Hospital and homecare malnutrition and nutritional therapy in Brazil. Strategies for alleviating it: a position paper

Dan Linetzky Waitzberg, José Eduardo de Aguilar-Nascimento, Maria Carolina Gonçalves Dias, Nivaldo Pinho, Robson Moura, Maria Isabel Toulson Davisson Correia

Resumen


Introduction: Malnutrition in hospitalized patients is not evaluated frequently. However, it is a critical issue given that it has been related to a high rate of infectious complications and increased mortality rates. There is a high prevalence of patients with nutritional impairment in the home environment, which favors their clinical worsening, the increase of re-hospitalizations and, consequently, the increase in public health expenditures.

Objective: Nutrition experts have thoroughly discussed and written this positioning paper on hospital and homecare malnutrition to describe the prevalence of malnutrition in Brazil. Best practice recommendations for nutrition therapy of patients in hospital and homecare, in particular the use of oral nutritional supplements (ONS), to those who are at risk of malnutrition or malnourished were evaluated, and the impact on clinical and economic data were assessed. In addition, they emphasize that investments in oral nutritional supplementation are also important in the homecare environment (home or nursing homes).

Materials and methods: Selected scientific articles on disease-related malnutrition, especially those carried out in Brazil, were assessed. Data on prevalence, clinical outcomes, and economic burdens were reviewed.

Results and conclusion: Several studies have shown the importance of in-hospital nutritional assessment for early detection of malnutrition and early intervention with nutrition therapy, in particular with oral nutritional therapy. Unfortunately, hospital malnutrition remains high in Brazil, with severe consequences for patients. The implementation of universal nutritional screening and diagnosis as well as the therapeutic approach of malnutrition, particularly with the use, when possible, of oral nutrition supplements as the first step to address this condition is still low, and demands the investment in educational resources to change practices. Routine use of nutritional therapy in hospital and homecare settings improves clinical outcomes, is cost effective, and would be expected to help reduce healthcare costs.


Palabras clave


Hospital malnutrition. Homecare malnutrition. Nutrition assessment. Enteral nutrition. Oral nutritional supplements.

Texto completo:

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Referencias


Cederholm T, Barazzoni R, Austin P, et al. ESPEN Guideline ESPEN guidelines on de fi nitions and terminology of clinical nutrition. Clin Nutr. 2016:1-16. doi:10.1016/j.clnu.2016.09.004.

Alberda C, Graf A, McCargar L. Malnutrition: Etiology, consequences, and assessment of a patient at risk. Best Pract Res Clin Gastroenterol. 2006;20(3):419-439. doi:10.1016/j.bpg.2006.01.006.

Neelemaat F, Kruizenga HM, de Vet HC, Seidell JC, Butterman M, van Bokhorst-de van der Schueren MA. Screening malnutrition in hospital outpatients. Can the SNAQ malnutrition screening tool also be applied to this population? Clin Nutr 2008; 27(3):439-446.

Suominen MH, Sandelin E, Soini H, Pitkala KH. How well do nurses recognize malnutrition in elderly patients? Eur J Clin Nutr 2009; 63(2):292-296.

Waitzberg DL, Caiaffa WT, Correia MITD. Hospital Malnutrition : The Brazilian National Survey (IBRANUTRI): A Study of 4000 Patients. Nutrition. 2001;17:573-580.

Brito PA, Generoso SDV, Correia MITD. Prevalence of pressure ulcers in hospitals in Brazil and association with nutritional status-A multicenter, cross-sectional study. Nutrition. 2013;29(4):646-649. doi:10.1016/j.nut.2012.11.008.

Garcia RS, Pastore CA. Rastreamento nutricional em pacientes cirúrgicos de um hospital universitário do sul do Brasil : o impacto do risco nutricional em desfechos clínicos the impact of nutritional risk in clinical outcomes. einstein. 2013;11(2):147-152.

Leandro-Merhi VA, Aquino JL De, Chagas JFS. Nutrition status and risk factors associated with length of hospital stay for surgical patients. J Parenter Enter Nutr. 2011;35(2):241-248.

Brock F, Bettinelli LA, Dobner T, Stobbe JC, Pomatti G, Telles CT. Prevalence of hypoalbuminemia and nutritional issues in hospitalized elders. Rev Lat Am Enfermagem. 2016;24:e2736. doi:10.1590/1518-8345.0260.2736.

INCA. Inquérito Brasileiro de Nutrição Oncológica.; 2013.

INCA. Inquerito Luso-Brasileiro de Nutrição Oncológica Do Idoso.; 2015.

Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr. 2008;27:5-15. doi:10.1016/j.clnu.2007.10.007.

