Trends at ESPEN 2020

Last month the NZMP team was present at the Virtual European Society for Enteral and Parenteral Nutrition (ESPEN) congress, both to present our portfolio of offerings and to review the new innovations in medical nutrition. 

Staying up to date and connected with our key opinion leaders is important to us, to ensure we continue to be at the leading edge for Medical Nutrition solutions.

Developments in the health care setting in the past year have been tremendous with Covid-19 and ICU care taking the spotlight at all levels, including the programme at ESPEN. 

Nutrition management of the ICU patient was a key topic, but there were novelties to be seen in other disease areas as well. Below, a shortlist of our interests.

Methodology to assess nutrition requirements got the attention it deserves in the programme. In an era where personalization is growing in patient care, the need for easy-to-use, valid methods are even more relevant.

Good nutrition management has shown to provide better health outcomes in treatment. The growing body of scientific studies in the field of nutrition compounds each year, enabling expert groups to build robust guidelines for various patient groups.

These guidelines served as the basis for Covid-19 patients. Another spotlight was put on telemedicine or patient care without the personal and physical interaction between clinician and patient. Although not new, this element of patient care has made a leap into the future in 2020.

How this way of treatment will further develop and what challenges and opportunities it will bring is not yet clear, but it is an opportunity for refining the patient journey and providing optionality aligned to patient requirements in the full treatment process – including nutrition. 

Several recent studies have shown the benefits of providing energy and protein in the right amounts and at the right time to patients in the ICU. In this situation, nutrient requirements are high and normal eating patterns hugely disturbed. 

Several presentations showcased recent studies in this area – there was clear link between energy and protein intake, and outcomes, including mortality. 

There were several studies presented on the additional protein requirements starting at day 4 and the possible nutritional strategies to achieve sufficient protein intake preferably using the oral route of whole proteins. 

This year was the launch of ‘Europe’s Beating Cancer Plan’ showing the importance of this disease and it’s societal impact. The expectation is that cancer cases could double by 2035 and become the leading cause of death in Europe. 

Malnutrition is a key factor in hospital outcomes and in chronic diseases and cancer treatment is more successful if weight and muscle loss can be avoided. Cancer-specific cachexia is even more challenging and nutritional guidelines have a lot of attention. 

Sufficient proteins are a key element in the treatment and increased intake can come from various sources, from adapting the foods in the diet but also using oral supplements which can be full ONS to provide energy and proteins, or a modular format focussing on proteins alone. 

Sarcopenia has a lot of attention and as it is a relevant marker for health outcomes and even mortality, this aligns with expectations. A new topic that will require more attention in the future is that of the obese sarcopenic patient. 

If not properly assessed, the body size of these patients can easily mislead the hospital care teams, letting the patient go unnoticed as malnourished and therefore without proper nutritional care. 

So far sarcopenic obesity doesn’t have its own individual guideline but during a session discussing the treatment for malnutrition, sarcopenia and cachexia it became clear that the time for such a guideline has come. 

Studies on weight loss while retaining muscle mass in obese subjects have used the combined strategy of higher protein – lower energy diets with exercise programmes showing good results.