Elsevier

Clinical Nutrition

Volume 36, Issue 1, February 2017, Pages 162-169
Clinical Nutrition

Original article
Economy matters to fight against malnutrition: Results from a multicenter survey

https://doi.org/10.1016/j.clnu.2015.10.010Get rights and content

Summary

Background and aim

Malnutrition represents a serious health care threat, as it increases morbidity, mortality and health care cost. The effective screening and treatment with enteral (EN) or parenteral (PN) nutrition are the key elements of the policy called Optimal Nutrition Care for All (ONCA). The study tried to analyze the impact of the state's economy on the implementation of EN and PN to define its role in ONCA.

Material and methods

an international survey in twenty two European countries was performed between January and December 2014. An electronic questionnaire was distributed to 22 representatives of clinical nutrition (PEN) societies. The questionnaire comprised questions regarding country economy, reimbursement, education and the use EN and PN. Return rate was 90.1% (n = 20).

Results

EN and PN were used in all countries surveyed (100%), but to different extent. The country's income significantly influenced the reimbursement for EN and PN (p < 0.05). It was also associated with the overall use of tube feeding and PN (p = 0.05), but not with the use of oral nutritional supplements (p = 0.165). The use of both, EN and PN at hospitals was not depended on the economy (p > 0.05). Education was actively carried out in all countries, however the teaching at the pre-graduate level was the least widespread, and also correlated with the country income (p = 0.042).

Conclusions

Results indicated that economic situation influences all aspects of ONCA, including education and treatment. The reimbursement for EN and PN seemed to be the key factor of effective campaign against malnutrition.

Introduction

Malnutrition (also: disease-related malnutrition, DRM) is undoubtedly a serious public health issue worldwide [1], [2]. It increases morbidity, mortality, the length of hospital stay, and health-care costs [1], [2], [3]. The prevalence of malnutrition differs depending on the patient's population, country, clinical settings, yet it can be diagnosed in 7–16% of outpatients and in 20–60% patients at admission to hospital [3], [4], [5], [6], [7], [8]. The criteria for that diagnostic varied significantly among authors, but in most of cases the body mass index (BMI) of <18.5 kg/m2 and unintentional body weight loss >10% last 3–6 months, were applied [3], [4], [5], [6], [7], [8]. Unfortunately, the problem of malnutrition is often unnoticed, undiagnosed or untreated, while it generates more costs than overnutrition or obesity, according to British Society for Enteral and Parenteral Nutrition (BAPEN) [9].

The European Society for Clinical Nutrition and Metabolism (ESPEN) recognized DRM as a grave problem more than thirty years ago. Since then, the society has undertaken many actions to change this situation. At the beginning, those activities were called the Fight Against Malnutrition (FAM) [1]. In 2014 FAM became a part of a campaign called Optimal Nutrition Care for All (ONCA) [10]. ONCA's aim is to facilitate screening for risk of disease-related malnutrition/undernutrition and nutritional care implementation across Europe [10]. ONCA includes, among others, the worldwide ‘NutritionDay’ survey, many local and international events (including ONCA conferences in Brussels, Prague, Vienna, Warsaw and Zagreb), scientific and research grants, scientific and educational symposia, workshops and trainings. This activity is administered by European Nutrition for Health Alliance (ENHS), an association of stakeholders, in which ESPEN is the strategic partner. Therefore, it is possible to perform all actions in a close cooperation with national scientific societies for enteral and parenteral nutrition (or clinical nutrition) societies, so-called ‘PEN’ societies. Those activities increased awareness, improved screening, amplified the use of enteral (EN) and parenteral nutrition (PN), representing two types of clinical nutrition support (CN), hence, improved the situation. Results differed, however, among countries. The question what are the key elements of efficient ONCA emerged and remained unanswered. Therefore, the purpose of the study was to answer that query by assessing the situation in European countries. Following aspects were analyzed: the presence of the reimbursement for each type of clinical nutrition (CN); the level of education for CN and the real use of EN and PN in various short- and long term settings.

Section snippets

Methods

An European survey was performed using an electronic questionnaire [Table 1]. The whole project was accomplished within 12 months, between January and December 2014, due to questionnaires distribution, local surveys and further data collecting. The questionnaire was circulated to representatives of twenty-two PEN societies. Participants were supposed to answer all questions, including the prevalence of malnutrition, using recent, already collected, data or new survey performed for the purpose

Results

Twenty answered questionnaires were returned (the response rate was 90.1%), and analyzed. Insurance companies operated as health care financiers in all twenty participating countries (100%). There were only private institutions in Serbia, Ukraine and the United Kingdom (UK), while in Croatia, France and Poland health care expenses were covered by the state-funded and state-governed entity. In the other fourteen countries both private and state insurance companies were present.

The Ministry of

Discussion

Malnutrition represent a serious health care thread as it increases morbidity, mortality and health care cost for all age groups [1], [2]. A new Croatian study showed that the total cost of adult malnutrition for selected diagnoses was €97.35 million per year, accounting for 3.38% of the total Croatian national health care budget, and the average cost per patient was estimated at €1640.48 [12]. The largest share was used for medications (43%), followed by 34% for hospitalization, 13% for

Conflict of interest

The authors hereby declare that the article is original, is not under consideration for publication anywhere else and has not been previously published. Authors declare no potential or actual personal, political or financial interest in the material, information or techniques described in the paper.

Statement of authorship

SK and MCh shared authorship of the manuscript. They were responsible for coordinating the research, critical data analysis, evaluation of the outcome, and writing of the manuscript.

AG was responsible for the statistics and data analysis. All authors have made substantial contributions to the data collection and drafting of the manuscript, for which they take collective responsibility.

Source of funding

None.

References (13)

There are more references available in the full text version of this article.

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