Collamati A, Marzetti E, Calvani R, et al. Sarcopenia in heart failure: mechanisms and therapeutic strategies. J Geriatr Cardiol 615624 J Geriatr Cardiol. 2016;13(13):615-624. doi:10.11909/j.issn.1671-5411.2016.07.004.

Saunders J, Smith T, Stroud M. Malnutrition and undernutrition. In: Medicine. Vol 39. Elsevier Ltd; 2010:45-50. doi:10.1016/j.mpmed.2010.10.007.

Yoo SH, Kook HY, Hong YJ, Kim JH, Ahn Y, Jeong MH. Influence of undernutrition at admission on clinical outcomes in patients with acute myocardial infarction. J Cardiol. 2016. doi:10.1016/j.jjcc.2016.05.009.

Słotwiñski R, Sarnecka A, Dąbrowska A, et al. Innate immunity gene expression changes in critically ill patients with sepsis and disease-related malnutrition. Cent Eur J Immunol. 2015;40(3):311-324. doi:10.5114/ceji.2015.54593.

Correia MITD, Perman MI, Waitzberg DL, et al. Hospital malnutrition in Latin America: A systematic review. Clin Nutr. 2016:1-10. doi:10.1016/j.clnu.2016.06.025.

Correia MITD, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22(3):235-239. doi:10.1016/S0261-5614(02)00215-7.

Beattie AH, Prach AT, Baxter JP, Pennington CR. A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients. Gut. 2000;46(6):813-818. doi:10.1136/gut.46.6.813.

Stratton RJ, Hébuterne X, Elia M. A systematic review and meta-analysis of the impact of oral nutritional supplements on hospital readmissions. Ageing Res Rev. 2013;12(4):884-897. doi:10.1016/j.arr.2013.07.002.

Guest JF, Panca M, Baeyens JP, de Man F, Ljungqvist O, Pichard C et al. Health economic impact of managing patients following a community-based diagnosis of malnutrition in the UK. Clin Nutr 2011; 30(4):422-429.

Snider JT, Jena AB, Linthicum MT, et al. Effect of hospital use of oral nutritional supplementation on length of stay, hospital cost, and 30-day readmissions among medicare patients with COPD. Chest. 2015;147(6):1477-1484. doi:10.1378/chest.14-1368.

Philipson TJ, Snider JT, Lakdawalla DN, Stryckman B, Goldman DP. Impact of oral nutritional supplementation on hospital outcomes. Am J Manag Care. 2013;19(2):121-128. http://www.ncbi.nlm.nih.gov/pubmed/23448109.

Freijer K, Bours MJL, Nuijten MJC, et al. The economic value of enteral medical nutrition in the management of disease-related malnutrition: A systematic review. J Am Med Dir Assoc. 2014;15(1):17-29. doi:10.1016/j.jamda.2013.09.005.

Arnaud-Battandier F, Malvy D, Jeandel C. et al. Use of oral supplements in malnourished elderly patients living in the community: a pharmaco-economic study. Clin Nutr. 2004 Oct;23(5):1096-103.

Lakdawalla DN, Mascarenhas M, Jena AB, et al. Impact of oral nutrition supplements on hospital outcomes in pediatric patients. J Parenter Enter Nutr. 2014;38(6):42S-49S. doi:http://dx.doi.org/10.1177/0148607114549769.

Elia M, Normand C, Laviano A, Norman K. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in community and care home settings. Clin Nutr. 2016;35(1):125-137. doi:10.1016/j.clnu.2015.07.012.

Elia M, Normand C, Norman K, Laviano A. A systematic review of the cost and cost effectiveness of using standard oral nutritional supplements in the hospital setting. Clin Nutr. 2016;35(2):370-380. doi:10.1016/j.clnu.2015.05.010.

Bounoure L, Gomes F, Stanga Z, et al. Detection and treatment of medical inpatients with or at-risk of malnutrition: Suggested procedures based on validated guidelines. Nutrition. 2016;32(7-8):790-798. doi:10.1016/j.nut.2016.01.019.

Arends J, Bachmann P, Baracos V, et al. ESPEN guidelines on nutrition in cancer patients. Clin Nutr. 2016. doi:10.1016/j.clnu.2016.07.015.

National Institute for Health and Care Excellence (NICE). Nutrition Support in Adults Overview.; 2016. http://pathways.nice.org.uk/pathways/nutrition-support-in-adults.

Ryan C. The Power to drive change: Working together for excellence. Creating a continuously improving consumer engagement framework for excellence in patient-centered care. World Hosp Health Serv. 2016;52(1):37-41.




DOI: http://dx.doi.org/10.20960/nh.1098

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