Medical Nutrition Therapy

Dr Syuma Adhy Awan Mkes SpGK (K)

Definitions and terminology of clinical nutrition

Medical nutrition
therapy / MNT
Overview of forms and products for nutritional
care and therapy
 Overview
➢ Definition
Ø Indication
Ø Classification : home-made/commercial & method of use.
Ø Oral nutritional supplements (ONS)
▪ Nutritionally complete ONS
▪ Nutritionally incomplete ONS
➢ Enteral tube feeding/enteral nutrition
▪ Total
▪ Supplemental
▪ Home
➢ Parenteral nutrition
▪ Total ▪ Supplemental ▪ Home ▪ Subcutaneous fluid therapy
▪ Intra-dialytic
 Definition

• Medical nutrition therapy is a term that encompasses

oral nutritional supplements, enteral tube feeding
(enteral nutrition) and parenteral nutrition.

T. Cederholm et al. / Clinical Nutrition 36 (2017) 49-64 Diabetes, Metabolic Syndrome and Obesity: Targets and
Therapy 2021:14 1703–1728
 Indications

• Patient Who are Malnourished, Thin weak have lost a lot

of wight
• Patient with increased calorie and protein need:
difficulty breathing , wound , sepsis
• Patient with poor apetite : oncology
• Patient with Dietary restrictions due to disease (such as
kidney disease)
• Patient with Chewing, swallowing or dextromotor
limitations : stroke
Classification
Method of use
 Oral nutrition therapy

• Mainly given as oral nutritional supplements (ONS) and defined

as FSMP
• FSMP, specially processed or formulated and intended for the
dietary management of patients, including infants, to be used
under medical supervision.
• ONS used in addition to the normal diet, when diet alone is
isufficient to meet daily nutritional requirement.
• Liquid ONS are sometimes referred to as sip feeds.
Categorization of ONS

Poulia et al., 2016 modul 8.2 LLL Programe

 Oral nutrition supplements…
• Nutritionally incomplete ONS
not suitable for use as the sole source of nutrients (specific nutrients
in higher amounts )

• Nutritionally complete ONS

sole source of nourishment for prolonged periods (have a balanced
nutritional composition )
standard and special (for specific diseases)
 Enteral Nutrition Therapy: Enteral tube
feeding

• Via a tube :
Naso-gastric, naso-jejunal or naso-post pyloric
tube feeding
• Via a stoma:
percutaneous endoscopic gastrostomy (PEG) or
with a jejunal extension (PEG-J) or into the
jejunum (percutaneous endoscopic jejunostomy
(PEJ)).
• i.e. surgical gastrostomy or jejunostomy.
 Enteral Nutrition Therapy

• Total enteral tube feeding Synonym: total enteral

nutrition (TEN) :

• Supplemental enteral tube feeding :

• Home enteral tube feeding. Synonym: Home Enteral

Nutrition (HEN):
Parenteral nutrition (PN) therapy

• Total parenteral nutrition (TPN). Synonym: exclusive parenteral

nutrition.
• Supplemental parenteral nutrition (SPN). Synonym: partial
parenteral nutrition or complementary parenteral nutrition
• Home Parenteral Nutrition.
• Subcutaneous fluid therapy.
• Intra-dialytic parenteral nutrition (IDPN).
 Summary

• MNT is an evidence-based nutrition therapy to help

treat medical conditions.
• FSMPs, used under medical supervision
• MNT can be used to treat numerous medical conditions,
such as heart disease, diabetes, cancer, kidney disease,
and digestive issues.
• MNT is determined to be appropriate only after a
thorough nutritional evaluation in a hospital or
outpatient setting.