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Glossary of terms

Adherence A term used to describe how well a patient or client is following the advice of his/her healthcare professional or treatment plan. Also known as compliance or concordance.
Cachexia A number of definitions of cancer cachexia have been proposed1-3 and a practical, easy-to-use classification of cancer cachexia has been developed, defined as ≥ 10% weight loss associated or not with anorexia, early satiation and fatigue; weight loss of < 10% is defined as pre-cachectic.4
Care settings These terms are not used consistently across different countries. For the purposes of this document:

  • Hospital The term ‘hospital’ refers to care in a hospital as an inpatient;
  • Outpatient The term ‘outpatient’ refers to a patient who attends a hospital or clinic for diagnosis or treatment but does not occupy a bed;
  • Community The term ‘community’ refers to care outside the hospital setting and can include people in institutions, in sheltered housing or in their own homes:
    • sheltered housing – groups of housing units provided for older or disabled people who require occasional assistance from a resident warden but who do not need full residential care;
    • institution – refers to care which does not take place in hospital or at home, i.e. it includes care in nursing homes, residential homes, long-term care institutions and mental health units (all of these are sometimes referred to informally as ‘care homes’);
    • nursing home – residents usually require nursing care and are more dependent than residents in residential care;
    • residential home – residents may need assistance with meals or personal care. Qualified nurses are not required to be present.
Cost-effectiveness The difference in costs is compared with the difference in consequences in an incremental analysis.5
Dietary advice /counselling The provision of information with the aim of increasing the frequency of consumption of food and fluids and increasing the energy and nutrient content of the foods and fluids consumed.
Economic evaluation The comparative analysis of alternative courses of action in terms of both their costs and consequences.5
Enteral Nutrition (EN) Enteral nutrition (also known as enteral tube feeding) is nutrition therapy given via a tube or stoma into the intestinal tract distal to the oral cavity.6 Enteral formulas are defined as FSMP (see below).
Enteral Tube Feeding (ETF) The term Enteral Tube feeding (ETF) is used synonymously with Enteral Nutrition (see definition above).
Failure to thrive/Faltering growth Inadequate growth in early childhood. Although no agreed consensus exists for the definition of faltering growth,7 in practice, abnormal growth patterns such as a fall across centiles, plateauing or fluctuating weight should trigger further assessment.8 The term ‘failure to thrive’ is also used in older people and is defined as ‘a syndrome involving poor nutrition, including decreased appetite and weight loss (often with dehydration), inactivity, depression, impaired immunity, and low cholesterol.’9
Food fortification Food fortification aims to increase the energy and nutrient density of foods and fluids without significantly increasing their volume.
Foods for Special Medical Purposes (FSMP) FSMPs are one of the food categories governed by EU Regulation No 609/2013 for Foods for Specific Groups (FSG).10 To supplement the FSG Regulation, specific legislation for FSMPs has been introduced and updates the previous EU directive governing FSMPs; this legislation is found in Commission Delegated Regulation (EU) 2016/128 of 25 September 2015 supplementing Regulation (EU) 609/2013 of the European Parliament and of the Council as regards specific compositional and information requirements for food for special medical purposes.

A FSMP is defined within the FSG Regulation as ‘a food specially processed or formulated and intended for the dietary management of patients, including infants, to be used under medical supervision; it is intended for the exclusive or partial feeding of patients with a limited, impaired or disturbed capacity to take, digest, absorb, metabolise or excrete ordinary food or certain nutrients contained therein, or metabolites, or with other medially-determined nutrient requirements, whose dietary management cannot be achieved by modification of the normal diet alone’.
Healthcare system A healthcare system is the sum total of all of the organisations, institutions and resources whose primary purpose is to improve health.11 In the UK, for example, healthcare includes hospitals, maternity units and services provided by district nurses.
Home Enteral Nutrition (HEN) HEN is another term used to describe the process of receiving ETF in a setting outside of hospital. It is often used synonymously with HETF. In some countries or studies the term HEN may also include patients receiving nutritional support in the form of ONS and fortified foods given orally. If this is the case this is identified in the text where relevant.
Home Enteral Tube feeding (HETF) HETF describes the process of enteral tube feeding in a setting outside of hospital. This is usually the patient’s own home, residential care home or nursing home.
Home Parenteral Nutrition (HPN) Parenteral nutrition administered outside the hospital, either at home or at nursing home.
Malnutrition Malnutrition can be defined as a ‘state resulting from lack of intake or uptake of nutrition that leads to altered body composition (decreased fat free mass) and body cell mass leading to diminished physical and mental function and impaired clinical outcome from disease’.6 Some definitions of malnutrition include over-nutrition (overweight and obesity) as well as under-nutrition12 but in the context of this resource ‘malnutrition’ is used to mean under-nutrition.

