Information for the public
Giving nutrition support
A balanced diet
You should be considered for nutrition support if:
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your BMI is less than 18.5
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you have lost more than 10% of your weight in the past 3 to 6 months without trying
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your BMI is less than 20 and you have lost more than 5% of your weight over the past 3 to 6 months without trying.
If you can swallow safely and you need nutrition support, you may be offered nutrition support by mouth (orally). Your healthcare professional should work with you to ensure your diet contains varying amounts of the following nutrients to meet your needs:
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calories
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protein
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water
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minerals
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vitamins.
Your healthcare professional will help you make changes to your current diet. For example, you may need to eat more high calorie foods such as butter, milk and sugar. Or you may need to eat more regularly – for example, having three meals and three snacks every day. You may be offered fortified foods or special supplement drinks with added nutrients. If you have vitamin or mineral deficiencies your healthcare professional should offer you supplements.
Any changes in your diet will need to be gradually introduced. This is because your body will have started to slow down and will need time to readjust to having nutrients again.
Your oral nutrition support should be stopped when you can take in enough nutrients by eating normally.
Tube feeding
Into your gut
If you can't eat and drink normally or you are not able to take in enough nutrients you may be offered a liquid diet through a tube into your gut. This is called enteral feeding.
Usually a tube is inserted into your nose and is passed down into your stomach. This tube is called a nasogastric tube. It is connected to a container of liquid feed. This feed can be given continuously or in fixed doses depending on your needs. This liquid feed should contain all of the nutrients needed by your body. If your stomach
isn't working properly the tube should be passed down into your small intestine instead.
If you need enteral feeding for more than 4 weeks you may be offered a different feeding tube; this is called a gastrostomy or a PEG (percutaneous endoscopic gastrostomy) tube or a jejunostomy tube.
A PEG tube is inserted through your abdomen into your stomach and can make enteral feeding easier and more comfortable. A jejunostomy tube is inserted directly into the jejunum (which is part of your small intestine). This means the feed doesn't go into the stomach and is given directly into the small intestine.
Your enteral feeding should be stopped when you are able to take in your nutrition support orally.
Into your blood
If you can't be fed by a tube into your stomach or intestine you may be offered a sterile liquid feed through a tube into your blood. This is called parenteral feeding.
A narrow tube known as a catheter is placed in a vein. This is connected to a container of sterile liquid feed. This sterile liquid feed should contain all of the nutrients needed by your body. The standard mixture of nutrients should be adjusted to suit your needs. For example, you may need additional vitamins to be added. The feed should be introduced gradually. It can be given continuously or in cycles depending on your needs.
Your healthcare professional should check improvements in your nutrition regularly. Once you are able to absorb nutrients and be fed by a tube into your gut, or eat normally, parenteral feeding should be gradually stopped. Your healthcare professional should check your progress daily.
Regular checks
Any changes to your diet should be checked regularly by your healthcare professional. This is called monitoring. These checks are to ensure that your diet is safe, and that the changes in your diet are improving your nutrition. Your diet might need to be adjusted to make it more effective. The NICE guideline gives details on how your diet should be monitored. For example, your healthcare professional may need to test your blood to check the levels of nutrients.
Monitoring could also involve taking your temperature regularly and checking your pulse and weight, as well as checking that your tube or catheter is working properly.
Your intake of nutrients should be checked at least twice a week until stable. If you need long-term nutrition support your needs should be reviewed every 3 to 6 months.