ASPEN ADULT NUTRITION SUPPORT

CORE CURRICULUM, 4th Edition

EDITOR-IN-CHIEF
Lingtak-Neander Chan, PharmD, BCNSP, FASPEN
Professor of Pharmacy, Interdisciplinary Faculty in Nutritional Sciences
School of Pharmacy and School of Public Health
University of Washington
Seattle, WA

ASSOCIATE EDITORS
Vanessa J. Kumpf, PharmD, BCNSP, FASPEN Stephen A. McClave, MD, PNS, FACN, FASGE, FASPEN, AGAF
Clinical Pharmacy Specialist Director of Clinical Nutrition
Vanderbilt University Medical Center University of Louisville
Nashville, TN Louisville, KY

Linda M. Lord, NP, ACNP-BC, MSN, CNSC, FASPEN Sarah J. Miller, PharmD, MS, BCNSP, FASPEN
Nurse Practitioner Professor Emeritus
Nutrition Support Educator Skaggs School of Pharmacy
University of Rochester Medical Center University of Montana
Rochester, NY Missoula, MT

Mary Marian, DCN, RDN, FAND, FASPEN Jose M. Pimiento, MD, FACS
Professor of Practice Professor, Gastrointestinal Surgical Oncology
School of Nutritional Sciences and Wellness Medical Director, Inpatient Surgical Service
University of Arizona, College of Agriculture Section Lead, Upper Gastrointestinal Tumors
& Life Sciences Moffitt Cancer Center
Tucson, AZ Tampa, FL

Mary S. McCarthy, PhD, RN, CNSC, FASPEN, FAAN Kristen M. Roberts, PhD, RDN, LD, CNSC, FASPEN, FAND
Senior Nurse Scientist, Defense Health Agency Associate Professor of Clinical Medicine
Center for Nursing Science & Clinical Inquiry School of Health and Rehabilitation Sciences,
Madigan Army Medical Center Department of Medical Dietetics
Tacoma, WA The Ohio State University, College of Medicine
Columbus, OH

AMERICAN SOCIETY FOR PARENTERAL AND ENTERAL NUTRITION

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Copyright © 2025 by the American Society for Parenteral and Enteral Nutrition (ASPEN). All rights reserved. Except as permitted under
the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form, including but not limited
to, the process of scanning and digitization, or stored in a database or retrieval system, without prior written permission from the publisher.

Published by ASPEN, 8401 Colesville Road, Suite 510, Silver Spring, MD 20910
[Link]
aspen@[Link]

ASPEN is a scientific society whose members are dietitians, nurses, pharmacists, physicians, scientists, students, other health professionals,
and researchers who envision an environment in which every patient receives safe, efficacious, and high-quality nutrition care. ASPEN’s
mission is to improve patient care by advancing the science and practice of clinical nutrition and metabolism.

NOTE: This publication is designed to provide accurate authoritative information regarding the subject matter covered. It is sold with the
understanding that the publisher is not engaged in rendering medical or other professional advice. Trademarked commercial product names
are used only for education purposes and do not constitute endorsement by ASPEN.

This publication does not constitute medical or professional advice and should not be taken as such. Use of the information published herein
is subject to the sole professional judgment of the attending health professional, whose judgment is the primary component of quality medical
care. The information presented herein is not a substitute for the exercise of such judgment by the health professional.

ISBN: 978-1-889622-58-3
eISBN: 978-1-889622-59-0

LCCN 2024046855 (print) | LCCN 2024046856 (ebook)

Classification: LCC R (print) | LCC R (ebook) | DDC 613.2—dc23/eng/20241125

LC record available at [Link]

LC ebook record available at [Link]

Printed in the United States of America

10 9 8 7 6 5 4 3 2 1

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Contents

List of Tables and Figures . . . . . . . . . . . . . . . . . . . . . . . ix 7. Fluids, Electrolytes, and Acid-Base

Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
Todd W. Canada, PharmD, BCNSP, BCCCP, FASHP,
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxi FTSHP, FASPEN
Linda M. Lord, ACNP-BC, MSN, CNSC, FASPEN

