Malnutrition, a problem for all. How can we combat it?

The scenario is urgent and alarming.

Malnutrition is a critical focus that requires a comprehensive effort by all sectors of society and which must be addressed beyond good habits, prevention or long-term medical treatment.

If in the past it has not been given the attention it deserves, today hospital nutrition, the one that comes into play when a patient enters the hospital, not being able to be treated in an outpatient clinic.

In this scenario, poverty related to access to quality nutrition appears as one of the main factors and enemies to overcome, at least in Mexico.

According to the National Council for the Evaluation of Social Development Policy (CONEVAL), during 2020 about 22.5% of the country's population was in a condition of vulnerability due to lack of access to nutritious and quality food, a percentage that translates into 28.6 million people, a figure 1.1 million higher than the 27.5 million that were estimated during 2018.

But not only this.

Many times, in addition to good habits and a complete and adequate diet, the call for awareness of nutrition also concerns health specialists, that is, the clinical line, since currently both in the public and private sectors it is complex for doctors to consult interdisciplinary.

What are the consequences of a poor diet?

The risks are not few and can extend seriously, even leading to death if not treated in a timely manner: micronutrient deficiency, inadequate growth, lower performance and physical and intellectual performance, as well as a significant increase in the risk of contracting some chronic non-communicable disease, among others.

(Catherine Delahaye/Getty Images)CATHERINE DELAHAYE (Getty Images)

A health system in check

A more extensive look at this reality indicates that, at least in Mexico, about 50% of the patients assessed in clinics and hospitals require some type of hospital nutritional care, which, if given in a timely and accurate manner, can reduce the immediate times and costs related to the patient's own health, as well as the expenses of the official health systems, which are currently at the limit of their capacities.

According to the pharmaco-economic study Economic burden of hospital malnutrition and the cost-benefit of supplemental parenteral nutrition in critically ill patients in Latin America, the financial effects directly related to hospital malnutrition derived from diseases is close to 10.2 billion dollars for all of Latin America.

The study places Brazil as the nation with the greatest economic burden (4.41 billion) and Panama with the least (44 million).

In the case of Mexico, second place on the list, spending amounts to 3.92 billion.

Given this scenario, the study underlines the importance of adequate nutrition to safeguard the lives of patients and reduce costs thanks to timely nutritional support,

which can be harnessed to improve the nutritional status as well as the clinical outcomes of hospitalized patients throughout the region.

Kiko Jimenez (Getty Images/Westend61)

Prevention is the last name of nutrition

The master in Clinical Nutrition (MNC) by the UVM and graduate in human nutrition graduated from the UAM-Xochimilco and professor at the TEC de Monterrey in the nutrition and well-being degree, Javier Alejandro Luna Morán, explains exclusively for El País that currently the nutrition must stop being seen as a luxury, pointing to a vital need for the quality of life and optimal levels of health of people.

"Nutrition is expensive when it is misused," says the teacher.

In this story, the professor emphasizes the importance of prevention and good patient habits, since the permanence and behavior in a scenario that requires hospital feeding will depend on it.

“It is important to do everything in our power to take care of our health.

And I try to take care of it from five points: The dietary aspect, what the body needs, how much we are giving it more or less;

physical activity, what we do daily.

The body is designed for us to move it, there are even world recommendations, which are the famous 30 minutes of daily exercise, with some type of vigorous activity and some cardiovascular training with a strength partner to improve that component.

It is the way in which we maintain our organs;

the hydration part, which is also very important.

We do not quantify the amount of liquid we consume.

And although the recommendation of 1.5 or 2 liters per day is very general, how many times do we reach that per day?

the part of the dream, to which we do not give importance either.

And lately there has been talk of a particular term that is sleep hygiene, which are all these habits that we can generate to really have a complete rest.

The body works with what we know as the circadian cycle, all the activities we do in light and all the activities we do in the dark.

In the light is when we consume the substrates, when we generate physical activities, and all the replenishments are nocturnal, how these nutrients are coupled to the muscle lines at night.

And finally, there are the emotional issues, what are we doing to keep ourselves as calm and even-tempered as possible?”, points out Professor Luna Morán.

And lately there has been talk of a particular term that is sleep hygiene, which are all these habits that we can generate to really have a complete rest.

The body works with what we know as the circadian cycle, all the activities we do in light and all the activities we do in the dark.

In the light is when we consume the substrates, when we generate physical activities, and all the replenishments are nocturnal, how these nutrients are coupled to the muscle lines at night.

And finally, there are the emotional issues, what are we doing to keep ourselves as calm and even-tempered as possible?”, points out Professor Luna Morán.

