The many positive responses to my article confirm the great clinical relevance of the subject and the interest in the problem area that is malnutrition in hospital. This is true not only for the known clinical sequelae but also the proven consequences in terms of the business finances, and it shows convincingly that modern nutritional medicine is a highly effective and integral part of medical therapy and prevention, for which awareness and acceptance in Germany are fortunately rising.
I thank Rieger, Stiebing, and Gebel for their additional comments. Dr Monika Gebel emphasizes rightly that in patients with chronic diseases with severe malnutrition and especially in pronounced eating disorders, bioimpedance analysis (BIA) provides a very detailed description of the individual body composition and forms a basis and observational method for the targeted nutritional medical care for these patients. With this indication it should be used generously in clinical practice; but BIA is too elaborate to be used as a screening tool in everyday clinical practice.
Dr Michael Stiebing rightly reminds us that doctors as well as nursing staff and family members need to pay attention to the complex factors that lead to malnutrition and that have to be borne in mind if individual treatment is to be adequate. In everyday clinical practice, it is often possible to achieve enormous successes by using measures that may strike one as banal at first glance. Many scientific studies have shown a high efficacy for such simple, basic measures. These need to be heeded and implemented by hospitals, old people’s residential homes, and nursing and care homes. Dr Ulrich Rieger’s comments confirm how important methodical nutritional medical care can be as an integral part of the complex interdisciplinary treatment principles especially in the surgical disciplines. Interdisciplinary treatment for chronic decubitus ulcers and perioperative conditioning are only two of the scientifically well supported examples for many relevant clinical situations.
I hope that my article, which has been so positively received, is a further contribution to making nutritional medical interventions gain the clinical importance in Germany that is long overdue in the context of modern, evidence based, medical care for patients, as is supported by a multitude of scientific data.
Prof. Dr. med. Christian Löser
Rotes Kreuz Krankenhaus, Kassel
Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists.
|1.||Löser C: Malnutrition in hospital—the clinical and economic implications. Dtsch Arztebl Int 2010; 107(51–52): 911–7.|