ESPEN practical short micronutrient guideline

TLDR

Micronutrients, including trace elements and vitamins, are essential for human metabolism and are increasingly recognized for their impact on common pathologies, where deficiencies can worsen outcomes. This short guideline aims to provide practical recommendations for clinical practice regarding micronutrient management. The guideline was developed through an extensive literature search across Medline, PubMed, Cochrane, Google Scholar, and CINAHL, focusing on physiological data, historical evidence, and observational or randomized trials, and addressing each micronutrient’s functions, analytical methods, inflammation impact, toxicity, and provision during enteral or parenteral nutrition, with recommendations graded using SOP wording for strength. Due to limited interventional trials, most recommendations are based on low‑level evidence, but a consensus process achieved >90 % agreement on three general and 26 specific micronutrient recommendations, including monitoring and management strategies.

Abstract

BackgroundTrace elements and vitamins, named together micronutrients (MNs), are essential for human metabolism. The importance of MNs in common pathologies is recognized by recent research, with deficiencies significantly impacting the outcome.ObjectiveThis short version of the guideline aims to provide practical recommendations for clinical practice.MethodsAn extensive search of the literature was conducted in the databases Medline, PubMed, Cochrane, Google Scholar, and CINAHL for the initial guideline. The search focused on physiological data, historical evidence (for papers published before PubMed release in 1996), and observational and/or randomized trials. For each MN, the main functions, optimal analytical methods, impact of inflammation, potential toxicity, and provision during enteral or parenteral nutrition were addressed. The SOP wording was applied for strength of recommendations.ResultsThe limited number of interventional trials prevented meta-analysis and led to a low level of evidence for most recommendations. The recommendations underwent a consensus process, which resulted in a percentage of agreement (%): strong consensus required of >90 % of votes. Altogether the guideline proposes 3 general recommendations and specific recommendations for the 26 MNs. Monitoring and management strategies are proposed.ConclusionThis short version of the MN guideline should facilitate handling of the MNs in at-risk diseases, whilst offering practical advice on MN provision and monitoring during nutritional support.