And lately there has been talk of a particular term that is sleep hygiene, which are all these habits that we can generate to really have a complete rest.

The body works with what we know as the circadian cycle, all the activities we do in light and all the activities we do in the dark.

In the light is when we consume the substrates, when we generate physical activities, and all the replenishments are nocturnal, how these nutrients are coupled to the muscle lines at night.

And finally, there are the emotional issues, what are we doing to keep ourselves as calm and even-tempered as possible?”, points out Professor Luna Morán.

The body works with what we know as the circadian cycle, all the activities we do in light and all the activities we do in the dark.

In the light is when we consume the substrates, when we generate physical activities, and all the replenishments are nocturnal, how these nutrients are coupled to the muscle lines at night.

And finally, there are the emotional issues, what are we doing to keep ourselves as calm and even-tempered as possible?”, points out Professor Luna Morán.

The body works with what we know as the circadian cycle, all the activities we do in light and all the activities we do in the dark.

In the light is when we consume the substrates, when we generate physical activities, and all the replenishments are nocturnal, how these nutrients are coupled to the muscle lines at night.

And finally, there are the emotional issues, what are we doing to keep ourselves as calm and even-tempered as possible?”, points out Professor Luna Morán.

(Maradek/Getty Images) Maradek (Getty Images/iStockphoto)

Hospital nutrition, a vital ally

In this story, the initiative of various instances around clinical nutrition stands out, which is an essential coadjuvant to undermine the risks associated with illness and clinical admission, where it is pertinent and, in many cases decisive, to carry out A timely early nutrition is carried out, where in 24 hours the patient's food needs are assessed and applied.

Javier Alejandro Luna Morán talks about enteral and parenteral nutrition, both ways in which patients can be nourished, either from diets that are adjusted to the needs of each one.

“There is, for example, a patient with diabetes, for whom you have to adjust carbohydrates, or one with oncological problems, for whom you have to increase proteins, calories.

But there are two other nutritional support systems, as they are known: the enteral (EN) is what is accompanied by specialized enteral formulas and what we can give through different access routes, through oral access to some system of probes , are temporary accesses, either nasal or oral, or permanent accesses such as gastrostomies (through the stomach), or enterostomies (when they are installed at the level of the intestine).

“On the other hand, the parenteral (PN) is what is entered intravenously, from central, high caliber or peripheral lines with smaller vascular accesses and they are the ones that one as a professional resorts to when the intestinal tract is not functional”, specifies the coordinator of the Clinical Nutrition Service of Hospital Ángeles del Pedregal (almost ten years).

In this context, the initiative created by the world health care company, specialized in medicines and technologies for infusion, transfusion and clinical nutrition, Fresenius Kabi -founded in 1912 by Dr. and pharmacist Eduard Fresenius- stands out, which puts into A joint, comprehensive and coordinated effort is underway between the health sector and the various strategic professionals in the field of nutritional avant-garde, in order to combat hospital malnutrition in Latin America and generate awareness on nutritional issues: United for clinical nutrition.

This joint work makes available on its website an extensive material of useful information resources to detect, manage and treat disease-related malnutrition in a pertinent and effective manner, as well as to fully understand the relevant nutritional diagnosis, the different risks of malnutrition, in addition to the administration, combination and proper management of quality enteral and parenteral nutritional support, as well as the different benefits of timely and reliable treatment, processes that are also strongly linked to monitoring and follow-up in hospitals, as well as various online and offline training or educational events covering clinical nutrition, focused on PN.

Through its Caring for life philosophy, Fresenius Kabi is one of the strategic players in the commitment to bring essential medicines and technologies into the hands of people who help patients find better solutions, the different challenges they face to preserve health.

In Mexico alone, the company has developed various clinical and educational programs, which help both patients (Alimenta la vida) and health professionals, as is precisely the case of Unidos por la Nutrición Clínica, which since 2014 that seeks to combat disease-related malnutrition in Latin America

Javier Alejandro Luna Morán reflects that on many occasions, medical interventions point to the medication or to the hospitalized, applying an intravenous solution and seeing an immediate improvement in the patient.

However, says the specialist, “we must remember that the body is made up of all the substrates we consume.

The phrase 'we are made of what we eat' is so functional and necessary to understand, that if we don't fully understand it, how can we expect the system to work 100%.

An interdisciplinary work between the different medical specialties is needed to have the average approach towards our patients.

And it is also necessary that nutritional interventions and pertinent considerations be taken from the patient's admission.

That is why nutritional support services are of the utmost importance;