Dietitian-nutritionist incorporation in a university hospital: position statement of the Commission on Nutrition, Hospital Universitario La Paz.

Introduction: The present document has the objective of justifying the incorporation of a dietician/nutritionist to the multidisciplinary teams of specialized care that provide education, food anamnesis, nutritional recommendations, treatment and follow up of those patients in risk of malnutrition in Madrid. The appropriate nutritional status of hospitalized patients bears a close relationship with the existence of dieticians at hospitals. Dieticians use nutrition therapy as a cost-effective means to achieve significant health benefits by preventing or altering the course of diabetes, obesity, hypertension, lipid metabolism disorders, heart failure, osteoporosis, celiac disease, and chronic kidney disease, among other diseases.

Introducción: El presente documento tiene como objetivo plantear y justificar la incorporación del dietista-nutricionista en los equipos multidisciplinares de atención integrada en la educación, el tratamiento y el seguimiento de aquellos pacientes con patologías que cursen con alteraciones del estado nutricional, tanto en su defecto como en su exceso, en el área sanitaria de la Comunidad Autónoma de Madrid. El estado nutricional de los pacientes hospitalizados se beneficiará de la incorporación del dietista-nutricionista al equipo multidisciplinar que, actualmente, se ocupa de la atención de estos. El manejo de la terapia nutricional por dietistas-nutricionistas ha demostrado ser costo-efectiva, habida cuenta de la repercusión sanitaria que tiene el estado nutricional en la evolución clínica y prevención de enfermedades como la diabetes, los trastornos de la conducta alimentaria, la obesidad, el cáncer, la insuficiencia cardiaca, la osteoporosis, la enfermedad celiaca y la enfermedad renal crónica, entre otras.

[Costs associated to disease-related malnutrition and treatment: a literature review]. / Costes asociados a la desnutrición relacionada con la enfermedad y su tratamiento: revisión de la literatura.

INTRODUCTION: disease-related malnutrition has a high prevalence, with clinical consequences potentially severe for the patient, and of high economic impact for the healthcare system. OBJECTIVE: to perform a review of the literature regarding the economic burden of disease-related malnutrition, to assess complications, and to determine the usefulness of enteral or oral nutritional supplementation from a cost analysis perspective. METHODS: a review of the literature up to June 2016 was carried out regarding economic costs of disease-related malnutrition and cost analysis of nutritional treatment, with special focus on retrieval of systematic reviews, meta-analysis, and randomized clinical trials. RESULTS: a total of 31 publications were selected, 15 on costs of disease-related malnutrition and 16 on costs of treatment. Disease-related malnutrition increases health care costs in relation to a longer hospital stay, higher incidence of infectious and non-infectious complications, greater need of treatment, increase in readmissions, more prolonged stay in the intensive care unit and/or the need of referral to continuing care centers at discharge. Publications regarding treatment with oral nutritional supplements suggest that these oral supplements are cost-effective and cost-beneficial both in ambulatory and hospitalized patients. CONCLUSIONS: disease-related malnutrition causes an increase in health care costs that could be minimized, among other approaches, by an early diagnosis and treatment for which oral nutritional supplements are cost-effective and cost-beneficial.