Hospital Malnutrition and Obesity, Metabolism, Health
Two health problems facing society
Hospital malnutrition and obesity: two health problems facing society
Claudia L. Angarita G, ND.1
Colombian Center for Integral Nutrition
In today’s world, most countries face a significant burden of morbidity due to malnutrition and obesity .
This burden places enormous demands on both governments, due to the high price of treatment, and on individuals and families by generating higher costs to society for days of disability and loss of quality of life.(1)
The two conditions share alarming statistics.Hospital malnutrition (NTD) affects 30 million people in Europe and generates a cost of 170 billion euros per year.
The review of several publications in recent years shows that the incidence and prevalence of the DNT remain very high: 21% and 37% respectively.This value can rise in up to 70% of patients when they are discharged from the hospital.(2)
In an article published in the journal Nutrition in Clinical Practice in 2010, it is described that the prevalence of Hospital DNT may vary according to the clinical condition.
This article indicates that in patients with pancreatic cancer the prevalence of malnutrition is 85%, lung cancer from 13% to 50 %, head and neck cancer 24% to 88%, gastrointestinal cancer 55%-80%, stroke 16%-49%, and chronic obstructive pulmonary disease (COPD) 25%.(3)
The IBRANUTRI
The IBRANUTRI, a multicenter epidemiological study that included 4,000 hospitalized patients in Brazil, showed that malnutrition was present in 48.1% of the patients, 12, 5% of whom had severe malnutrition.
The Latin American Nutrition Study (ELAN), with 9,360 patients, carried out in 13 countries, showed a prevalence of malnutrition of 50.1%.(4)
In Colombia, the results of the multicenter cross-sectional study called Nutrition Day, called in Europe Nutrition Day, carried out in Bogotá by the Colombian Association of Clinical Nutrition (ACNC) in 2010 demonstrated that 50% of the hospitalized patients evaluated had lost weight in the last three months and that only 30% had specialized nutritional intervention.
In contrast, the prevalence of obesity has increased by least three times since the eighties in many European countries and in the United States, especially in children and young people.
However, only in the last 15 years has overweight and obesity begun to be treated. obesity as “health problems”.Although in developed countries the problem is generating severe headaches, its rapid increase in developing countries makes it even more worrying.
In Colombia, overweight and obesity are increasing .
The National Survey of the Nutritional Situation in Colombia (ENSIN), carried out by the Colombian Institute of Family Welfare (ICBF), the National Institute of Health (INS) and the Ministry of Social Protection in 2010, shows that the prevalence of overweight and obesity in children and adolescents between 5 and 17 years old has increased by 25.9% in the last five years.
In the adult population (18 to 64 years) the panorama is not more encouraging: 50% of the population has problems with excess weight, being higher in women than in men.This indicator is higher in high socioeconomic strata (4 or more).
Abdominal obesity occurs in a greater proportion in women, mostly in the group of 50 to 64 years. (5)
Hospital DNT contributes to increasing the morbidity and mortality of patients by increasing health care costs due to a delay in recovery, a prolongation of hospital stay , an increase in the readmission rate and susceptibility to infections.
On the other hand, obesity is responsible for some chronic non-communicable diseases (NCCD) that today occupy the first places in morbidity and mortality statistics in Colombia according to DANE (National Administrative Department of Statistics).
In addition, malnutrition and obesity are responsible for the detriment of the individual’s economy, since which makes it less productive.
This contributes to the gradual detriment of the family economy, absenteeism from work and the increase in family expenses derived from its treatment.(AMAEE), among others.
This document defines six lines of action:
Nutritional evaluation and treatment in hospitals, nutritional care providers, health care practices, hospital food services, pediatric nutrition, health economics and research.(7)
In relation to obesity, the “Action Plan of the Global Strategy for Prevention and Control” was constructed. of Non-Communicable Diseases 2008-2013” which emphasizes the pressing need to invest in the prevention of these diseases as an integral part of the sustainable socioeconomic development of countries and highlights how chronic diseases can be prevented through the elimination of risk factors.
To comply with said plan, the WHO called on the entire world community to provide support for its implementation and proposes establishing health promotion programs in all life cycles that affect the reduction of the burden of premature mortality and disability, together with the development of self-care programs and their cost-effective analysis.(8)
The states Members of the World Health Organization called for the development and promotion of the “Global Strategy on Diet, Physical Activity and Health”.
This strategy was developed through a broad consultation process that included organizations scientists worldwide and representatives of civil society and the private sector.
The strategy addresses two of the main risk factors for NCDs:
The diet and physical activity and, in response to this situation, guidelines were generated that guide the creation of favorable environments for the adoption of sustainable measures at the individual, community, national and global levels that lead to a reduction in morbidity and mortality associated with an inadequate diet and a lack of physical activity.
The actions described in the strategy contribute to the achievement of the Millennium Development Goals and the fulfillment of the countries' public health goals.(9)
In Colombia, several strategies have been carried out to combat these two problems.
The ACNC based on the results of the “Nutrition Day” held in 2010:
Enunciated some recommendations to prevent and treat hospital malnutrition for the institutions that participated to implement and Colombian institutions have been invited to follow them and participate in the research to be carried out in 2011:
- Perform nutritional screening on all patients entering every health center to identify risk.This screening must be done in the first 48 hours of admission in case of hospitalization.
