Should Starving Hospital Patients Receive Nutritional Support?

Patients who are hospitalized with acute and severe illnesses often lose their appetites — initially to their incapacitation, but later to protein-energy malnutrition (PEM). Clinical studies addressing nutritional supplements and enteral feeding have yielded mixed results, as some have indicated forced feeding and increased caloric intake can help, while others have suggested the treatments are detrimental.

In a recent issue of Swiss Medical Weekly, a team of endocrinologists researched the topic of PEM treatment, noting that balancing the efficacy of an intervention with its potential adverse effects can be a juggling act. For their study, the clinicians reviewed the limited information on the effectiveness of nutritional support in an acutely ill medical patient population outside of critical care.

Although the therapy’s design to correct nutritional inadequacies appears reasonable, no clinical trials or guidelines exist to devise the best treatment plan, and current nutritional screening tools are not well validated.

After examining the failures of parenteral nutrition, some research has found starvation may promote cell recycling by inducing detoxification and autophagy — a survival mechanism that recycles intracellular nutrients like toxic protein aggregates and damaged organelles.

Ultimately, the authors called for a reappraisal of nutritional support in acutely ill medical inpatients outside of critical care, as they noted more trial data is desperately needed to improve clinicians’ understanding of the issue.