Guideline Of The German Society For Nutritional Medicine (Dgem) Methodology For The Guideline-Update Clinical Nutrition

Purpose: Under the direction of the German Society of Nutritional Medicine the already existing guidelines of the German Society of Nutritional Medicine and the European Society for Clinical Nutrition and Metabolism (ESPEN) on the subjects Enteral Nutrition and Parenteral Nutrition will be updated and combined to one guideline on Clinical Nutrition.Methods: 13 interdisciplinary teams of altogether 96 experts in clinical nutrition were working on the guideline-update. A structured literature search applying a defined search strategy with inclusion criteria and specified keywords was the basis of the update. The strength of the evidence was evaluated according to published standards. Furthermore, the outcome-parameters of the trials were also evaluated by a system specially designed for this guideline-update. It was verified, if individual recommendations of other guidelines could be accepted or adapted. On this basis, recommendations were formulated which were not only based on the evidence levels of the studies but also on the judgment of the working groups concerning the consistence, clinical relevance and validity of the evidence. The initial recommendations were discussed and reworked under the nominal working group process. The voting of statements throughout the plenum took place in a preliminary voting and following consensus conference by the Delphi principle.Results: The several chapters of the guideline-update Clinical Nutrition reflect the current medical knowledge in the field of enteral and parenteral nutrition and summarize the evidence when nutritional support is indicated and which goals can be reached. They will be published gradually within a year.