Review of ESPEN Enteral Guidelines for Use in the EAL



Review of European Society for Clinical Nutrition Metabolism (ESPEN) Enteral Guidelines for Use in the EAL

ESPEN developed 10 disease-specific adult enterable guidelines and published these in Clinical Nutrition 2006;25:177-360. These guidelines include:

Cardiology and Pulmonology, Gastroenterology , Geriatrics, Hepatology, Wasting in HIV, Intensive care, Non-surgical oncology, Pancreas, Renal failure, Surgery and transplantation

The abstracts for these guidelines are in Attachment #8.4, the full articles can be viewed at .

Each guideline follows the same format and methodology (see Attachment #8.3 Methodology for the development of the ESPEN

Guidelines on Enteral Nutrition).

ADA’s criteria and summary of the documentation is below.

|ADA Criteria for using Guidelines in EAL |Meets Criteria |Documentation in guideline methodology |

|Produced under appropriate organization type (relevant |( |Under the auspices of the European Society for Clinical Nutrition and Metabolism (ESPEN) clinical practice |

|professional society). | |guidelines on enterable nutrition were systematically developed between spring 2004 and winter 2005 in a both |

| | |evidence and consensus based process. |

|Includes Systematic Review which involves: |( | |

|Determining the problem and formulating into a question |( |Each guideline consists of a series of questions and answers followed by supporting information. |

| | |The disease-specific working groups were encouraged to adopt the structure of the German guidelines on enterable |

| | |nutrition which were developed |

| | |according to the following clinical questions: |

| | |*Which influence does the disease exert on nutritional state and energy and substrate metabolism? |

| | |*Which influence does nutritional state exert on outcome? |

| | |*Which are the goals of enterable nutritional therapy? |

| | |*When is enterable nutrition indicated? Is enterable nutrition superior to normal food? |

| | |*In which way is enterable nutrition practically implemented? |

| | |*Are there disease specific contraindications for enterable nutrition? |

| | |*Are there disease specific complications of enterable nutrition? |

| | |*When is oral feeding initiated? |

|Gathering and selecting relevant evidence |( |Evidence was gathered by each working group by conducting a structured literature search which was adapted to the|

| | |German guidelines. A defined search strategy, inclusion criteria and specified keywords (in combination with |

| | |appropriate disease specific keywords) were used to retrieve literature from the Medline, EMBASE, PubMed and |

| | |Cochrane databases) e (See Table 2 in Methodology article) |

|Synthesizing and grading the evidence |( |The quality and strength of the supporting evidence was graded according to the criteria of |

| | |the SIGN and the Agency for Health Care Policy and Research (AHCPR). This grading system relies primarily on |

| | |studies of high quality, i.e. prospective randomized controlled trials. Evidence levels were then translated into|

| | |recommendations according to Table 3 (in Methodology article) taking into account study design and quality as |

| | |well as consistency and clinical relevance. The highest grade (A) is assigned to recommendations which are based |

| | |on at least one randomized controlled trial whereas the lowest recommendation (C) is based on expert opinion, |

| | |including the view of the working groups. |

|Formulating recommendations using the best available evidence |( |Noted above |

|Disseminating the findings |( |Publication in Clinical Nutrition also available as free full text articles on ESPEN website. The guidelines were|

| | |also offered to the national societies of clinical nutrition for approval, distribution, and implementation. |

| | |Moreover, the guidelines were presented to a broad |

| | |audience at the ESPEN congresses 2004 and 2005 in special sessions. |

|Most recent version produced. |( |Published April 2006. Also noted: Two years after publication each chapter of the |

| | |guidelines will be reassessed for validity by an ESPEN panel and adapted to new scientific evidence if indicated.|

|Safeguards to ensure funding did not affect the process. |( |ESPEN paid the cost for the guideline development, i.e. the translation of the German guidelines into English, |

| | |the central organising office (L.V.) and the editorial meetings. Only the consensus conference was supported by |

| | |an unrestricted fund allocated to ESPEN by the Industry Liaison Group. (See additional documentation under |

| | |Funding in Methodology article) |

| | |Conflict of Interest: All 89 experts participating in the guideline development process (members of the steering|

| | |committee, the working groups, authors of the introductory chapters, and the methodological adviser) as well as |

| | |the authors of the editorial, the introduction and the methodology chapters disclosed any potential conflicts of |

| | |interests on a form which was created according to ESPEN specifications. (See additional information under |

| | |Conflict of interest disclosure in Methodology article) |

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