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These data suggest TPN use is safe in patients aged ≥ 80 years and advanced age alone should not preclude TPN use.

Nutrition support in the intensive care unit can impact favorably on disease severity, development of complications, modulation of the immune response, and length of stay, resulting in improved outcomes (ASPEN [American Society for Parenteral and Enteral Nutrition] 2009 guideline), but determining an individual's precise nutritional requirements remains a clinical challenge. By understanding the impact of critical illness on nutrient requirements, the dietitian can estimate needs and provide nutrition support. Monitoring tolerance to individualized nutrition support helps avoid the negative consequences of under-and overfeeding. Evidence-based nutrition support guidelines and specifically tailored care plans play a significant role in optimizing nutritional management, thus improving patient outcomes and reducing health care costs.

support. The documented prevalence of malnutrition in patients with chronic disease ranged from 7%-15%, and of these, 18%-34% were prescribed nutrition support (see Table 1).This is the largest survey of GP records to assess recording of malnutrition and prescription of ONS and other enteral nutrition support in adults with chronic conditions in the UK. Malnutrition was common in the chronic conditions, but overall prevalence was lower than previously reported in GP practices [4], possibly due to under-reporting by GPs, lack of screening for malnutrition, or the malnutrition criteria used (i.e. lower BMI cut off). The data in the GP database also suggests under-treatment of patients with malnutrition as more than two thirds did not receive a prescription for nutrition support, although the use of other dietary strategies/dietetic intervention could not be assessed. Further research is required to more clearly elucidate the prevalence, detection and management of malnourished patients with chronic diseases in GP practice, in the UK.

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