Home nutritional support, including both oral and artificial (enteral and parenteral) methods of feeding, is an important modality of treatment that is being used for an increasing number of people with disease and disability who are managed in the community. The identification of individuals who are at increased risk of malnutrition and who may benefit from additional nutritional support is a vital first step, which can be undertaken using a validated screening tool (such as MUST; Figure 1). Oral nutritional support, including liquid multinutrient supplements, is of value in improving the nutritional intake and functional well-being of patients with malnutrition in the community. Without ETF, many patients with persistent swallowing difficulties would die; similarly, without PN, many patients with persistent intestinal failure would not survive. Although these forms of home therapy can be life-saving, they may restrict normal lifestyle and lead to life-threatening complications. These complications can be prevented or treated by establishing an adequate organizational infrastructure. This should include education and training of both health workers and patients/caregivers as well as a management structure that allows all patients to be followed up and, when necessary, admitting patients to the hospital for more intensive investigations and therapy. Ethical difficulties about withholding or withdrawing artificial nutritional support are likely to continue and to vary with time and from country to country. Intestinal transplantation is becoming a potentially realistic option for a few patients with irreversible intestinal failure who cannot be adequately maintained on long-term PN, but it has not yet become part of routine clinical care in the same way as renal transplantation has become routine in patients with renal failure, who would otherwise receive a lifelong treatment with dialysis.

See also: Food Fortification: Developed Countries; Developing Countries. Malnutrition: Secondary, Diagnosis and Management. Nutritional Support: Adults, Enteral; Adults, Parenteral; Infants and Children, Parenteral. Supplementation: Dietary Supplements; Developing Countries; Developed Countries.

Breaking Bulimia

Breaking Bulimia

We have all been there: turning to the refrigerator if feeling lonely or bored or indulging in seconds or thirds if strained. But if you suffer from bulimia, the from time to time urge to overeat is more like an obsession.

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