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The provision of nutritional support for patients in hospital and in the community has derived from a heightened awareness of the impact of malnutrition on patient outcome and quality of life. Attention has focused on the prevalence of disease related malnutrition, both in terms of weight loss and weight for height, but also in terms of micronutrient deficiencies. Drives to enhance awareness of undernutrition in the community have followed efforts to improve nutrition in hospitals through food improvement, supplement provision, and artificial feeding. The need for routine nutritional assessment in clinical practice, especially in chronic disease, and its careful documentation has become ever more appreciated, particularly among gastroenterologists.
It is widely acknowledged that the approach to nutritional care is best made via a multiprofessional team which combines the skill and knowledge of dieticians, nutrition nurse specialists, pharmacists, and doctors. Teams like this are the key to excellent patient centred nutritional care and lead to overall hospital strategies for nutritional support which seamlessly combine, in a cost effective way, the use of food and supplements with artificial feeding to provide nutrients by the simplest safest route acceptable to the patient. Such teams need to develop more in the community too.
As the more enlightened hospitals form teams, a demand develops for a comprehensive textbook. This one is widely seen as one of the best and it now enters its enlarged second edition. It is an edited collation in which British authors dominate but it also includes contributions from key players from continental Europe making it representative of much of what goes on in the more Anglophone corners of ESPEN. As such it unsurprisingly contains some excellent chapters and others which are a little more patchy. But the collations is comprehensive, with a sensible mixture of the practical and the theoretical, the general and the more specialist. I would recommend it as a sound basis and as a useful resource for further reading.
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