- Formulate the patient’s medical nutritional management on a daily basis and work together with the clinical and feeding nutritionist to determine adjustments according to their pathology, the tastes and culture of the patient, in order to achieve an adequate intake of calories and nutrients.
- Evaluate the possibility of starting oral supplementation for patients with nutritional risk.
- Do daily monitoring of patients undergoing nutritional intervention.Patients who do not have nutritional risk should be evaluated every week to avoid changes in nutritional status.
- Nutritional intervention should be carried out by the group of nutritionists and/or the interdisciplinary nutritional therapy team and metabolic.
- Nutritional education should be provided to patients in the primary care setting in hospitalization and extended to family members.
- Nutritional education should be provided to professionals of health.
- Nutritional monitoring should be carried out after the patient leaves the hospital, create and improve nutritional home care if necessary and improve the opportunity for specialized nutrition consultation.
Work has been done on the issue of obesity in different areas.
Laws have been developed that regulate physical activity and sports in Colombia, strategies that promote a balanced and healthy diet and decrees that regulate the advertising and marketing of foods and beverages in the media and the resolution by which the technical regulations are established on the labeling or nutritional labeling requirements that packaged foods must meet. human consumption.
The prevention of hospital malnutrition and obesity must occur at different levels: from the individual to the legislative.
The health system must play a crucial role in the promotion of health and the prevention of these diseases through guidance to staff and users in the different central issues that combat it, such as the promotion of breastfeeding, growth monitoring and the promotion of a correct nutrition;even when you are sick;as well as an active life.
Prevention must also be a priority public health strategy:
It must begin in childhood and continue throughout life. and place greater emphasis on older people, and have the active and committed participation of health personnel, along with other sectors of society.
It is worth insisting that the earlier your At the beginning, the benefits in the short, medium and long term will be more important, evident and effective.
In conclusion, hospital malnutrition and obesity, being completely opposite diseases, are increasing morbidity and mortality in the world.For this reason, the opportunity for consultation with the specialist and the Interdisciplinary Nutritional and Metabolic Therapy Teams must be improved, education programs developed by health personnel who are aware of the problem and are trained in the subject of prevention of the disease, both of the individual and the family.
It is also important to unify the concepts of a balanced and therapeutic diet, improve and redesign food services in clinics and hospitals, emphasize the promotion of healthy eating habits, physical activity and lifestyles that aim at the health of the individual and the population.
Bibliographical references
- 1.Leal M del C. Low birth weight: a look from the influence of social factors.Rev Cub Public Health.2008;34(1).
- 2.García de Lorenzo L, Álvarez Hernández J, Planas M, Burgos R, Araujo A. The multidisciplinary consensus work-team on the approach to hospital malnutrition in Spain.Multidisciplinary consensus on the approach to hospital malnutrition in Spain.Nutr Hosp.2011;26(4): 701-10.
- 3.The American Society for Parenteral and Enteral Nutrition.Disease-Related Malnutrition and Enteral Nutrition Therapy: A significant problem with a cost-effective solution.National Alliance for Infusion Therapy and the American Society for Parenteral and Enteral Nutrition Public Policy Committee and Board of Directors.Nutr Clin Pract.2010;25: 548.
- 4.Correia MITD, Campos ACL, for the ELAN Cooperative Study.Prevalence of Hospital Malnutrition in Latin America: The Multicenter ELAN Study.Nutrition.2003;19: 823-5.
- 5.National Survey of the Nutritional Situation in Colombia (ENSIN).Colombian Institute of Family Welfare (ICBF), the National Institute of Health (INS) and the Ministry of Social Protection.2010.
- 6.Prague Declaration to combat malnutrition.Ministry of Health of the Member States of the European Union (EU), Czech Presidency of the EU, ESPEN (European Society for Clinical Nutrition and Metabolism) and ENHA (European Nutritional Health Alliance).2009. https://www.senpe.com/DOCS/PRAGA/Declaration_Prague_2009.pdf
Bibliographical sources
- 7.International Declaration on the Right to Nutrition in Hospitals.FELANPE (Latin American Federation of Nutritional Therapy, Clinical Nutrition and Metabolism), Mexican Association of Clinical Nutrition and Nutritional Therapy AC (AMAEE), School of Medicine.Universidad Anáhuac México, Norte, International Federation of Catholic Universities (IFCU), Pan American Health Organization (PAHO), Mexican Academy of Surgery.2008. https://www.felanpeweb.org/dec_cancun_ 2008.pdf
- 8.Action plan of the Global Strategy for the Prevention and Control of Noncommunicable Diseases 2008-2013.
World Health Organization, WHO.https://apps.who.int/gb/ebwha/pdf_ files/A61/A61_8-sp.pdf - 9.Global Strategy on Diet, Physical Activity and Health.World Health Organization, WHO.2004. https://www.who.int/ dietphysicalactivity/strategy/eb11344/ strategy_spanish_web.pdf
Authors
1.Claudia L. Angarita G, ND.Nutritionist – Dietician, Pontificia Universidad Javeriana Specialist in Hospital Administration.Experience in clinical nutrition.
President of the Colombian Association of Clinical Nutrition.Director, Colombian Center for Integral Nutrition.
Correspondence: claudiaangarita@gmail.com
presidency@nutriclinicacolombia.org
Received: June 2011
Accepted for publication: June 2011
RMNC 2011;2(1): 1-4.
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