Addressing Disease‐Related Malnutrition in Healthcare

Abstract

Alarmingly high rates of disease-related malnutrition have persisted in hospitals of both emerging and industrialized nations over the past 2 decades, despite marked advances in medical care over this same interval. In Latin American hospitals, the numbers are particularly striking; disease-related malnutrition has been reported in nearly 50% of adult patients in Argentina, Brazil, Chile, Costa Rica, Cuba, Dominican Republic, Ecuador, Mexico, Panama, Paraguay, Peru, Puerto Rico, Venezuela, and Uruguay. The tolls of disease-related malnutrition are high in both human and financial terms—increased infectious complications, higher incidence of pressure ulcers, longer hospital stays, more frequent readmissions, greater costs of care, and increased risk of death. In an effort to draw attention to malnutrition in Latin American healthcare, a feedM.E. Latin American Study Group was formed to extend the reach and support the educational efforts of the feedM.E. Global Study Group. In this article, the feedM.E. Latin American Study Group shows that malnutrition incurs excessive costs to the healthcare systems, and the study group also presents evidence of how appropriate nutrition care can improve patients’ clinical outcomes and lower healthcare costs. To achieve the benefits of nutrition for health throughout Latin America, the article presents feedM.E.’s simple and effective Nutrition Care Pathway in English and Spanish as a way to facilitate its use.

Quick Fix for Hospital‐Acquired Malnutrition?

“…For example, malnutrition caused by famine is observed during natural disasters or during political strife and can be successfully prevented and managed by increasing access to a balanced diet. Hospital‐acquired malnutrition, on the other hand, is universally present, as pointed out by Correia and colleagues 2 . Awareness of the problem of hospital‐acquired malnutrition was first raised by Butterworth 3 in the 1970s with a seminal publication expressing deep concerns over the “skeleton in the hospital closet.” There are superficial similarities between malnutrition caused by the different conditions such as famine and hospital‐acquired malnutrition, tempting clinicians to jump into proposing overly simplified solutions.…”

“…In their article, Correia and colleagues 2 bypass making a diagnosis (a required step in quality improvement) of the barriers that prevent successful implementation of nutrition practices across Latin America, relying instead on an assessment offered by leaders in each country. The authors imply that lack of awareness by clinicians is the main cause of why malnutrition is still present.…”

“…Correia and colleagues 2 claim to have an instrument that generates awareness of risk of malnutrition and prompts effective interventions. Their tool employs a simplified algorithm for the screening of inadequate dietary intake.…”

“…To the extent that the use of simplified algorithms helps detect inadequate nutrient delivery within hospitals and that oral nutrition supplements help enhance meeting the prescribed nutrition goals, Correia and colleagues 2 may have an argument in support of their protocol. This issue has been pointed out by other investigators.…”

“…Raising awareness as to the negative effects of hospital‐acquired malnutrition, understanding its causes, designing effective treatments, and successfully implementing these at the bedside is a laudable goal. Correia and colleagues 2 make a sincere effort at raising awareness of the problem, reporting their work in the article entitled “Addressing Disease‐Related Malnutrition in Healthcare: A Latin American Perspective” this month in the Journal of Parenteral and Enteral Nutrition .…”