Furthermore, the term “malnutrition” is used in this resource to encompass the additional concept of nutritional risk (see definition below), reflecting common practice whereby these terms are often used interchangeably. Where possible in relation to studies and trials, attempts have been made in this report to describe in detail the definitions and methods used for detecting malnutrition/nutritional risk where feasible.
Medical nutrition A term used to describe commercially available products for nutritional intervention, including oral nutritional supplements (ONS), enteral tube feeding (ETF) and parenteral nutrition (PN).
Nutritional assessment A detailed, more specific and in-depth evaluation of a patient’s nutritional state, typically by an individual with nutritional expertise (e.g. a dietitian, a clinician with an interest in nutrition or a nutrition nurse specialist) or by a nutritional support team. This will usually be conducted in the case of nutritional problems identified by the screening process or when there is uncertainty about the appropriate course of action. The assessment process allows more specific nutritional care plans to be developed for the individual patient.13 Further details of what measures should be included as part of nutritional assessment are outlined in ESPEN guidelines.6
Nutritional care programme A range of activities, including nutritional screening, care planning, nutritional interventions (food, ONS, tube and/or parenteral feeding) and follow-up, designed to ensure that patients’ nutritional needs are evaluated, met and regularly reviewed.
Nutritional risk Severe malnutrition (under-nutrition) is clinically obvious. However, there is uncertainty about recognising lesser degrees of malnutrition. In the absence of universally accepted criteria for identifying malnutrition with high sensitivity and specificity, the concept of risk is invoked. Risk is a measure of likelihood that malnutrition is present or likely to develop.13 It also reflects the risk of a poor outcome as a result of impaired nutritional status.14 Prior to the diagnosis of malnutrition the criteria for being ‘at nutritional risk’ according to any validated nutritional risk screening tool must be fulfilled.6
Nutritional screening Risk screening is a rapid process performed to identify subjects at nutritional risk, and should be performed using an appropriate validated tool in all subjects that come in contact with healthcare services.6
Nutritional support/Nutritional intervention/ Nutrition Therapy Nutrition therapy describes how nutrients are provided to manage any nutritional-related condition. Nutrition or nutrients can be provided orally (regular diet, therapeutic diet e.g. fortified food, ONS), as enteral tube feeding or as parenteral nutrition.6 These terms are often used interchangeably.
Nutritionally complete A product may be called ‘nutritionally complete’ if it contains all essential macronutrients and micronutrients in a quantity and balance that allows the product to be used as a sole source of nutrition.
Oral nutritional supplements (ONS) Multi-nutrient liquid, semi-solid or powder products that provide macronutrients and micronutrients with the aim of increasing oral nutritional intake. ONS are typically used to supplement food intake which is insufficient to meet requirements. However, in many cases, ONS are nutritionally complete and could also be used as a sole source of nutrition.

ONS are distinct from dietary supplements which provide vitamins, minerals and or/trace elements in a pill format (also known as food supplements) and they must comply with the information and compositional requirements of Foods for Special Medical Purposes (FSMP).15
Parenteral Nutrition (PN) Parenteral Nutrition – also known as ‘intravenous feeding’ – is a method of getting nutrition directly into the blood circulation, bypassing the gastrointestinal tract. PN is delivered via a catheter inserted into a peripheral or central vein. Parenteral nutrition represents an alternative or additional approach for nutritional intervention when other routes are not succeeding (not necessarily having failed completely) or when it is not possible or would be unsafe to use other routes (i.e. oral or tube).16
Public health Public health is concerned with improving the health of the population rather than treating the diseases of individual patients.17
Social care system Social care includes nursing homes, residential homes, care at home and adult placement schemes.
Starvation The term ‘starvation-related malnutrition’ has been proposed to describe when there is chronic starvation without inflammation. Examples of this include medical conditions like anorexia nervosa.18 The ESPEN diagnoses tree of malnutrition describes malnutrition (undernutrition) without disease as ‘socioeconomic or psychologic related malnutrition’ arising from poverty, self-neglect etc. and ‘hunger- related malnutrition’ arising from deprivation of food e.g. in developing countries or as a result of natural disasters.6
Stunting (in children) A deficit in height-for-age that signifies slowing of skeletal growth and reflects chronic malnutrition.19
Under-nutrition Malnutrition includes both over-nutrition (overweight and obesity) and under-nutrition (underweight). Here the term malnutrition will be used to mean under-nutrition (also frequently referred to as disease-related malnutrition).
Wasting (in children) A deficit in weight-for-height resulting from failure to gain weight or from weight loss. It reflects a process occurring in the recent past and it is indicative of acute malnutrition.19

