Patricia Savino1
Monitoring nutritional status is a necessity for hospitalized patients. The only way to establish the degree of malnutrition or overweight is through nutritional screening and, from that point on, closely monitor them in the hospital. Those who are malnourished may have an increased risk of in-hospital complications. One wonders how a situation of “not eating” goes unnoticed in hospitals, while it normally generates so much concern in daily life (1,2); It is as if we all take it for granted that being hospitalized means starvation or “semi-starvation.” Also, when we want to say that a food is unpleasant, we say “it looks like hospital food.”
For very few patients, losing a few kilos during hospitalization is beneficial; For the majority it means a warning notice and, therefore, implies the need to act to modify this situation (3,4).
Nutritional screening is so simple that it only requires good will to do it and determination to implement it. However, in most hospitals it is not routine.
Hospital malnutrition is an evil that afflicts us globally. Developed countries are not spared, much less those in development, like ours. The situation becomes more serious to the extent that several factors come together, such as patients with low economic resources, who due to their condition of poverty have a poor diet, those with adequate income but who have bad eating habits, the increase in age, the presence of disease, or the combination of any of the factors mentioned above (3,4). In this edition, the Colombian Association of Clinical Nutrition publishes the consensus for nutritional screening, with the aim of making it available to different health professionals and facilitating its implementation.
Nutrition education is essential for all health professionals. Unfortunately, it is not taught in most medical schools, and it can cause harm mainly to patients, who are helpless and have to follow the recommendation of their treating doctor. I have cared for many diabetic patients who are malnourished and disoriented because their doctors have prohibited so many foods, leaving them with a poor and unbalanced diet.
At the hospital level, the situation is not better, many of them go without food for days and even weeks, since nutrition is not a priority. The oral route is suspended for different procedures (5). Food remains served, gets cold or, in other cases, becomes so restricted that it is not really appetizing (1-4). In more delicate situations, patients require enteral nutrition by tube; however, this requires knowledge of gastrointestinal physiology, characteristics of enteral nutrition formulas, and tubes and access routes.
Doctors of different specialties do not have this complex information, since it is not part of their routine management. The lack of nutritional support groups in hospitals makes it difficult to implement enteral nutrition by tube, preferring the administration of parenteral nutrition, which avoids all these variables and simplifies administration because it is intravenous, neglecting the negative side effects that it entails ( 6 ).
The Colombian Association of Clinical Nutrition, as shown in the article on the educational course of total nutritional therapy (7), has so far educated 2,730 doctors in Colombia with the aim of providing greater knowledge in the field of nutrition and achieve adequate selection and administration of enteric or parenteral nutritional support.
Knowledge of parenteral nutrition has undergone several changes in recent times. Colombia is fortunate to have most – if not all – of the substrates available in both North America and Europe to be able to administer adequate parenteral nutritional support. For those of us who follow North American standards, including those of the American Society for Parenteral and Enteral Nutrition (ASPEN), they fall short because they do not have European infusions of lipid emulsions, as they are not approved by the Food and Drug Administration. In fact, I have seen with surprise that for a couple of years, very difficult times have been going on due to the inadequate supply of vitamins and trace minerals.
In order to contribute to updating information on the management of parenteral nutrition, the Colombian Association of Clinical Nutrition has obtained a special permit with the European Society for Parenteral and Enteral Nutrition (ESPEN) to translate parenteral nutrition management guidelines. At the end of this edition you will find the first two chapters belonging to this series.
Finally, I want to express my pleasure at being once again in charge of the official magazine of the Colombian Association of Clinical Nutrition and I hope to obtain feedback on the different editions and the information that you want to receive.
References
- 1. Kondrup J. Can food intake in hospitals be improved? Clin Nutr. 2001;20:153-60.
- 2. Savino P. Hospital malnutrition: metabolic and nutritional support groups. First part. Rev Colomb Cir. 2012;27:46-54.
- 3. Savino P. Hospital malnutrition: metabolic and nutritional support groups. Second part. Rev Colomb Cir. 2012;27:79-84.
- 4. Kondrup J, Johansen N, Plum L, Bak L, Larsen I, Martinsen A, et al. Incidence of nutritional risk and causes of inadequate nutritional care in hospitals. Clin Nutr. 2002;21:461-8.
- 5. Lamb S, Close A, Bonnin C, Ferrie S. ‘Nil by mouth’. Are we starving our patients? e-SPEN. 2010;5:e90-2.
- 6. Dhaliwal R, Jurewitsch B, Harrietha D, Heyland DK. Combination enteral and parenteral nutrition in critically ill patients: Harmful or beneficial? A systematic review of the evidence. Intensive Care Med. 2004;30:1666-71.
- 7. Waitzberg D, Correia I, Echenique M, Lamache I, Soto K, Mijares M, Alvarez N, et al. Total nutrition therapy: A nutrition education program for physicians. Nutr Hosp. 2004;19:28-33.
Correspondence:
Patricia Savino, ND, MBA, CNSD
[email protected]
Bogota, DC, Colombia
1 Patricia Savino. Graduate in Nutrition and Dietetics, Pontificia Universidad Javeriana, Bogotá, DC, Colombia; Master of Business Administration.
Certified Nutrition Support Dietitian
Received: July 25, 2012; Accepted: July 25, 2012