By Filomena Gomes and Philipp Schuetz

The European Society for Clinical Nutrition and Metabolism (ESPEN) holds several guidelines and position papers which guide clinicians in providing nutritional support in particular groups of patients, usually disease or age specific (http://www.espen.org/education/espen-guidelines).

However, many of the patients requiring nutritional support may suffer from multiple diseases. In fact, polymorbidity (multimorbidity) is highly prevalent, affecting more than 70% of the hospitalized adult population, and is associated with higher mortality and costs. In this context, a group of 14 European experts is developing guidelines on nutritional support for polymorbid (multimorbid) internal medicine patients, with the aim to help clinicians who struggle with the uncertainties of applying disease-specific guidelines to their patients who suffer from multiple conditions.

This project, which is endorsed by ESPEN, started with an initial meeting in Zurich, in January 2015, and the methodology used follows the standard operating procedures for ESPEN guidelines (Clinical Nutrition. 2015;34(6):1043-51). The working group has developed 12 important clinical questions, covering different areas of nutritional support: indication, route of feeding, energy, protein, micronutrients, disease-specific nutrients, timing, monitoring and procedure of intervention. Systematic literature searches were conducted in 3 different databases (as well as in secondary sources) resulting in a total of 4532 retrieved abstracts. These abstracts were screened to identify papers which meet the inclusion criteria; the quality of the included papers was evaluated and a level of evidence was assigned, which then resulted in a proposal of 22 recommendations and 4 statements. The first DELPHI online voting for these recommendations and statements is now completed and a final consensus conference will take place in April 2017, which will be followed by the preparation of the manuscript for publication.