Türkiye’deki Klinik Nütrisyon Uygulamalarının ve ESPEN Rehberlerine Uyumunun Değerlendirilmesi

Year 2023, Volume: 8 Issue: 2, 355 - 363, 21.06.2023

Sema Çalapkorur , Hilal Toklu

Abstract

Amaç: Bu çalışma, Türkiye’deki klinik beslenme uygulamalarının ve ESPEN rehberlerine uyumun değerlendirilmesi amacıyla planlanıp yürütülmüştür.

Gereç ve Yöntem: Çalışma, Türkiye'nin farklı illerinde beslenme destek ekibinde (BDE) yer alan 60 diyetisyen ile online platformda gerçekleştirilmiştir. Çevrimiçi form beslenme destek ekibinin özellikleri ve hastalıklara özgü beslenme uygulamalarının değerlendirilmesine yönelik bölümlerden oluşmuştur.

Bulgular: Diyetisyenlerin %60’ı kurumlarındaki BDE’nin klinik nütrisyona yönelik eğitimi olduğunu belirtmiştir. Bireylerin tamamı beslenme durumunun taranmasında Nütrisyonel Risk Skoru (NRS-2002)’nin kullanıldığını belirtirken, katılımcıların %50’si kurumlarında antropometrik ölçüm uygulamalarının düzenli olarak yapılmadığını ifade etmiştir. İlk 3 gün içinde ağızdan tam doz nütrisyona başlaması beklenmeyen yoğun bakım hastalarına enteral nütrisyon başlandığını ifade eden diyetisyenlerin oranı %71,7’dir. Cerrahi öncesi hastalara preoperatif açlık uygulamayan diyetisyenlerin oranı %3,4, postoperatif dönemde beslemeye devam ettiklerini belirten diyetisyenlerin oranı ise %10,5’tir. Bakımsız ve bağırsaklarında inflamatuar steanoz gelişen olgularda kombine terapi kullanılma oranı %23,3, bağırsaktaki inflamasyonun devamı halinde oral nutrisyon desteği yapılma oranı ise %46,6 olarak belirlenmiştir. Karaciğer hastalarında tam protein içeren formüllerin kullanım oranı %77, hepatik ensefalopati gelişen hastalarda dallı zincirli aminoasit (DZAA) lerden zengin formüllerin kullanılma oranı ise %51,9’dur.

Sonuç: Beslenme destek ekibi profesyonelleri klinik beslenme eğitimine odaklanmalı ve kılavuz önerileri konusunda farkındalıklarını artırmalıdır.

Keywords

Klinik beslenme, kılavuzlar, beslenme destek ekibi, beslenme uygulamaları, ESPEN.

Evaluation of Compliance of Clinical Nutrition Practices in with ESPEN Guidelines in Turkey

Abstract

Objective: This study was planned to assess clinical nutrition practices and compliance with ESPEN guidelines in Turkey.

Material and Method: The study was conducted on the online platform with 60 dieticians who were in the nutritional support team in different provinces of Turkey. The online form consists of sections on the particulars of the nutritional support team and an assessment of disease-specific nutrition practices.

Results: Dietitians’ 60% stated that NST (Nutritional Support Team) in their institution had training in clinical nutrition. While all the participants stated that the Nutritional Risk Score (NRS-2002) was used in screening the nutritional status, 50% of the participants reported that anthropometric measurement practices were not carried out regularly. The rate of dietitians who stated that enteral nutrition was started in intensive care patients who were not expected to start full oral nutrition in the first 3 days was 71.7%. The rate of dietitians who stated that preoperative fasting was not applied in patients before surgery was 3.4%, while continued to be fed in the post-operative period was 10.5%. The rate of using combined therapy was 23.3% in patients who were neglected and who developed inflammatory stenosis in the intestines, applying for oral nutritional support in case of continued inflammation in the intestines was determined as 46.6%. The rate of using formulas containing whole protein in liver patients was 77%, and using formulas rich in branched-chain amino acids in patients with hepatic encephalopathy was 51.9%.

Conclusion: Nutritional support team professionals should focus on clinical nutrition education and increase their awareness of guideline recommendations.

Keywords

Clinical nutrition, nutritional support team, guidelines, nutrition practices, ESPEN.