PART I 8. Fat-Soluble Vitamins . . . . . . . . . . . . . . . . . . . . 193

Liam McKeever, PhD, RDN, FASPEN
FUNDAMENTAL CONCEPTS IN NUTRITION
9. Water-Soluble Vitamins . . . . . . . . . . . . . . . . . . 209
1. Nutrient Intake, Digestion, Absorption, Liam McKeever, PhD, RDN, FASPEN
and Excretion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Tina Colaizzo-Anas, PhD, RD-AP, CDN, CNSC, 10. Trace Elements and Other Compounds . . . . . 231
FAND Liam McKeever, PhD, RDN, FASPEN
2. Gastrointestinal Microbiota and Health . . . . . . 37
Gail A.M. Cresci, PhD, RD, LD, FASPEN PART II
Kaitlyn Daff, MS, RD, LD
SKILLS, TECHNIQUES, PATIENT SAFETY,
3. Energy Expenditure and Caloric Needs . . . . . . . 57 AND ETHICAL CONSIDERATIONS IN NUTRITION
David Frankenfield, MS, RD SUPPORT
4. Carbohydrates . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 11. Malnutrition Screening and Assessment . . . 257
Karen C. McCowen, MD Marianne Galang, RD, CSO, LD
Pei Ra Ling, MD Christan Bury, MS, RD, LD, CNSC
Cassandra Pogatschnik, RD, LD, CNSC, CCTD
5. Lipids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Lindsay Dowhan, MS, RD, LD, CNSC, CCTC
Kathleen M. Gura, PharmD, BCNSP, FASPEN
Mary Hise-Brown, PhD, RD, CNSC, FASPEN 12. Overview of Enteral Nutrition . . . . . . . . . . . . . 293
John C. Brown, PhD Jennifer Doley, MBA, RD, CNSC, FAND
Wendy Phillips, MS, RD, LD, FAND, FASPEN
6. Protein . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137
Lorraine S. Young, MS, RD, LDN, CNSC 13. Enteral Nutrition Formulations . . . . . . . . . . . . 313
Dong Wook Kim, MD, PNS Endashaw Omer, MD, MPH, PNS, FACG, AGAF
Adam Hoehn, DO
Susan Roberts, DCN, RDN, LDN, CNSC, FAND

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vi Contents

14. Enteral Access Devices . . . . . . . . . . . . . . . . . . 345 25. Neurological Injuries and Diseases . . . . . . . . 649
John C. Fang, MD Natalia Bailey Groat, MS, RD, CD
Merin Kinikini, DNP, RD, CNSC Stephanie Dobak, MS, RD, LDN, CNSC
Meghann Bruden, PharmD, BCCCP
15. Complications of Enteral Nutrition . . . . . . . . 365 Cuong V. Hoang, PharmD
Ainsley M. Malone, MS, RD, LD, CNSC, FAND,
FASPEN 26. Renal Disease . . . . . . . . . . . . . . . . . . . . . . . . . . 677
David S. Seres, MD, FASPEN, PNS Alyssa Carlson, RD, CSO, LDN, CNSC
Linda M. Lord, ACNP-BC, MSN, CNSC, FASPEN Nadia Khambati, RDN, LDN
Csaba P. Kovesdy, MD, FASN
16. Overview of Parenteral Nutrition . . . . . . . . . . 387 Menaka Sarav, MD
Jay M. Mirtallo, MSc, RPh, FASPEN
Diana W. Mulherin, PharmD, BCNSP, BCCCP, FCCM, 27. Pulmonary Disease . . . . . . . . . . . . . . . . . . . . . . 711
FASPEN Michelle L. Schneider, MS, RD, CNSC, CCTD,
FASPEN
17. Parenteral Nutrition Formulations . . . . . . . . . 403 Kellie R. Jones, MD, FCCP
Rina Patel, PharmD, BCNSP, FASPEN Jayshil J. Patel, MD
Christine Mowatt-Larssen, PharmD
28. Gastrointestinal Disease . . . . . . . . . . . . . . . . . 733
18. Parenteral Access Devices . . . . . . . . . . . . . . . 435 Lena B. Palmer, MD, MSCR
Kathleen Tushar, BSN, RN
29. Liver Disease . . . . . . . . . . . . . . . . . . . . . . . . . . . 765
19. Complications of Parenteral Nutrition . . . . . 467 Nancy Yang, MD
Vanessa J. Kumpf, PharmD, BCNSP, FASPEN Joseph W. Caravella, DO
Valentina A. Medici, MD, FAASLD
20. Drug-Nutrient Interactions Overview . . . . . . . 487 Matthew R. Kappus, MD
Carol J. Rollins, MS, RD, CNSC, PharmD, BCNSP,
FASPEN 30. Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . 803
Si Bui, PharmD, MPH Mohamed Eisa, MD
Stephen A. McClave, MD, FASPEN, FASGE, FACN,
21. Dietary Supplements . . . . . . . . . . . . . . . . . . . . 515 AGAF
Avleen Kaur, MD
Gerard E. Mullin, MD 31. Short Bowel Syndrome . . . . . . . . . . . . . . . . . . . 823
Berkeley N. Limketkai, MD, PhD
22. Ethical and Legal Foundations in Nutrition Neha D. Shah, MPH, RD, CNSC, CHES
Support. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 541 Lena B. Palmer, MD, MSCR
Denise Baird Schwartz, MS, RD, FADA, FAND,
FASPEN 32. Solid Organ Transplantation . . . . . . . . . . . . . . 845
Albert Barrocas, MD, FACS, FASPEN Jeanette M. Hasse, PhD, RD, LD, CNSC, CCTD,
FASPEN, FADA
Abby Wood, MS, RD, LD, CNSC, CCTD
PART III Lindsay Dowhan, MS, RD, LD, CNSC, CCTD
NUTRITION SUPPORT IN SPECIFIC PATIENT 33. Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 867
POPULATIONS OR DISEASE STATES Mary Marian, DCN, RDN, FAND FASPEN, FNAP
Todd Mattox, PharmD, BCNSP, FASPEN
23. Diabetes Mellitus . . . . . . . . . . . . . . . . . . . . . . . 577 Valaree Williams, MS, RDN, CSO, LDN, CNSC, FAND
Anne M. Tucker, PharmD, BCNSP, FASPEN
Karrie Derenski, PharmD, MBA, BCNSP, BCCCP, 34. Critical Illness and Sepsis . . . . . . . . . . . . . . . . 903
CNSC, DPLA, FASPEN Jayshil J. Patel, MD
Renee Walker, MS, RD, LD, CNSC, FAND, FASPEN Faraaz Shah, MD