References:

  1. Fearon KC, Voss AC, Hustead DS. Definition of cancer cachexia: effect of weight loss, reduced food intake, and systemic inflammation on functional status and prognosis. Am J Clin Nutr 2006; 83(6):1345-1350.
  2. Bozzetti F, Arends J, Lundholm K, Micklewright A, Zurcher G, Muscaritoli M. ESPEN Guidelines on Parenteral Nutrition: non-surgical oncology. Clin Nutr 2009; 28(4):445-454.
  3. Fearon K, Strasser F, Anker SD, Bosaeus I, Bruera E, Fainsinger RL et al. Definition and classification of cancer cachexia: an international consensus. Lancet Oncol 2011; 12(5):489-495.
  4. Bozzetti F, Mariani L. Defining and classifying cancer cachexia: a proposal by the SCRINIO Working Group. J Parenter Enteral Nutr 2009; 33(4):361-367.
  5. Drummond M, Sculpher M, Torrance G, O’Brien B, Stoddart G. Methods for the economic evaluation of health care programmes. 3rd ed. Oxford: Oxford University Press; 2005.
  6. Cederholm T, Barazzoni R, Austin P et al. ESPEN guidelines on definitions and terminology of clinical nutrition. Clin Nutr 2017; 36, 49-64.
  7. Goulet O. Growth faltering: setting the scene. Eur J Clin Nutr 2010; 64 (Suppl 1):S2-S4.
  8. Shaw V & Lawson M (Eds) Clinical Paediatric Dietetics. 3rd ed. Oxford: Blackwell; 2007.
  9. Institute of Medicine. Extending Life, Enhancing Life: a national research agenda on aging. Lonergan ET (Ed).Washington D.C.: National Academy Press; 1991. Ref Type: Report
  10. Regulation (EU) No 609/2013 of the European Parliament and of the Council of 12 June 2013 on food intended for infants and young children, food for special medical purposes, and total diet replacement for weight control and repealing Council Directive 92/52/EEC, Commission Directives 96/8/EC, 1999/21/EC, 2006/125/ EC and 2006/141/EC, Directive 2009/39/EC of the European Parliament and of the Council and Commission Regulations (EC) No 41/2009 and (EC) No 953/2009 Text with EEA relevance. Commission Delegated Regulation (EU) 2016/128 of 25 September 2015 supplementing Regulation (EU) 609/2013 of the European Parliament and of the Council as regards specific compositional and information requirements for food for special medical purposes. EUR-Lex website.
  11. http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=uri serv%3AOJ.L_.2016.025.01.0030.01.ENG
  12. World Health Organization (WHO). Q&As: Health Systems. 2005. http://www.who.int/topics/ health_sys- tems/qa/en/index.html Accessed on 5-4-2010. Ref Type: Online Source
  13. Elia M. Detection and management of undernutrition in the community. A report by The Malnutrition Advisory Group (A standing committee of The British Association for Parenteral and Enteral Nutrition). Maidenhead, BAPEN. 2000. Ref Type: Report
  14. Elia M. Screening for malnutrition: a multidisciplinary responsibility. Development and use of the Malnutrition Universal Screening Tool (‘MUST’) for adults. Redditch, BAPEN. 2003. Ref Type: Report.
  15. Kondrup J, Allison SP, Elia M, Vellas B, Plauth M. ESPEN guidelines for nutrition screening 2002. Clin Nutr 2003; 22(4):415-421.
  16. Commission Delegated Regulation (EU) 2016/128 of 25 September 2015 supplementing Regulation (EU) No 609/2013 of the European Parliament and of the Council as regards specific compositional and information requirements for food for special medical purposes.
  17. Singer P, Berger MM, van den Berghe G, Biolo G, Calder P, Forbes A et al. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clin Nutr 2009; 28(4):387-400.
  18. Department of Health. DH Glossary: Public Health. 2008. www.dh.gov.uk/health/category/ policy-areas/ public-health/ Accessed on 5-4-2010. Ref Type: Online Source
  19. Jensen GL, Mirtallo J, Compher C, Dhaliwal R, Forbes A, Grijalba RF et al. Adult starvation and disease-related malnutrition: a proposal for etiology-based diagnosis in the clinical practice setting from the International Consensus Guideline Committee. JPEN 2010; 34(2):156-159.
  20. Shah MD. Failure to thrive in children. J Clin Gastroenterol 2002; 5(5):371-374.


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