References

• Cederholm T, Barazzoni R, Austin P, Ballmer P, Biolo G, Bischoff SC, et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr. 2017 Feb;36(1):49-64.
• Mistiaen P, Van den Heede K. Nutrition Support Teams: A Systematic Review. JPEN J Parenter Enteral Nutr. 2020 Aug;44(6):1004-20.
• DeLegge M, Wooley JA, Guenter P, Wright S, Brill J, Andris D, et al. The state of nutrition support teams and update on current models for providing nutrition support therapy to patients. Nutr Clin Pract. 2010 Feb;25(1):76-84.
• Gonzalez-Granda A, Schollenberger A, Thorsteinsson R, Haap M, Bischoff SC. Impact of an interdisciplinary nutrition support team (NST) on the clinical outcome of critically ill patients. A pre/post NST intervention study. Clin Nutr ESPEN. 2021 Oct;45:486-91.
• Nightingale J. Nutrition support teams: how they work, are set up and maintained. Frontline Gastroenterol. 2010 Oct;1(3):171-7.
• Klinik Enteral Parenteral Nütrisyon Derneği. ESPEN Parenteral Nütrisyon Rehberi. Ankara; 2011. Available from: http://www.kepan.org. tr/userfiles/ESPEN_PN_KILAVUZ/ESPEN_PN_rehber_Turkce.pdf Erişim tarihi: 28 Mayıs 2022
• Klinik Enteral Parenteral Nütrisyon Derneği. ESPEN Enteral Nütrisyon Rehberi. Ankara; 2012. Available from: http://www.kepan.org.tr/ userfiles/ESPEN_EN_KILAVUZ/ESPEN_EN_KILAVUZ_Turkce.pdf Erişim tarihi: 28 Mayıs 2022
• Demirkan K, Gündoğdu H, Uyar M, Kılıçturgay S, Demirağ K, Abbasoğlu O. The trending topic of specialty in Turkey: Clinical nutrition. Clin Sci Nutr. 2020 Apr;2(1):43-8.
• Bozkırlı BO, Gündoğdu RH, Akbaba S, Sayın T, Ersoy PE. Surgeons’ approach toward clinical nutrition: A survey based study. Turk J Surg. 2017 Sep 1;33(3):147-52.
• Demirağ K, Kılıçturgay S, Hopancı Bıçaklı D, Sungurtekin H, Demirkan K, Gündüz M, et al. Nutritional support practices among intensive care units in Turkey: One-day cross-sectional study. Clin Sci Nutr. 2019;1(3):123-8.
• Bhagavatula M, Tuthill D. The role of a hospital Nutrition Support Team. Paediatr Child Health. 2011;21(9):389-93.
• Skipper A, Ferguson M, Thompson K, Castellanos VH, Porcari J. Nutrition screening tools: An analysis of the evidence. JPEN J Parenter Enteral Nutr. 2012 May;36(3):292-8.
• van Bokhorst-de van der Schueren MAE, Guaitoli PR, Jansma EP, de Vet HCW. Nutrition screening tools: Does one size fit all? A systematic review of screening tools for the hospital setting. Clin Nutr. 2014 Feb;33(1):39-58.
• Hoffmann M, Schwarz CM, Fürst S, Starchl C, Lobmeyr E, Sendlhofer G, et al. Risks in management of enteral nutrition in intensive care units: a literature review and narrative synthesis. Nutrients. 2021 Dec;13(1):82.
• Pradelli L, Graf S, Pichard C, Berger MM. Supplemental parenteral nutrition in intensive care patients: A cost saving strategy. Clin Nutr. 2018 Apr;37(2):573-9.
• Çelik F, Edipoğlu İS. Yoğun bakım hastalarında erken enteral immünonütrisyon uygulamasının enflamatuvar yanıta etkisi. Turk J Intensive Care 2019;17:88-95
• McCarthy MS, Martindale RG. Immunonutrition in critical illness: What is the role? Nutr Clin Pract. 2018 Jun;33(3):348-58.
• Robinson LA, Tanvetyanon T, Grubbs D, Robinson NA, Pierce CM, McCarthy K, et al. Preoperative nutrition-enhanced recovery after surgery protocol for thoracic neoplasms. J Thorac Cardiovasc Surg. 2021 Sep;162(3):710-20.
• Sarin A, Chen LL, Wick EC. Enhanced recovery after surgeryPreoperative fasting and glucose loading-A review. J Surg Oncol. 2017 Oct;116(5):578-82.
• Bilku DK, Dennison AR, Hall TC, Metcalfe MS, Garcea G. Role of preoperative carbohydrate loading: a systematic review. Ann R Coll Surg Engl. 2014 Jan;96(1):15-22.
• Kratzing C. Pre-operative nutrition and carbohydrate loading. Proc Nutr Soc. 2011 Aug;70(3):311-5.
• Kłęk S, Jankowski M, Kruszewski WJ, Fijuth J, Kapała A, Kabata P, et al. Clinical nutrition in oncology: Polish recommendations. Oncol Clin Pract. 2015;11(4):173-90.
• Yu K, Zheng X, Wang G, Liu M, Li Y, Yu P, et al. Immunonutrition vs Standard Nutrition for Cancer Patients: A Systematic Review and MetaAnalysis (Part 1). JPEN J Parenter Enteral Nutr. 2020 Jul;44(5):742-67.
• Balestrieri P, Ribolsi M, Guarino MPL, Emerenziani S, Altomare A, Cicala M. Nutritional Aspects in Inflammatory Bowel Diseases. Nutrients. 2020 Jan;12(2):372-83.
• Palmer LB, Kuftinec G, Pearlman M, Green CH. Nutrition in cirrhosis. Curr Gastroenterol Rep. 2019 Jul;21(8):38.