Nutritional Support

Malnutrition is common among young adults with chronic childhood conditions and requires special attention from adult primary care providers (PCPs) as patients transition care and as nutrition goals shift from growth to maintenance. Malnutrition may result from several contributing factors including altered nutrition needs as a result of underlying conditions, inadequate intake due to oral or enteral feeding difficulties, and gastrointestinal issues resulting in nutritional losses. In addition to caloric needs, common nutritional issues to consider in this population include bone health, drug–nutrient/food interactions, and nutrition to support wound healing. In patients unable to meet nutritional needs through oral diet, nutrition support may be indicated, with options including oral supplements, enteral nutrition, or parenteral nutrition. Chronic enteral nutrition requires a permanent enteral access device such as a gastric or gastrojejunal tube. Common complications of chronic tubes include peristomal infection or leakage, clogged or dislodged tube, buried bumper syndrome, and bleeding. Enteral formulas vary in protein, carbohydrate, and fat content as well as fiber and caloric density. Enteral nutrition can be associated with changes in gastrointestinal function such as diarrhea, constipation, nausea, or abdominal discomfort. PCPs should be familiar with the evaluation and management of such complications, including when subspecialty referral is appropriate. Parenteral nutrition is reserved for patients unable to tolerate enteral nutrition due to gastrointestinal dysfunction such as short gut syndrome, severe malabsorption, or intestinal dysmotility. Consultation with a dietitian is recommended when the patient is initiating or making significant adjustments to enteral and parenteral nutrition, the patient is not meeting weight goals despite adjustments by the PCP, or the patient would benefit from in-depth assessment of nutrition goals or counseling.