24. Obesity and Metabolic Disorders . . . . . . . . . . 617 35. Trauma, Surgery, and Burns . . . . . . . . . . . . . . 921
Carolyn Newberry, MD David C. Evans, MD, FACS, FCCM, FASPEN, PNS
Jayshil J. Patel, MD Bryan R. Collier, DO, FACS, FCCM
Manpreet S. Mundi, MD
Robert G. Martindale, MD, PhD
Ryan T. Hurt, MD, PhD

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 Contents vii

36. Wound Healing . . . . . . . . . . . . . . . . . . . . . . . . . 945 PART IV

Mary Marian, DCN, RDN, FAND, FASPEN, FNAP KEEPING UP WITH EVIDENCE AND CONTINUOUS
Anna de Jesus, MBA, RDN
QUALITY IMPROVEMENT IN PRACTICE
37. Surgical Alteration of the GI Tract . . . . . . . . . 969
41. Evidence-Based Medicine and Derivation
Hiley D. Cammock, MD
Neal Bhutiani, MD of Clinical Guidelines . . . . . . . . . . . . . . . . . . . 1093
Matthew V. Benns, MD Stephen A. McClave, MD, FACN, FASGE,
Sam Pappas, MD FASPEN, AGAF
Lena B. Palmer, MD, MSCR Sarah Peterson, RD, PhD
Keith R. Miller, MD
42. Healthcare Quality Standards and
38. Nutrition Support for Older Adults . . . . . . . . . 997 Improvement in Clinical Practice . . . . . . . . . 1107
Phyllis Famularo, DCN, RD, LDN, FAND Kristen Mathieson Simoneau, MBA, RD, CDN
Rena Zelig, DCN, RD, CDE, CSG
Melinda Manuel, MS, RD, CSG, CDP, LDN Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1121
39. Pregnancy and Lactation. . . . . . . . . . . . . . . . 1031 Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1163
Kris M. Mogensen, MS, RD-AP, LDN, CNSC Reviewers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1169
Miriam Erick, MS, RD, LDN

40. Home Nutrition Support. . . . . . . . . . . . . . . . . 1063

Denise Jezerski, RD, LD, CNSC
Jamie Davila, RD, LD, CNSC
Courtney Wood, PharmD, BCNSP, CNSC

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