Aggressive
nutrition therapy is essential to improve nutrition and function in patients with
malnutrition and
sarcopenia.
Malnutrition and
sarcopenia negatively affect functional recovery and
activities of daily living. Nutrition improvement is associated with better functional recovery. Target energy intake in aggressive
nutrition therapy is defined as total energy expenditure (TEE) plus the amount of energy accumulated. The amount of energy accumulation per 1 kg of
body weight is generally 7500 kcal. If the goal is to gain 1 kg of weight over 30 d, TEE + 250 kcal is the target daily energy intake. Aggressive
nutrition therapy is implemented using a rehabilitation nutrition care process, which consists of five steps: assessment and diagnostic reasoning, diagnosis, goal setting, intervention, and monitoring. Aggressive
nutrition therapy sets clear goals using the Specific, Measurable, Achievable, Relevant, and Time-bound principles. The application and effect of aggressive
nutrition therapy differs depending on the etiology and condition of
malnutrition. Precachexia,
short bowel syndrome, and older people with mild to moderate
dementia are indications for aggressive
nutrition therapy. Nevertheless, aggressive
nutrition therapy is usually contraindicated in cases of refractory
cachexia,
acute disease or injury with severe
inflammation, and bedridden patients with severe
dementia and reduced activity. Aggressive
nutrition therapy should be combined with aggressive exercise and rehabilitation. Enhanced nutritional
therapy combined with rehabilitation in patients with
cerebrovascular disease, hip fracture, or
acute disease is recommended in the 2018 clinical practice guidelines for rehabilitation nutrition. Further evidence for aggressive
nutrition therapy is however required.