What is happening with the clinical nutritionist? Realities and challenges.

BACKGROUND: At hospital level, clinical nutritionists play a fundamental role in health recovery, contributing to shorter hospital stays and addressing hospital malnutrition. However, in Latin America no studies have been conducted on the activities of the nutritionist and the factors influencing their performance. AIMS: to describe the activities of the clinical nutritionist in public and private hospital settings in Latin America and to determine the factors associated with disciplinary practice. METHODS: A cross-sectional analytical, quantitative study was conducted. Participants consisted of hospital nutritionists from 13 Latin American countries who had participated in a previously validated online survey on the activities performed during their daily work, obtaining a Professional Activities Score (PAS). RESULTS: 1222 nutritionists participated. Of the activities associated with the professional role, the only ones who reached over 75 % of execution were: performing nutritional intervention; performing nutritional assessment and diagnosis; providing counseling and dietary prescription; developing nutritional care plans for patients with nutritional problems; and performing the monitoring and evaluation of results of priority patients. The least frequent activities were: university teaching and collaborating in research. Regarding the reasons for not performing activities: 34.0 % reported not being included in the activities, 24.5 % mentioned lack of time, and 13.6 % indicated that the activities were conducted by another professional. Variables positively associated with an increase in the PAS were: having spent more years exercising the profession (Beta: 0.028, 95 % CI: 0.004; 0.051), and having a greater number of specialties (4 or more, Beta: 2.294, 95 % CI: 1.031; 3.557). Working in lower-complexity facilities (Low: Beta: -1.037, 95 % CI: -1.443; -0.630), and having more reasons for not performing the activities (3 or more: Beta: -3.105, 95 % CI: -4.111; -2.099) were inversely associated. From the sample, 1.8 % held a doctorate in clinical nutrition, 43.9 % had a specialty, and 64.4 % had a diploma or postgraduate degree in clinical nutrition. CONCLUSION: None of the activities related to the nutritionist work was performed on a 100 % basis. In Latin America, Ministries of Health should standardize and regulate the functions of the clinical nutritionist, as well as quantifying understaffing and proposing solutions to alleviate the shortage of these professionals, acknowledging the positive impact that they have on the recovery of hospital patients.

Barriers and Opportunities for Clinical Nutritionists in 13 Latin American Countries: A Qualitative Study.

A clinical nutritionist (CN) is a university-educated professional trained to perform preventive and recovery functions in the health of patients. The actions of these professionals, both worldwide and in Latin America, may face barriers and opportunities that require careful identification and examination. The main objective of this study is to identify the most important barriers and opportunities for the clinical nutritionist in 13 Latin American countries. A qualitative study was carried out; the initial phase involved conducting in-depth individual interviews with 89 informants, experienced CNs from 13 Latin American countries. After calculating the mean and standard deviation, we ranked the top 10 most frequently reported barriers by assigning a score ranging from 1 to 10. Additionally, 3 opportunities were identified with a lower score from 1 to 3. Means and standard deviation were calculated to sort the responses. Results: the most important barrier was the absence of public policies that regulate and/or monitor compliance with the staffing of CNs according to the number of hospital beds, while the most important opportunity was the advances in technology such as software, body analysis equipment and other tools used in Nutritional Care. The identified barriers can interfere with the professional performance of CNs and, moreover, make it difficult to monitor the good nutritional status of patients. It is recommended to consider the barriers identified in this study, as well as the opportunities, with a view to improving the quality of hospital services with an adequate supply of nutritionists.

