NutritionDay

"nutritionDay in Europe" is a large scale, European-wide action project designed to reduce disease related malnutrition. The aim of this project is to increase awareness and knowledge regarding disease related malnutrition in hospitalised patients and the elderly.

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Background

Disease related malnutrition is a much underrated public health issue. It is estimated that over 50 million Europeans are at risk. A recent study estimated the cost of malnutrition to the UK to be € 10.6 b per year, double the projected € 5.1 b cost of obesity. Two population groups are at particularly high risk: hospitalised patients and residents of nursing homes. It is estimated that disease related malnutrition is responsible for prolonged length of hospital stay, morbidity and premature mortality in hospitalised patients. Research has shown that up to 40% of hospitalised patients suffer from malnutrition.

Obesity and Disease related Malnutrition

Generally health care focuses mainly on the increasing incidence of obesity.

It used to be the accepted opinion that only patients with low body weight or low body mass index (BMI, BMI<18.5) are malnourished. Today it is known that patients who unintentionaly lose weight, who can not eat enough or who do not have sufficient appetite are also at risk of disease related malnutrition. Hence patients with normal body weight or obesity can also be affected. Illness is frequently accompanied by inadequate food intake. It is generally known that decreased oral intake of hospitalised individuals and the associated decline in their nutritional status is often not detected or is attributed to the illness itself.

Disease related Malnutrition in Hospitals

Internationally, the issue of disease related malnutrition was raised in various forums, most clearly in the adoption of a resolution by the Council of Europe. Resolution ResAP (2003)3 on Food and Nutritional Care in Hospitals of the Committee of Ministers of the CoE emphasises inter alia the unacceptable number of undernourished people in hospitals and the beneficial effects of adequate food service and nutritional care in hospitals on patients’ recovery and quality of life. The resolution identifies a long list of actions to be undertaken to remedy the situation.

To date unfortunately, little follow up action has taken place on this resolution neither at the level of the CoE, nor at the individual country level. To respond to this problem it is essential that all parties (medical attendants, patients, relatives, hospital management and political stakeholders) are aware of the importance of nutrition on recovery This has proven challenging as the interaction between nutrition and recovery is not always as visibly obvious as the effects of medications on recovery.

nutritionDay in Europe – The Project

The project “nutritionDay in Europe” addresses improved patient safety and quality of care by raising awareness and increasing knowledge about disease related malnutrition. In January 2006 the project was conducted for the first time under direction of Univ. Prof. Dr. Michael Hiesmayer (Medical University of Vienna) with support of the Austrian Society of Clinical Nutrition (AKE) and the European Society for Clinical Nutrition and Metabolism (ESPEN). A subsequent audit took place in January 2007 when the project was extended to intensive care units and nursing homes.

The audit is unit and patient centred. Information about the actual nutrition care and nutrition monitoring on participating wards is gathered using four questionnaires. This happens on one single day throughout Europe. The hospital ward as an organisational unit is of particular interest. The ward, with all its´ specific characteristics and local culture, is the direct centre of care for a group of patients within the hospital. The direct interview of patients is a characteristic specific to “nutritionDay project”. Patients are surveyed about their eating habits on the day (“how much of your meal did you eat?”) and about the reasons for not eating.

Transnational multilingual Approach

The questionnaires are available in almost every European language. This enables the project to include minority groups of patients (e.g. immigrants, non native speakers).

Each unit receives feedback about its position compared with all other participating units of the same specialty type. Repeated participation in the audit allows bench-marking designed to enhance learning within units and to track changes in local practice and international trends.

In the first two years about 1 000 units with more than 30 000 patients participated in 25 European countries. About 90 wards of German speaking nursing homes joined the pilot project “nutritionDay in nursing homes” in 2007. Implementation of this sub-project in other European countries is planned.

nutritionDay Objectives

• Raising awareness of the interaction between food intake and recovery. Target groups are health care professionals as well as patients, their relatives and political and economical stakeholders.
• Gathering knowledge about inadequate food intake in European hospitals in relation to risk factors, medical specialty type, organisational units and countries
• Decrease human suffering and reduce community costs.
• Initiate research for “eating despite illness” and the ideal utilisation of clinical nutrition

List of Literature

1. Stratton, IM, et al., The cost of diseaserelated malnutrition in the UK and economic considerations for the use of oral nutritional supplements (ONS) in adults., de. M. Elia. BAPEN. 2005
2. Hill GL, Blackett RL, Pickford I, et al., Malnutrition in surgical patients. An unrecognised problem. LANCET. 1977; 1(8013):689-92
3. Bistrian BR, Blackburn GL, Vitale J, Cochran D, Naylor J., Prevalence of malnutrition in general medical patients. Jama. 1976;235(15):1567-70.

Links

• http://www.nutritionday.org
• http://www.ake-nutrition.at
• http://www.espen.org
• http://www.meduniwien.ac.at