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Seitlicher Blick auf eine Gruppe Ärzte und Ärztinnen in weißen Kitteln, die einem Vortrag zuhören. Die Köpfe sind unscharf aufgenommen.

Nutritional Medicine

One of the clinic's main fields of activity is the treatment of malnutrition. The enteral and parenteral nutrition therapy is carried out according to guidelines and includes the transition management to home enteral or home parenteral nutrition. 

Patients with diabetes mellitus are also treated and trained according to the latest medical findings.

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Evaluation methods

The risk or presence of malnutrition is assessed with easy-to-use screening methods such as the Malnutrition Universal Screening Tool (MUST), Nutritional Risk Screening (NRS), or Subjective Global Assessment (SGA). For older patients and female patients, the Mini Nutritional Assessment is available. There is also the option of a more in-depth nutritional assessment, for which the following methods are used, depending on the issue.

Body composition is determined using both anthropometric measurements (circumferences, skinfold thicknesses) and bioelectrical impedance analysis (BIA). The evaluations provide an indication of the proportion of body cell mass, extracellular mass and fat mass in the body weight.

To calculate the energy balance, it is necessary to determine both the energy intake and the energy consumption. To measure the individual resting energy metabolic rate, indirect calorimetry is performed, in which oxygen consumption and carbon dioxide production are measured. Energy and nutrient intake is determined by means of a nutrition protocol or diet history and evaluated with nutrition software. Special wristbands are available for measuring physical activity, which are used in the home environment.

For the examination of the functional state, partly apparative methods are available such as hand force dynamometry for the measurement of the muscle function of the upper extremities and knee extension and hip flexion for the measurement of the muscle function of the lower extremities. Cognitive function will be assessed partly by apparatus (flicker test, cognitrone) and partly by classical psychometric test procedures.

Furthermore, a wide variety of validated questionnaire techniques are used to examine quality of life (SF-36, QLQ-30, IBDQ, BFI) and physical activity and performance status (IPAQ, ECOG, IADL), as well as to determine anxiety and depression (CES-D, STAI).

Investigations into the permeability of the gastrointestinal tract complement the range of tests. Thus, according to established methods, sucrose is used to measure gastric permeability, lactulose and mannitol to measure small intestinal permeability, and sucralose to measure large intestinal permeability. After drinking the corresponding sugar solutions, the concentration of the sugars in the urine is measured by HPLC.