Strategies for High‐Quality Nutrition Therapy in Brazil

Abstract

It is a great honor to present the 2015 Rhoads Lecture and to discuss strategies for high-quality nutrition therapy (NT), as well as to address the problem of malnutrition in Brazilian hospitals.Dr Rhoads is known for his outstanding achievements in nutrition care, and his unquestionable legacy is demonstrated by the translation of his many scientific papers and books into several languages. The importance of artificial nutrition in the overall care of a patient is reflected in Dr Rhoads's own words: "intravenous feeding is one of the rare things in Medicine that has turned out to be better than its sponsors anticipated." Moreover, when Dr Rhoads was awarded for his contributions and leadership in the field of nutrition, in his speech, he referred to a quote by Nobel laureate economist Milton Friedman: "success lies on the degree to which one's ideas and contributions become embedded in the body of knowledge that comprised one's discipline."1 Indeed, we are here to confirm the veracity of this statement regarding Dr Rhoads's scientific contributions.Accumulating evidence supports the utmost relevancy of artificial nutrition, including oral nutrition, enteral nutrition (EN), and parenteral nutrition (PN), as one of the cornerstones of patient care. Nonetheless, for the full success of NT to be achieved, it is imperative that standardized procedures be followed to prevent life-threatening associated complications and, above all, to avoid the "one-size-fits-all" practice of nutrition, which should be condemned by those following the evidence behind science. History of NT in BrazilHere, the steps that have helped Brazil implement an NT practice are presented and discussed. The statements herein are based on the experience and data of the authors, although we also acknowledge and cite the work of other professionals who have contributed to the development of NT practice in Brazil. In combination, these scientific data highlight the importance of applying advances in laboratory research to the clinical setting to improve patient care. First, we review the history of clinical nutrition in Brazil, with a particular emphasis on the role of nutrition screening and nutrition assessment as demonstrated by a malnutrition prevalence study that encompassed 4000 patients.2 Next follows a discussion of to whom, when, and what NT should be administered, particularly regarding immunonutrition and parenteral lipid emulsions. Finally, strategies that have been used to implement hospital clinical nutrition are presented, with a focus on patients with short bowel syndrome (SBS) and obesity. The outcomes, costs, quality control, and education in clinical practice that are currently involved with these strategies are also presented, as well as how these strategies have the potential to affect perspectives.Very briefly, Brazil is a country that has approximately 200 million inhabitants, 10% of whom are elderly. Life expectancy AbstractStrategies for improving nutrition therapy (NT) are of utmost importance in any healthcare system. The ...

Relationship between Expenses on Nutritional Therapy and Mortality Rate in Public Hospitals in Salvador, Bahia: An Ecological Study

“…Thus, for every dollar invested in NT, US$ 4.00 could be saved in the total health costs. 17 This explains the potential good costbenefit ratio of such procedures.…”

“…Moreover, most of these teams are concentrated in medium and large private hospitals, not reaching the same proportion in public hospitals. 17 To show the cost-benefit ratio of NT, a research 18 involving 19 hospitals showed that quality care in this field with the Fig. 2 Geometric regression regarding the expenses on ENT in qualified hospitals and the mortality rate in these units in Salvador, Bahia.…”

Implementing Quality Assessment Is Fundamental to Guarantee Optimal Nutrition Therapy

“…2 Therefore, it would greatly benefit from adequate quality control to minimize its subjective practice. 2,3 NT has been controlled, in some countries, by health authorities, but this is not a reality worldwide. In Brazil, the Health Department and the National Agency for Sanitary Control (ANVISA) have determined the minimum requirements for hospitals that perform NT (oral supplements, enteral, and parenteral nutrition [PN]).…”

“…In Brazil, the Health Department and the National Agency for Sanitary Control (ANVISA) have determined the minimum requirements for hospitals that perform NT (oral supplements, enteral, and parenteral nutrition [PN]). [3][4][5] The institutions must have a team of interprofessional experts to guarantee the efficacy and safety of treatment for patients under NT, especially considering the very high prevalence of hospital malnutrition, which varies from 20% to 63% depending on the assessment tools used. [6][7][8] Malnutrition is associated with increased morbimortality and length of hospital stay, as well as increased costs.…”

“…6,7,10,13 Therefore, quality management assessment is a promising initiative to guarantee the effectivity of nutrition treatment and to prevent the discrepancies observed in literature results, which put its efficacy at stake. 3 Some authors have addressed quality assessment of NT, 3,14-18 but to our knowledge, none have fully audited the various steps of the process. This would include interviewing administrators and staff members of the NT team (NTT) or assisting personnel and analyzing patients' medical records to acquire information on how this therapy is being carried out.…”