American Society of Parenteral and Enteral Nutrition Presidential Address: Food for Thought: It's More Than Nutrition

Abstract

Three issues were highlighted in the 30(th) Presidential Address to the society: (1) A.S.P.E.N.'s unique interdisciplinary structure; (2) support of the A.S.P.E.N. Rhoads Research Foundation; and (3) the meaning of food from the perspective of the patient who is receiving life-sustaining home enteral or parenteral nutrition. A.S.P.E.N., founded as a multidisciplinary society in the 1970s has evolved into an interdisciplinary society with an expanded and diverse membership of health care professionals and scientists with overlapping interests in clinical nutrition and metabolism. A.S.P.E.N. envisions an environment in which every patient receives safe, efficacious, and high quality patient care. The society is committed to advancing the science and practice of nutrition support therapy. In support of this direction, the A.S.P.E.N. Rhoads Research Foundation exists to fund research grants, promote evidence-based practice, and foster training and mentorship in nutrition and metabolic research. The scientific advances and technologic innovations that have enabled our profession to provide enteral and parenteral nutrition to patients has caused practitioners to forget that the meaning of food extends beyond nutrient value. Some individuals receiving long term enteral nutrition or home parenteral nutrition have expressed feelings of anger, anxiety, and depression resulting from the inability to eat normally, from losses of independence, and control of body functions. The ritual of eating may be altered when the enteral or intravenous feedings provide nourishment and, for some, the loss of the eating function is a distressing experience, especially given the cultural focus on social gatherings and meals. The emotional meaning attributed to food, and changes in food preferences and eating behaviors, may become a source of conflict for individuals who have substantial dietary restrictions, or for those individuals dependent on enteral or parenteral nutrition therapy. The value of food intake on social patterns, self-esteem, pleasure, and enjoyment, may impact quality of life. While nutrition support can provide the basic need for nutrients, its impact on human needs associated with food requires further investigation.

The impact of gastrostomy in motor neurone disease: challenges and benefits from a patient and carer perspective

“…These experiences have potential to lead to social isolation and depression. It is therefore important for health professionals to understand these social consequences on the quality of life of patients, monitor for any signs of social isolation and depression and help people to develop effective coping strategies 24. Most patient participants had delayed the gastrostomy decision until they were struggling to swallow, and consequently following gastrostomy they stopped any oral intake attempt 20.…”

Caregivers’ Perspectives on the Slight Recovery of Oral Intake of Home‐Dwelling Patients Living With a Percutaneous Endoscopic Gastrostomy Tube: A Qualitative Study Using Focus Group Interviews

“…The effects of slight recovery of oral intake were organized based on the following themes: reconstructing and/or strengthening a sense of family belonging, combining oral intake and other rehabilitation, reducing the burden of providing care, and relieving social isolation. These themes, especially “relieving social isolation,” may reflect that “food provides more than nutrition.” Several studies indicated that caregivers of community‐dwelling patients with stroke or TBI feel emotionally overwhelmed and that their family dynamics shifted dramatically . Our findings highlighted that even a slight recovery of oral intake in patients living with a PEG tube for EN led to positive impacts on emotionally overwhelmed caregivers.…”

Factors influencing decision-making in relation to timing of gastrostomy insertion in patients with motor neurone disease

“…In addition, the idea of having a gastrostomy may provoke feelings of loss of control and independence 14. Besides eating being a fundamental biological and physiological need,15 many people perceive food as a source of satisfaction 16. Being able to share a meal with others is an important element of social, cultural and psychological quality of life and its loss can be experienced as social bereavement 17.…”