Abstract
This study aimed to evaluate the Eco-efficiency (EE) and demand for enteral diets used in adult (EDA) patients of a Brazilian public hospital before and during the COVID-19 pandemic. Data collection occurred in two moments: (1) from April 2019 up to March 2020; (2) from April 2020 to March 2021. Data on food EDA composition was obtained from labels. For the EE calculations, the variables considered were total consumption, energy and financial values of EDA, and greenhouse gas (GHG) emissions, also considering their origin (manufacturing place). The statistical analysis consisted of total values, averages, and Pearson's Correlation test application. Eight of the 17 types of EDA used in the hospital during the pandemic period represented 95.4% of the total consumption during the investigation. The eight EDA nutritional values in both periods ranged from 1.000 to 2.400 kcal. The distance in kilometers (km), considering the distance from the origin of the EDA to the destination, ranged from 1.137 to 11.751 km. More than 60% (n = 5) of the EDA is produced in Brazil. Considering EDA energy value, one single item from Germany (HPxF) represented 63.27% of the total energy of all items. Regarding EE, the worst results associated with GHG generation were from imported products, while in the financial aspect, a Brazilian product had the worst result. Environmental impacts also occur in the provision of health services, and this study proved it with the application of the EE of EDAs used during the COVID-19 pandemic.
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References
Aleksandrowicz, L., Green, R., Joy, E. J. M., Smith, P., & Haines, A. (2016). The impacts of dietary change on greenhouse gas emissions, land use, water use, and health: a systematic review. PLoS ONE, 11(11), e0165797. https://doi.org/10.1371/journal.pone.0165797
Alencar, E. S., Muniz, L. S. D. S., Holanda, J. L. G., Oliveira, B. D. D., Carvalho, M. C. F., Leitão, A. M. M., Cavalcante, M. I. A., Oliveira, R. C. P., Silva, C. A. B. D., & Carioca, A. A. F. (2022). Enteral nutritional support for patients hospitalized with COVID-19: Results from the first wave in a public hospital. Nutrition, 94, 111512. https://doi.org/10.1016/j.nut.2021.111512
Ambade, B., Sankar, T. K., Kumar, A., Gautam, A. S., & Gautam, S. (2021). COVID-19 lockdowns reduce the Black carbon and polycyclic aromatic hydrocarbons of the Asian atmosphere: Source apportionment and health hazard evaluation. Environment, Development and Sustainability, 23(8), 12252–12271. https://doi.org/10.1007/s10668-020-01167-1
BAPEN. British Association for Parenteral and Enteral Nutrition (2016). Oral Nutritional Supplements (ONS). Enteral Nutrition. https://www.bapen.org.uk/nutrition-support/enteral-nutrition. accessed Feb 2022
Barazzoni, R., Bischoff, S. C., Breda, J., Wickramasinghe, K., Krznaric, Z., Nitzan, D., Pirlich, M., & Singer, P. (2020). ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Clinical Nutrition, 39(6), 1631–1638. https://doi.org/10.1016/j.clnu.2020.03.022
Barone, A. S., Matheus, J. R. V., de Souza, T. S. P., Moreira, R. F. A., & Fai, A. E. C. (2021). Green-based active packaging: Opportunities beyond COVID-19, food applications, and perspectives in circular economy—A brief review. Comprehensive Reviews in Food Science and Food Safety., 20, 4881–4905. https://doi.org/10.1111/1541-4337.12812
Bengali, S. (2020). The COVID-19 pandemic is unleashing a tidal wave of plastic waste. Los Angeles times. https://www.latimes.com/world-nation/story/2020-06-13/coronavirus-pandemic-plastic-waste-recycling. Accessed 13, Jul 2020
Bengtsson, J., Bullock, J. M., Egoh, B., Everson, C., Everson, T., O’Connor, T., O’Farrell, P. J., Smith, H. G., & Lindborg, R. (2019). Grasslands – more important for ecosystem services than you might think. Ecosphere, 10(2), e02582. https://doi.org/10.1002/ecs2.2582
Brasil. Ministério da Saúde. (2021a). Coronavírus Brasil—Painel coronavírus. https://covid.saude.gov.br/. Accessed Jan 2022.
Brasil. Ministério da Saúde. Agência Nacional de Vigilância Sanitária. (2021b). Instrução Normativa—IN nº 503. https://www.in.gov.br/en/web/dou/-/resolucao-rdc-n-503-de-27-de-maio-de-2021-322985331. Accessed Feb 2022.
