Clinical nutrition centers on the prevention, diagnosis, and management of nutritional changes in patients linked to chronic diseases and conditions primarily in

health care Health care or healthcare is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health pr ...

. Clinical in this sense refers to the management of patients, including not only outpatients at

clinic A clinic (or outpatient clinic or ambulatory care clinic) is a health facility that is primarily focused on the care of outpatients. Clinics can be privately operated or publicly managed and funded. They typically cover the primary care needs ...

s and in private practice, but also inpatients in hospitals. It incorporates primarily the scientific fields of

nutrition Nutrition is the biochemical and physiological process by which an organism uses food to support its life. It provides organisms with nutrients, which can be metabolized to create energy and chemical structures. Failure to obtain sufficient ...

and

dietetics A dietitian, medical dietitian, or dietician is an expert in identifying and treating disease-related malnutrition and in conducting medical nutrition therapy, for example designing an enteral tube feeding regimen or mitigating the effects of ...

. Furthermore, clinical nutrition aims to maintain a healthy energy balance, while also providing sufficient amounts of nutrients such as protein, vitamins, and minerals to patients.

Dietary needs and disease processes

Normally, individuals obtain the necessary nutrients their bodies require through normal daily diets that process the foods accordingly within the body. Nevertheless, there are circumstances such as disease, distress, stress, and so on that may prevent the body from obtaining sufficient nutrients through diets alone. In such conditions, a dietary supplementation specifically formulated for their individual condition may be required to fill the void created by the specific condition. This can come in form of Medical Nutrition.

Methods of nutrition

Among the

routes of administration A route of administration in pharmacology and toxicology is the way by which a medication, drug, fluid, poison, or other substance is taken into the body. Routes of administration are generally classified by the location at which the substance i ...

, the preferred means of nutrition is, if possible,

oral administration Oral administration is a route of administration where a substance is taken through the mouth. Per os abbreviated to P.O. is sometimes used as a direction for medication to be taken orally. Many medications are taken orally because they are ...

. Alternatives include enteral administration (in nasogastric feeding) and

intravenous Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...

(in

parenteral nutrition Parenteral nutrition (PN) is the feeding of nutritional products to a person intravenously, bypassing the usual process of eating and digestion. The products are made by pharmaceutical compounding companies. The person receives a nutritional mi ...

Clinical malnutrition

In the field of clinical nutrition,

malnutrition Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues ...

has causes, epidemiology and management distinct from those associated with malnutrition that is mainly related to poverty. The main causes of ''clinical malnutrition'' are: *

Cachexia Cachexia () is a complex syndrome associated with an underlying illness, causing ongoing muscle loss that is not entirely reversed with nutritional supplementation. A range of diseases can cause cachexia, most commonly cancer, congestive heart fa ...

caused by diseases, injuries and/or aging * Difficulties with ingestion, such as

stroke A stroke is a disease, medical condition in which poor cerebral circulation, blood flow to the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemorr ...

paresis In medicine, paresis () is a condition typified by a weakness of voluntary movement, or by partial loss of voluntary movement or by impaired movement. When used without qualifiers, it usually refers to the limbs, but it can also be used to desc ...

dementia Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...

, depression,

dysphagia Dysphagia is difficulty in swallowing. Although classified under "symptoms and signs" in ICD-10, in some contexts it is classified as a condition in its own right. It may be a sensation that suggests difficulty in the passage of solids or liq ...

Clinical malnutrition may also be aggravated by

iatrogenic Iatrogenesis is the causation of a disease, a harmful complication, or other ill effect by any medical activity, including diagnosis, intervention, error, or negligence. "Iatrogenic", ''Merriam-Webster.com'', Merriam-Webster, Inc., accessed 27 ...

factors, i.e., the inability of a

entity to appropriately compensate for causes of malnutrition. There are various definitions of clinical malnutrition. According to one of them, patients are defined as ''severely undernourished'' when meeting at least one of the following criteria: BMI < or = 20 kg/m² and/or > or = 5% unintentional weight loss in the past month and/or > or = 10% unintentional weight loss in the past 6 months. By the same system, the patient is ''moderately undernourished'' if they met at least one of the following criteria: BMI 20.1–22 kg/m² and/or 5-10% unintentional weight loss in the past six months.

Medical nutrition therapy

Medical nutrition therapy (MNT) is the use of specific nutrition services to treat an illness, injury, or condition. It was introduced in 1994 by the American Dietetic Association to better articulate the nutrition therapy process. It involves the assessment of the nutritional status of the client and the actual treatment, which includes nutrition therapy, counseling, and the use of specialized nutrition supplements, devised and monitored by a medical doctor

physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...

or registered

dietitian A dietitian, medical dietitian, or dietician is an expert in identifying and treating disease-related malnutrition and in conducting medical nutrition therapy, for example designing an enteral tube feeding regimen or mitigating the effects of ...

nutritionist (RDN). Registered dietitians started using MNT as a dietary intervention for preventing or treating other health conditions that are caused by or made worse by unhealthy eating habits. The role of MNT when administered by a

or dietitian nutritionist (RDN) is to reduce the risk of developing complications in pre-existing conditions such as

type 2 diabetes Type 2 diabetes, formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urinatio ...

as well as ameliorate the effects any existing conditions such as high cholesterol. Many medical conditions either develop or are made worse by an improper or unhealthy diet. An example is the use of macronutrient preload in type 2 diabetes.

Administration

In most cases the use of Medical Nutrition is recommended within international and professional guidelines. It can be an integral part of managing acute and short-term diseases. It can also play a major role in supporting patients for extended periods of time and even for a lifetime in some special cases. Medical Nutrition is not meant to replace the treatment of disease but rather complement the normal use of drug therapies prescribed by physicians and other licensed healthcare providers. Unlike Medical Foods which are defined by the

U.S. Department of Health and Human Services The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is " ...

Food and Drug Administration The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...

, within their ''Medical Foods Guidance Documents & Regulatory Information'' guide in section 5(b) of the Orphan Drug Act (21 U.S.C. 30ee (b) (3)); as "a food which is formulated to be consumed or administered enterally under the supervision of a physician and which is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation,"

Advantages

The following advantages come with medical nutrition: * It is often very effective in treating type 1 or

. * It can help one to live better at any age

Disadvantages

The following are some disadvantages of medical nutrition: * A patient may need to follow a strict diet to see benefits while using a medical nutrition plan. * Some forms of medical nutrition can be very expensive. A poor patient may not afford such.

Journals

The ''

American Journal of Clinical Nutrition ''The American Journal of Clinical Nutrition'' (''AJCN'') is a monthly peer-reviewed biomedical journal in the fields of dietetics and clinical nutrition. The journal was established in 1952 as the ''Journal of Clinical Nutrition'', edited by ...

'' is the highest-ranked journal in

ISI ISI or Isi may refer to: Organizations * Intercollegiate Studies Institute, a classical conservative organization focusing on college students * Ice Skating Institute, a trade association for ice rinks * Indian Standards Institute, former name of ...

's nutrition category.

Notes and references

External links

Academy of Nutrition and Dietetics
{{Portal bar, Food Nutrition by type