Disease related malnutrition: new diagnostic criteria but unchanged prevalence. A call for an improvement of nutritional care (original) (raw)

2021, Nutricion Hospitalaria

Disease related malnutrition: new diagnostic criteria but unchanged prevalence. A call for an improvement of nutritional care Desnutrición relacionada con la enfermedad: nuevos criterios de diagnóstico pero sin cambios en la prevalencia. Una llamada a la mejora de los cuidados nutricionales Nutritional status can be assessed according to three aspects. It can be studied whether food intake provides sufficient nutrients for an individual of a given sex, age, weight and height. Body composition reflects, at least partially, the individual´s food intake and assimilation, with an important influence of the usual physical activity performed. The measurement of an individual's functional capacity also reveals his or her nutritional status, because when malnutrition is present, different body functions may be reduced. In children, growth parameters must also be considered. The application of these three ways of assessing nutritional status in clinical practice is only approximate. There are limitations related to the methodology used in these determinations and to the influences of other variables, systems and diseases. Beyond the experimental setting, it is difficult to know the real nutritional needs of an individual, his or her dietary intake, or the exact nutrient composition of a particular food. Also, the measurement of body composition with reliable direct techniques that analyze body chemical components, rather than indirect techniques that measure properties of the organism, are usually unavailable in the clinical setting. Last but not least, the relationship between food and function is not direct. In addition to dietary intake, physical activity, hormonal, immunological, neurological and psychological systems influence nutritional status. Regardless of the difficulties intrinsic to the methods of nutritional evaluation, there is a mutual influence between nutritional status and acute or chronic disease, both in the sense of deterioration and improvement. In theory, the definition of malnutrition should be universal, regardless of whether it is due to causes of poverty, war, natural catastrophes, etc., and whether it is due to organic or psychiatric disease (1). The impact of these factors make it difficult to establish diagnostic criteria for what constitutes malnutrition and how they can be accurately measured. Multiple tools have been developed to estimate nutritional risk (2) and a consensus has been reached on the diagnostic definition of malnutrition (3). Unfortunately, confusion between nutritional risk and established malnutrition is common. However, it is true that multiple studies have shown an association between nutritional risk, and even more so malnutrition, with an increase in comorbidities and complications, as well as in health care costs, compared to well-nourished individuals (4).