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At the end of 2018, the “Collectif de lutte contre la dénutrition” launched a prevention campaign against a “little-known” disease. According to this collective, “undernutrition results from insufficient nutritional intakes in relation to the body’s needs. It increases medical and surgical complications and slows the healing of a curable disease. In the event of an incurable disease, it reduces life expectancy.”
In France, 2 million undernourished people have been identified, including the elderly (4% to 10% among elderly people at home over 70 years of age), the sick (20% to 40% of hospitalized people) and children (1 in 10 children hospitalized).
How to identify undernutrition?
Most often we talk about protein-energy malnutrition, i.e. a lack of protein and energy. The warning symptom is weight loss (loss of more than 5% in 1 month, or more than 10% in 6 months), which is why it is necessary to monitor the weight by regular weighing. There are also other ways to detect it using BMI, albuminemia or the Mini Nutrional Assessment test.
Health professionals in EHPAD or hospitals must follow the patient and the indicators in order to set up nutritional management as quickly as possible and to measure the effectiveness of this management. While the doctor is in charge of screening, it is up to the dieticians and nurses to provide support for the patient. Cooks are also involved, in conjunction with dieticians they are able to offer meals adapted to the patient’s needs.
Undernutrition, what care is there?
Oral nutritional supplements (ONS) are intended to improve the nutritional management of patients. They have various uses: prevention of malnutrition, special needs related to a pathology (swallowing disorders…). In healthcare facilities, ONS are given during meals or as a snack. The forms are very different: drinks, desserts, biscuits, powders… As the traditional ONS lose perspective, they tend to diversify by introducing the notion of delicacy and by developing the entry through food. The future will surely involve more ONS to be challenged again in the kitchen with more collaboration and training of cooks, dieticians, nurses and doctors on these products.
When the malnourished are hospitalized, they may not be able to eat normally. Food is then supplied by medical devices (MD) (enteral or parenteral nutrition).
On the market, several actors are in competition. Lactalis with its very complete range of CNO Délical, Danone with Nutricia and in particular its Fortimel products, the first brand prescribed in France, and Nestlé with the Clinutren range which, like Nutricia, markets medical devices in addition to nutritional solutions.
But it is neither the ONS nor the MD that are used mainly for enrichment. The traditional enrichment carried out by cooks with eggs, cream, grated cheese, milk and butter remains the most common. Cooks or medical professionals also regularly use ready-to-use enriched products such as Force+ or Nutrisens desserts.
The economic impact of undernutrition
Following a patient and treating undernutrition would save significant costs in the hospital environment. According to the MNI (Medical Nutrition International Industry), the cost of managing these malnourished patients amounts to 120 billion euros in the European Union. On average, the hospitalization costs of an undernourished patient are 2 to 3 times higher than those of a normal patient.
A subject that makes people talk and react:
- The 5th conference “Optimal nutritional care for all” (ONCA) addressed the subject last November (2018).
- The Committee to Combat Undernutrition has developed 10 concrete proposals to combat undernutrition. Such reforms require a new rethinking of the hospital system, a reconsideration that is part of a more global approach to rethinking hospital nutrition.
- The CLANs (Comité de Liaison Alimentation Nutrition) are working to improve screening by offering training.
Technology is also at the service of undernutrition, for screening and application monitoring, which facilitates the work of health professionals.