Cáceres, P., Strasburg, V., Morales, M., Huentel, C., Jara, C., & Solís, Y. (2021). Determinación de la ecoeficiencia en desperdícios alimentarios generados a nivel de hogar: Caso piloto en Chile. Revista de Ciencias Ambientales (Tropical Journal of Environmental Sciences), 55(2), 295–310. https://doi.org/10.15359/rca.55-2.14
Caiado, R. G. G., Dias, R. F., Mattos, L. V., Quelhas, O. L. G., & Filho, W. L. (2017). Towards sustainable development through the perspective of eco-efficiency—A systematic literature review. Journal of Cleaner Production, 165, 890–904. https://doi.org/10.1016/j.jclepro.2017.07.166
Callegari-Jacques, S. M. (2003). Bioestatística: Princípios e aplicações (p. 256). Artmed.
Castro e Cardoso, M. G., Senna Prates, S. M., & Anastácio, L. R. (2018). Fórmulas para nutrição enteral padrão e modificada disponíveis no Brasil. BRASPEN Journal, 33(4), 402–417.
Chiche, A. & Lachapelle, U. The Conversation. (2021). Du fermier au citadin: la pandémie accélère l’agriculture soutenue par la communauté. https://theconversation.com/du-fermier-au-citadin-la-pandemie-accelere-lagriculture-soutenue-par-la-communaute-153607. Accessed Feb 2022.
DECC (Department of Energy & Climate Change). GOV.UK (2021). Greenhouse gas reporting—Conversion factors. https://www.gov.uk/government/publications/greenhouse-gas-reporting-conversion-factors-2021. Accessed Feb 2022.
Distância entre cidades. http://www.distanciasentrecidades.com/. Accessed Feb 2022.
FAO & INRAE. (2020). Enabling sustainable food systems: Innovators’ handbook. Food and Agriculture Organization of the United Nations – FAO. https://doi.org/10.4060/ca9917en
Feil, A. A., & Schreiber, D. (2017). Sustentabilidade e desenvolvimento sustentável: Desvendando as sobreposições e alcances de seus significados. Cad. EBAPE BR. 15.
HCPA. Hospital de Clínicas de Porto Alegre/RS. (2022). Principais números. https://www.hcpa.edu.br/institucional/institucional-apresentacao/institucional-apresentacao-principais-numeros. Accessed sept 2023.
Hospitais saudáveis. (2023). Agenda Global para Hospitais Verdes e Saudáveis. https://www.hospitaissaudaveis.org/AgendaGlobal. Acessed Oct 2023.
IBM Corp. (2015). IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp.
Kumar, A., Singh, P., Raizada, P., & Hussain, C. H. (2022). Impact of COVID-19 on greenhouse gases emissions: A critical review. Science of The Total Environment, 806, 150349. https://doi.org/10.1016/j.scitotenv.2021.150349
Li, T., Zhang, Y., Gong, C., Wang, J., Liu, B., Shi, L., & Duan, J. (2020). Prevalence of malnutrition and analysis of related factors in elderly patients with COVID-19 in Wuhan, China. European Journal of Clinical Nutrition, 74, 871–875. https://doi.org/10.1038/s41430-020-0642-3
Lins, M., Zandonadi, R. P., Strasburg, V. J., Nakano, E. Y., Botelho, R. B. A., Raposo, A., & Ginani, V. C. (2021). Eco-inefficiency formula: A method to verify the cost of the economic, environmental, and social impact of waste in food services. Foods, 10(6), 1369. https://doi.org/10.3390/foods10061369
Liu, J., Vethaak, A. D., An, L., Liu, Q., Yang, Y., & Ding, J. (2021). An environmental dilemma for China during the COVID-19 pandemic: The explosion of disposable plastic wastes. Bulletin of Environmental Contamination and Toxicology, 106, 237–240. https://doi.org/10.1007/s00128-021-03121-x
Ma, Y. (2018). Changing tetra pak: From waste to resource. Science Progress, 101(2), 161–170. https://doi.org/10.3184/003685018X15215434299329
Matci, D. K., Kaplan, G., & Avdan, U. (2022). Changes in air quality over different land covers associated with COVID-19 in Turkey aided by GEE. Environmental Monitoring and Assessment, 194, 762. https://doi.org/10.1007/s10661-022-10444-7
Mathers, J. C. (2021). Nutrition and COVID-19. British Journal of Nutrition. https://doi.org/10.1017/S0007114521003305
Minelli, N., Gibbs, L., Larrivee, J., & Sahu, K. K. (2020). Challenges of maintaining optimal nutrition status in COVID-19 patients in intensive care settings. Journal of Parenteral and Enteral Nutrition, 44(8), 1439–1446. https://doi.org/10.1002/jpen.1996
Muñoz-Batista, M. J., Blázquez, G., Franco, J. F., Calero, M., & Martín-Lara, M. A. (2022). Recovery, separation and production of fuel, plastic and aluminum from the Tetra PAK waste to hydrothermal and pyrolysis processes. Waste Management, 137, 179–189. https://doi.org/10.1016/j.wasman.2021.11.007
NHS. National Health Service. (2012) Sustainable Development Unit. Goods and Services Carbon Hotspots. https://www.sduhealth.org.uk/policy-strategy/reporting/natural-resource-footprint-2018/carbonhotspots.aspx. Acessed Sept 2023.
