feedings, nutrients go directly into the stomach or small intestine. With intravenous feedings, nutrients go directly into the bloodstream.
If people are dying or have advanced dementia, artificial feeding is usually not recommended.
Determining Nutritional Requirements
(See also Nutritional Requirements.)
Before starting nutritional support, doctors must first determine the amount and mix of nutrients the person needs. People need a certain amount of nutrients for energy, which is measured in calories. The number of calories people need varies depending on the following:
Their weight, height, age, and sex
Their activity level
The demands created by their illness, injury, or other physical problem
The mix of nutrients typically includes carbohydrates, protein, fat, vitamins, minerals, fiber, and fluids.
Usually, doctors or nutrition professionals (for example, dietitians) who work closely with doctors estimate the person's needs using equations based on the person's weight, height, age, sex, and activity level. Doctors adjust the requirements if the person has a condition that increases the need for calories and protein, such as a serious illness, kidney failure that requires dialysis, an infection, an injury, or recent surgery, or is over 70 years old.
Some centers use a special technique to obtain a more accurate estimate. This technique, called indirect calorimetry, measures how much oxygen is inhaled and how much carbon dioxide is exhaled—an indication of how much energy the body is using.
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Monitoring Nutritional Support
Health care professionals must carefully manage artificial feeding methods to make sure people are receiving the nutrients they need and to prevent problems, such as infections. To determine whether nutritional support is appropriate and effective, doctors regularly monitor a person's factors such as the following:
Body mass index (BMI—weight in kilograms divided by height in meters squared)
Body composition (measurements that estimate the proportion of fat and muscle tissue)
Level of wound healing
Substances in blood, urine, and stool that indicate nutritional status
Muscle strength (for example, by measuring how strong the hand grip is)
Improvement in endurance (for example, how long people are able to maintain physical activity)
An increase in muscle strength indicates an increase in muscle mass and thus improved nutritional status.
