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Chapter 29 — Further Reading
⚠️ This chapter is written for a general reader but its content is clinical. The sources below are professional guidelines — they are free, they are more current than any textbook, and they are the documents that would actually be used.
⚠️ Read this if you take one thing away
Your national guidance on nutrition support in adults. In the UK that is NICE guideline CG32, Nutrition support for adults — free, and ⚠️ it contains the refeeding risk criteria and management that §29.7 is built on. ESPEN publishes equivalent European guidelines; ASPEN the American ones.**
⚠️ Read the refeeding section specifically. It is two pages, it is the highest-stakes material in this book, and it is written as a checklist because that is how it needs to be used.
BAPEN (bapen.org.uk) — ⚠️ free MUST screening tool, calculator, and explanatory material.
If you work anywhere near inpatients, this is the practical resource.
On malnutrition and screening
Search "GLIM criteria malnutrition diagnosis consensus" for the 2018 global framework, ⚠️ and note the muscle mass criterion — Chapter 25's sarcopenia arriving in a hospital.
On prevalence and outcomes: search "hospital malnutrition prevalence length of stay outcomes". ⚠️ The association with discharge destination is the one that makes it concrete.
⚠️ And on whether screening changes outcomes — search "nutritional screening impact clinical outcomes". This is an uncomfortable literature: screening reliably identifies risk and the evidence that it changes outcomes is weaker than you would hope, largely because identification without a triggered action does nothing. §29.2's fourth point.
⚠️ On refeeding syndrome
The NICE criteria (above), and search "refeeding syndrome mechanism management review" for a clinical overview.
On the history: search "refeeding syndrome prisoners of war Minnesota starvation". ⚠️ The Minnesota Starvation Experiment (also relevant to Chapter 34) and the post-war literature are where this was described, and knowing that people survived years of starvation and died within days of being fed is what makes the rule memorable.
On practice: search "refeeding syndrome anorexia nervosa medical stabilization guidelines" — ⚠️ the eating disorder literature has the most detailed protocols, because it deals with the highest- risk population routinely. Chapter 34.
On enteral and parenteral nutrition
On NG tube safety: ⚠️ search your national patient safety body's alerts on nasogastric tube misplacement — NHS England has published several, and they include the specific checks and the specific invalid ones. If you place or use NG tubes, read the current alert, not this chapter.
On PEG in dementia: search "percutaneous endoscopic gastrostomy advanced dementia outcomes" and ⚠️ the position statements from geriatrics and palliative care societies. The consistency across bodies is striking, and it remains a common request.
On home enteral nutrition: ⚠️ PINNT (pinnt.com) and equivalent patient organizations —
worth reading if you want a corrective to the assumption that tube feeding means hospital.
On parenteral nutrition: search "catheter-related bloodstream infection parenteral nutrition prevention" and "intestinal failure associated liver disease."
⚠️ On critical illness — read the trials
Because §29.8's conclusion is counterintuitive and you should see it yourself.
EPaNIC — search "early versus late parenteral nutrition critically ill NEJM 2011." EDEN — "initial trophic versus full enteral feeding ARDS." TARGET — "energy-dense versus routine enteral nutrition critically ill NEJM 2018." EFFORT Protein — "high versus usual protein critically ill randomized 2023."
⚠️ Read at least the abstracts of all four, and then a current ESPEN or ASPEN critical care guideline to see how the trials were absorbed into practice.
On the recovery phase: search "post-intensive care syndrome nutrition rehabilitation" — ⚠️ the part §29.8 says matters most and is delivered least.
On perioperative nutrition
The ERAS Society (erassociety.org) — ⚠️ free protocols by operation type, including the fasting
and carbohydrate loading components.
On fasting: your national anaesthetic society's preoperative fasting guidance. ⚠️ Two hours for clear fluids is not new and is still not universally practised.
On prehabilitation: search "prehabilitation major surgery outcomes randomized". ⚠️ Growing, heterogeneous, and the window between diagnosis and surgery is usually dead time.
On drug–nutrient interactions
Your national formulary — BNF, or equivalent — ⚠️ and your pharmacist, who will do a full review free and in ten minutes (Chapter 16's advice, unchanged).
On warfarin specifically: search "warfarin vitamin K consistent intake dietary advice". ⚠️ The consistency message is decades old and the avoidance myth persists.
On enteral feed interactions: search "phenytoin enteral feeding interaction" — ⚠️ the classic example, and the reason feeds get held around doses.
⚠️ On end of life
Your national palliative care guidance on clinically assisted nutrition and hydration. ⚠️ In the UK, GMC guidance and NICE end-of-life care guidance both address it.
Search "clinically assisted nutrition hydration end of life evidence" for the outcome data, ⚠️ and then read something written for families rather than clinicians — Marie Curie, Hospice UK, or your national equivalent.
⚠️ §29.13's point is that the family's distress is the clinical problem as much as the physiology is, and the family-facing material handles that better than the professional material does.
A note on what to be careful with
⚠️ This chapter's failure mode is unusual: it is the one most likely to make a general reader feel that they now know something clinical.
Three cautions:
1. ⚠️ Refeeding management is a protocol, not a principle. §29.7 tells you to recognize the risk and ask the question. It does not qualify anyone to run the feeding, and the electrolyte replacement, monitoring intervals and cardiac considerations are genuinely specialist. The useful thing a non-clinician can do is ask whether it has been assessed.
2. ⚠️ The critical care findings do not generalize. "Feed less" applies to the acute phase of critical illness and nowhere else in this book — not to ward patients, not to older adults, not to recovery, and emphatically not to Ivor. Misapplying §29.8 would be a serious error.
3. ⚠️ And PEG decisions, end-of-life decisions and immunotherapy decisions are made with clinicians, with families, over time. This chapter is background for those conversations, not a substitute for them.
⚠️ What a general reader can actually use, and it is not nothing:
⚠️ Ask what someone in hospital has actually eaten. Open the packaging. Ask whether they've been fasted for a procedure that didn't happen. Ask whether they've been weighed. Ask whether refeeding risk has been assessed if they've eaten little for days.
⚠️ Five questions. All of them free. Every one of them would have changed Ivor's nine days.