Doble carga de malnutrición en prescolares, escolares y adolescentes bolivianos que viven a gran altura, municipio de La Paz / Double burden of malnutrition in Bolivian preschool, school age children and adolescents living at high altitudes, municipality of La Paz

INTRODUCCIÓN: la presencia simultánea del retraso del crecimiento y del exceso de peso en una persona representa una de las principales paradojas en la salud pública global y es de creciente preocupación en Bolivia, donde ambas condiciones en su conjunto no han sido abordadas y ocurren en un contexto de transición nutricional en el que se encuentra el país. OBJETIVO: describir la coexistencia de la doble carga de malnutrición a nivel individual en la población escolar (3-19 años) del municipio de La Paz. MÉTODOS: se realizó un estudio observacional de corte transversal analítico con datos antropométricos de 7.654 escolares pertenecientes al municipio de La Paz del año 2019. Se determinaron las prevalencias y los intervalos de confianza al 95% para emaciación, retraso en el crecimiento, sobrepeso, obesidad y sobrepeso + obesidad por sexo y grupo de edad. A nivel poblacional, la doble carga de malnutrición (DCM), se estimó en base a los umbrales de alta prevalencia sugeridos por organizaciones internacionales, a saber, prevalencias por encima del 20% y 10% para retraso en el crecimiento y sobrepeso, respectivamente. Para los análisis a nivel individual, la DCM se definió como la coexistencia de retraso en el crecimiento y sobrepeso + obesidad en los tres grupos de estudio y se comparó con su valor esperado, bajo el supuesto de distribuciones independientes de cada condición. RESULTADOS: a nivel poblacional, la prevalencia de emaciación para toda la muestra analizada fue de 3,7%, sin diferencias significativas por sexo. La prevalencia de retraso del crecimiento para el año 2019 no superó el 20% en todos los grupos de edad analizados. La prevalencia de sobrepeso fue mayor al 10% para el grupo de escolares y adolescentes. A nivel individual la doble carga de malnutrición se encontró en 2,8%, 1,9% y 2,9% en prescolares, escolares y adolescentes, respectivamente. Valores que se encontraron por debajo de lo esperado. CONCLUSIONES: las prevalencias de doble carga de malnutrición, retraso del crecimiento y sobrepeso + obesidad a nivel individual, fueron menores de lo esperado en los tres grupos de estudio, asumiendo distribuciones independientes de las dos condiciones. A pesar de ello, la coexistencia de la doble carga poblacional (municipio de La Paz) debe ser abordada en políticas y programas adecuados de salud pública(AU).

INTRODUCTION: the simultaneous presence of growth retardation and excess weight in a person represents one of the main paradoxes in global public health and is of growing concern in Bolivia, where both conditions as a whole have not been addressed and occur in a context of nutritional transition in which the country finds itself. OBJECTIVE: to describe the coexistence of the double burden of malnutrition at the individual level in the school population (3-19 years) of the municipality of La Paz. METHODS: an analytical cross-sectional observational study was carried out with anthropometric data from 7,654 schoolchildren belonging to the municipality of La Paz in 2019. The prevalences and 95% confidence intervals were determined for wasting, stunting, overweight, obesity and overweight+obesity, by sex and age group. At the population level, the double burden of malnutrition (DBM) was estimated based on thresholds of high prevalence suggested by international organizations, namely, prevalence above 20% and 10% for stunting and overweight, respectively. For individual level analyzes, DBm was defined as the coexistence of stunting and overweight + obesity in the three study groups and was compared with its expected value, under the assumption of independent distributions of each condition. RESULTS: at the population level, the prevalence of wasting for the entire sample analyzed was 3.7%, with no significant differences by sex. The prevalence of stunting for the year 2019 did not exceed 20% in all the age groups analyzed. The prevalence of overweight was higher than 10% for the group of schoolchildren and adolescents. At the individual level, the double burden of malnutrition was found in 2.8%, 1.9% and 2.9% in preschool, schoolchildren and adolescents, respectively. Values that turned out to be lower than expected. CONCLUSIONS: the prevalence of double burden, growth retardation and overweight and obesity at the individual level, were lower than expected in the three study groups, assuming independent distributions of the two conditions. Despite this, the coexistence of the double burden in the municipality of La Paz must be addressed in appropriate public health policies and programs(AU).