Nigam, R., Tripathi, G., Priya, T., Luis, A. J., Vaz, E., Kumar, S., et al. (2022). Did Covid-19 lockdown positively affect the urban environment and UN- sustainable development goals? PLoS ONE, 17(9), e0274621. https://doi.org/10.1371/journal.pone.0274621
Osuna-Padilla, I., Rodríguez-Moguel, N. C., Aguilar-Vargas, A., & Rodríguez-Llamazares, S. (2021). Safety and tolerance of enteral nutrition in COVID-19 critically ill patients, a retrospective study. Clinical Nutrition ESPEN, 43, 495–500. https://doi.org/10.1016/j.clnesp.2021.02.015
Pencheon, D., & Wight, J. (2020). Making healthcare and health systems net zero. BMJ,368:m970. https://www.bmj.com/content/368/bmj.m970. Acessed Sept 2023.
Ribeiro, K. R., Rolim, P. M., Seabra, L. M. J., & Strasburg, V. J. (2021). Evaluation of the ecoefficiency of greenhouse gases generation in the provision of complementary meals in a public hospital. Research, Society and Development, 10(4), e10110413995. https://doi.org/10.33448/rsd-v10i4.13995
Richardson, D. P., & Lovegrove, J. A. (2021). Nutritional status of micronutrients as a possible and modifiable risk factor for COVID-19: A UK perspective. British Journal of Nutrition, 125, 678–684. https://doi.org/10.1017/S000711452000330X
Ricker, H. & Kardas-Nelson, M. (2020). Community Supported Agriculture is surging amid the pandemic. Civil Eats. https://civileats.com/2020/04/09/community-supported-agriculture-is-surging-amid-the-pandemic/. accessed Feb 2022.
Ritchie, H. & Roser, M. Our World in Data (2020). Environmental impacts of food production. https://ourworldindata.org/environmental-impacts-of-food. Accessed Feb. 2022.
Rouget, A., Vardon-Bounes, F., Lorber, P., Vavasseur, A., Marion, O., Marcheix, B., Lairez, O., Balardy, L., Fourcade, O., Conul, J., & Minville, V. (2021). Prevalence of malnutrition in coronavirus disease 19: The NUTRICOV study. British Journal of Nutrition, 126, 1296–1303. https://doi.org/10.1017/S0007114520005127
Sannigrahi, S., Kumar, P., Molter, A., Zhang, Q., Basu, B., Basu, A. S., & Pilla, F. (2021). Examining the status of improved air quality in world cities due to COVID-19 led temporary reduction in anthropogenic emissions. Environmental Research, 196, 110927. https://doi.org/10.1016/j.envres.2021.110927
Scaraboto, D., Joubert, A. M., & Gonzalez-Arcos, C. (2019). Using lots of plastic packaging during the coronavirus crisis? You’re not alone. The Conversation, 668, 1077–1093.
