As mentioned in my post last week, we have a problem of malnutrition in the clinical setting and a second problem is the gap between prevalence and actual diagnosis of malnutrition. In Argentina and many other countries, there is no consensus on how to diagnose malnutrition and criteria like ASPEN/Academy or ESPEN are barely used. The Subjective Global Assessment (SGA) tool is sometimes more popular. Its good to know now that, a few weeks ago, during ESPEN Congress, the Criteria for the Diagnosis of Malnutrition — a Consensus Report from the Global Clinical Nutrition Community were released. The report provides the much needed global consensus scheme for diagnosing malnutrition in adults in clinical settings. It was elaborated by the Global Leadership Initiative on Malnutrition (GLIM) working group with representatives from ASPEN, ESPEN, the Latin American Federation for Parenteral and Enteral Nutrition (FELANPE), and the Parenteral and Enteral Nutrition Society of Asia (PENSA). The consensus document can be found at doi.org/10.1002/jpen.1440 .
The five criteria for malnutrition include unintentional weight loss, low body mass index, and reduced muscle mass as phenotypic criteria, and reduced food intake/assimilation and inflammation/disease burden as etiologic criteria. It is proposed that the diagnosis of malnutrition be based upon the presence of at least one phenotypic criterion and one etiologic criterion. The severity of phenotypic criteria classifies malnutrition into severe or moderate (note that poor oral intake is not used to determine moderate vs severe malnutrition)
In my country Argentina, 48% of people - practically 1 out of 2 - arrive at the hospital with some degree of malnutrition (AANEP 2014 study), similarly to what happens in the rest of the world. We also know that during hospitalization this malnutrition can be exacerbated (by fasting, dietary restrictions, adverse effects of treatments, depression, etc.). And, many times malnutrition is not so obvious because it coexists with obesity (we still have doctors that say: "but he is overweight, why does he needs supplemental nutrition? ...").
From September 24thto 28th, ASPEN (American Society of Parenteral and Enteral Nutrition) organizes Malnutrition Awareness Week # MAW2018 to raise awareness (at all levels: professionals, health administrators, patients, general public) of the importance of early detection and treatment of malnutrition. The Academy of Nutrition and Dietetics also joins this initiative with a series of events and webinars for its members.
Malnutrition has a negative impact on patient outcomes: increased rates of infections, poor healing, prolonged hospitalization, higher frequency of readmission, increased costs and deaths. It was also shown that timely nutritional intervention is cost effective. Knowing all this, why does not the diagnosis of malnutrition appear in medical records? Why is there a gap between the prevalence of malnutrition (which can range between 30-50%) and screening and treatment (only 7%)? I invite colleagues to continue to raise awareness among health administrators of the importance of having qualified food and nutrition experts and multidisciplinary teams working to reduce this gap. I believe that our argument should be related to “nutrition for better clinical results and lower health care costs” as well as our research.
In view of this global problem, the use of quality indicators such as the Malnutrition Quality Improvement Initiative (MQII) is being promoted. MQII uses tools that can be integrated into the electronic medical record (EHR), to improve early diagnosis and effective treatment of malnutrition in hospitals.
More resources and information here:
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