Nutritional support practices in hematopoietic stem cell transplantation centers: A nationwide comparison.

OBJECTIVE: In 2009, international nutritional societies published practice guidelines on screening and nutritional support for patients undergoing stem cell transplantation. Little is known about how these guidelines are implemented in clinical practice. We performed a nationwide survey with the aim of understanding current practice patterns, differences between clinical practice, and international recommendations as well as barriers to the use of nutritional therapy. METHODS: We performed a qualitative survey including all centers across Switzerland offering allogeneic (n = 3) or autologous (n = 7) stem cell transplantation. We focused on in-house protocols pertaining to malnutrition screening, indications for nutritional support, types of nutritional therapy available and provided, and recommendations regarding neutropenic diets. RESULTS: All centers offering allogeneic, and most of the centers offering autologous transplantation, had a malnutrition screening tool, mainly the nutritional risk score (NRS 2002) method. Only one center does not provide nutritional support. There is wide variation regarding start and stop of nutritional therapy as well as route of delivery, with five centers recommending parenteral nutrition and five centers recommending enteral nutrition as a first step. Although all centers offering allogeneic transplantation, and approximately every other autologous transplant center, used a neutropenic diet, specific recommendations regarding the type of food and food handling showed significant variation. CONCLUSION: This Swiss survey found wide variation in the use of nutritional therapy in patients undergoing stem cell transplantation, with low adherence overall to current practice guidelines. Understanding and reducing barriers to guideline implementation in clinical practice may improve clinical outcomes. Close collaboration of centers will facilitate future research needed to improve current practice and ensure high quality of treatment.

[Oral nutritive supplements : efficiency and clinical use in community-dwelling patients]. / Suppléments nutritifs oraux : efficacité et aspects pratiques en ambulatoire.

Undernutrition represents a wide-spread clinical state in outpatients and inpatients. It is associated with a high morbidity and mortality, an impaired quality of life, and increased healthcare costs. Early diagnosis and treatement help to reduce these medical and economic consequences. Oral nutritive supplements (ONS) are simple, effective and economic medical treatments to fight against undernutrition. However, they are insufficiently used for outpatients because of lack of knowledge. This article reviews the impact of ONS, their indications and contraindications and their modalities of prescription and focuses especially on community-dwelling patients.

La dénutrition est un état clinique répandu chez les personnes hospitalisées et ambulatoires. Elle augmente la morbi-mortalité, les coûts et diminue la qualité de vie. Un diagnostic et une prise en charge précoces permettent de diminuer ses conséquences médico-économiques. Les suppléments nutritifs oraux (SNO) sont un traitement médical simple, efficace et économique pour lutter contre la dénutrition. Ils sont peu utilisés chez les patients ambulatoires, car méconnus. Cet article précise l'impact des SNO, les indications et les contre-indications, et les modalités de prescription, en se focalisant sur les patients ambulatoires.