Secretaria da Saúde do Estado do Rio Grande do Sul. Governo Estadual do Rio Grande do Sul. (2021). Painel Coronavírus RS. https://ti.saude.rs.gov.br/covid19/. Accessed January 2022
Silva, R., Oliveira, F., & Santos, C. (2014). Características sensoriais e nutricionais de suplementos alimentares. Semina: Ciências Biológicas e da Saúd, e, 35(2), 31–38. https://doi.org/10.5433/1679-0367.2014v35n2p31
Simzari, K., Vahabzadeh, D., Saeidlou, S. N., Khoshbin, S., & Bektas, Y. (2017). Food intake, plate waste and its association with malnutrition in hospitalized patients. Nutrición Hospitalaria, 34(6), 1376–1381. https://doi.org/10.20960/nh.1102
Singh, S.H. (2020). Lockdown helps bring back plastic bags. The Hindu. https://www.thehindu.com/news/national/telangana/lockdown-helps-bring-back-plastic-bags/article31381638.ece
Staub, C. (2020). Country lockdowns bring ‘unprecedented implications. Resource recycling. https://resource-recycling.com/plastics/2020/04/01/country-lockdowns-bring-unprecedented-implications/. Accessed 13 July 2020
Strasburg, V. J., de Bassanesi, F. V., & Silveira, A. C. J. L. (2022). Avaliação da ecoeficiência de refeição fornecida por unidade de internação pediátrica de um hospital público do sul do brasil: um estudo de caso. Interfaces Científicas - Saúde E Ambiente, 9(1), 273–289. https://doi.org/10.17564/2316-3798.2022v9n1p273-289
Strasburg, V. J., Hammes, T. O., Gonzales, A. C. S., von Zeidler, G., Venzke, J. G., Santos, Z. E. A., & Bosa, V. L. (2020). COVID-19: Contingency actions for the provision of meals to employees of a university hospital in southern Brazil. Scientia Medica Porto Alegre, 30, 1–7.
Strasburg, V. J., & Jahno, V. D. (2017). Application of eco-efficiency in the assessment of raw materials consumed by university restaurants in Brazil: A case study. Journal of Cleaner Production, 161, 178–187. https://doi.org/10.1016/j.jclepro.2017.05.089
Vanapalli, K. R., Sharma, H. B., Ranjan, V. P., Samal, B., Bhattacharya, J., Dubey, B. K., & Goel, S. (2021). Challenges and strategies for effective plastic waste management during and post COVID-19 pandemic. Science of The Total Environment, 750, 141514. https://doi.org/10.1016/j.scitotenv.2020.141514
Virgens, I., Santana, N., Lima, S., & Fayh, A. P. T. (2021). Can COVID-19 be a risk for cachexia for patients during intensive care? Narrative review and nutritional recommendations. British Journal of Nutrition, 126(4), 552–560. https://doi.org/10.1017/S0007114520004420
Witte, R. S., & Witte, J. S. (2005). Estatística (7th ed., p. 486). LTC.
World Health Organization (2022). WHO coronavirus disease (COVID-19). Dashboard. https://covid19.who.int. Accessed February 2022
Yan, D., Ahmad, S. Z., & Yang, D. (2013). Matthew effect, ABC analysis and project management of scale-free information systems. Journal of Systems and Software, 86(2), 247–254. https://doi.org/10.1016/j.jss.2012.08.013
Zhu, N., Zhang, D., Wang, W., Li, X., Yang, B., Song, J., Zhao, X., Huang, A., Shi, W., Lu, R., Niu, P., Zhan, F., Ma, X., Wang, D., Xu, W., Wu, G., Gao, G. F., & Tan, W. (2019). A novel coronavirus from patients with pneumonia in China, 2019. New England Journal of Medicine, 382, 727–733. https://doi.org/10.1056/NEJMoa2001017
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To the Nutrition and Dietetics Service and the Medical Archive and Health Information Service of the Hospital de Clínicas de Porto Alegre.
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The research was partially supported by the Dean of Research (Pró-Reitoria de Pesquisa—PROPESQ) of Universidade Federal do Rio Grande do Sul (UFRGS) in the payment of scientific initiation scholarship.
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VJS. participated in data collect and analysis, the manuscript concept and writing; LYS participated in the manuscript concept, writing and revising; DE participated in the data collect and analysis, and revising. BJS participated in the revising and traduction. AAF participated in data analysis, and revising; RPZ participated in writing and the revising.
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Strasburg, V.J., da Silva, L.Y., Eberhardt, D. et al. Eco-efficiency and demand of enteral diets used in patients of a Brazilian public hospital before and during the COVID-19 pandemic. Environ Dev Sustain (2024). https://doi.org/10.1007/s10668-023-04259-w
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DOI: https://doi.org/10.1007/s10668-023-04259-w