Malnutrition, a disease within the disease

The joint Milan Appeal (13 November 2013)

ADI and SINPE (the Italian association of dietetics and clinical nutrition and the Italian society of artificial nutrition and metabolism) presented in Milan a joint document on the problem of "malnutrition", which now costs the health system more than the treatment of obesity.

The numbers behind the problem

The number of malnourished individuals is extremely high, especially among the elderly: estimates speak of 1 patient in 3 in hospitals and in RSAs (residential care facilities).
Indeed, a worsening of the clinical picture following admission is recorded for 2 patients in 10 due to nutritional problems.
The situation reaches its peak among cancer patients, where it is estimated that 20% of patients die not so much from consequences directly linked to the disease as from the direct consequences of malnutrition. The situation can vary greatly from Region to Region. The autonomous Province of Bolzano brought its own case to attention, presenting itself as a best practice where the centralisation of Artificial Nutrition guaranteed substantial savings from the very first months after the system was introduced.

Studies and data keep piling up

This appeal adds to the data gathered by econometric studies such as ″Impact of Oral Nutritional Supplementation on Hospital Outcomes", conducted in the United States in 2012 and promoted by a party - certainly an interested one - like Abbott, but which seems to chart a path with no alternatives: investing in clinical nutrition means improving the cost-benefit ratio of the health service.
The study in question, conducted on roughly 1 million patients, appears to show that artificial nutritional support during a hospital stay guarantees, in 21.3% of cases, a reduction of the average length of stay of up to 2.3 days. In 21.6% of cases this translated into a lower hospitalisation cost for the healthcare facility of $4,734.

These are mostly meta-analyses, based on the administration of individual ONS (oral nutritional supplements) associated with specific conditions, from which a result is derived through a statistical reading of the measurements taken.

The steps still to be taken

Many hospitals still carry out no screening of the nutritional status of admitted patients, and the percentage of patients receiving nutritional support during treatment remains tiny.
The studies available to date are numerous, but they all concern extremely circumscribed case studies, and many more would be needed to derive unambiguous data describing the large-scale benefit of nutritional support.
As a result, there is a lack of uniformity in choices and treatment, due to the fact that for some products "reimbursability" varies from Region to Region, while for most the cost remains entirely borne by the patient, who in many cases does not even benefit from a tax deduction.