Nutrition Transition in the Post-Economic Crisis of Greece: Assessing the Nutritional Gap of Food-Insecure Individuals. A Cross-Sectional Study.

Food insecurity has risen by 40% in Europe's post-economic crisis, linked to the economic turmoil and austerity. Despite the intensification of efforts to fight all forms of poverty, including the implementation of programs targeted to the most deprived, the study of individuals at risk of food insecurity has been largely neglected. This study aimed to map the nutritional habits and needs of the most deprived in Greece, one of the countries most affected by the economic crisis. Individuals classified as most deprived under the Fund for the European Aid to the Most Deprived (FEAD) criteria (n = 499) from across Greece and an age matched control from the general population (n = 500) were interviewed between December 2017 and December 2019. Participants provided information about demographic characteristics, and self-reported anthropometric measures and nutritional intake of the past month via a food frequency questionnaire (FFQ). Protein and energy malnutrition were defined as daily intake <1.950 kcal and ≤0.75 g/kg body-weight accordingly. Protein and energy malnutrition were high among FEAD recipients (52.3% and 18.6% respectively, p < 0.001), alongside a high prevalence of overweight and obesity (BMI > 25: 68.4% versus 55.1%; p < 0.001). The diet of FEAD recipients included higher amounts of carbohydrates, lower amounts of monounsaturated fat (MUFA) and polyunsaturated fat (PUFA; p < 0.001 compared to control), larger amounts of plant-based proteins (5.81 ± 1.7 versus 4.94 ± 1.3% E respectively, p < 0.001) and very limited intake of fish (0.07 portions/day). Despite being enrolled in a food assistance program, protein and energy malnutrition is prevalent among Greece's most deprived who experience not only lower diet quality but also the double burden of malnutrition.

Coding for Malnutrition in the Hospital: Does It Change Reimbursement?

Protein calorie malnutrition (PCM) is prevalent in the acute care setting, affecting up to 50% of hospitalized patients. PCM is associated with poor outcomes, including increased hospital and intensive care unit length of stay, hospital readmission rates, incidence of pressure injuries and nosocomial infections, and mortality. PCM is a financial burden on the healthcare system through direct costs related to treatment as well as indirect costs related to poorer outcomes and complications. Medical coding for malnutrition after a patient's hospital stay is poorly representative of the actual prevalence of malnutrition, as only a small percentage of these hospital stays are coded for PCM. Improvements in identification and coding of malnutrition can result in significant increases in hospital reimbursement, which can in part help defray increased costs associated with the condition.

Cost of oropharyngeal dysphagia after stroke: protocol for a systematic review.

INTRODUCTION: Oropharyngeal dysphagia (OD) is a major disorder following stroke. OD can produce alterations in both the efficacy and safety of deglutition and may result in malnutrition, dehydration, frailty, respiratory infections and pneumonia. These complications can be avoided by early detection and treatment of OD in poststroke patients, and hospital stays, medication and mortality rates can be reduced. In addition to acute in-hospital costs from OD complications, there are other costs related to poststroke OD such as direct non-healthcare costs or indirect costs. The objective of this systematic review is to assess and summarise literature on the costs related to OD in poststroke patients. METHODS AND ANALYSIS: A systematic review of studies on the cost of OD and its complications (aspiration, malnutrition, dehydration, aspiration pneumonia and death) in patients who had a stroke will be performed from the perspectives of the hospital, the healthcare system and/or the society. The main outcomes of interest are the costs related to poststroke OD. We will search MEDLINE, Embase and the National Health Service Economic Evaluation Database. Studies will be included if they are partial economic evaluation studies, studies that provide information on costs in adult (>17 years) poststroke patients with OD and/or its complications (malnutrition, dehydration, frailty, respiratory infections and pneumonia) or economic evaluation studies in which the cost of this condition has been estimated. Studies will be excluded if they refer to oesophageal dysphagia or OD caused by causes other than stroke. Main study information will be presented and summarised in tables, separately for studies that provide incremental costs attributable to OD or its complications and studies that report the effect of OD or its complications on total costs of stroke, and according to the perspective from which costs were measured. ETHICS AND DISSEMINATION: The results of this systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42018099977.

Identifying in-patient costs attributable to the clinical sequelae and comorbidities of alcoholic liver disease in a national hospital database.

BACKGROUND AND AIMS: The clinical sequelae and comorbidities of alcoholic liver disease (ALD) often require hospitalization. The aims of this study were to (1) compare the average costs of hospitalizations with ALD and the costs of hospitalizations with other alcohol-related diagnoses that do not involve the liver; and (2) estimate the percentage of the difference in costs between the ALD and non-ALD hospitalizations that may be attributed to ascites, protein-calorie malnutrition and other conditions. DESIGN: The 2012 National Inpatient Sample is a population-based cross-sectional database representing more than 94% of all discharges from community hospitals in the United States. SETTING: Community hospitals in the United States. PARTICIPANTS: The sample included 72 531 hospitalizations with ALD and 287 047 hospitalizations with other alcohol-related diagnoses. MEASUREMENTS: The dependent variable was total in-patient costs. We estimated the contribution of ascites, protein-calorie malnutrition and other conditions to the difference in costs between patients with ALD and patients with other diagnoses. FINDINGS: Average costs for ALD patients were $3188.4 higher than those for patients with other diagnoses ($13 543 versus $10 355; P < 0.001). Among all conditions in the analysis, protein-calorie malnutrition had the largest impact on costs [$6501; 95% confidence interval (CI) = 5956, 7045; P < 0.001] accounting for 12% of the higher costs of ALD stays. CONCLUSIONS: Costs of hospital care for patients with alcoholic liver disease are higher than those for patients with other alcohol-related diagnoses. These increased costs are associated with specific clinical sequelae and comorbidities, with protein-calorie malnutrition-a largely preventable condition-making a substantial contribution.

Comparative analysis of undernutrition screening and diagnostic tools as predictors of hospitalisation costs.

BACKGROUND: Undernutrition is associated with higher hospitalisation costs. The present study aims (i) to explore whether undernutrition status at hospital admission, as evaluated by different screening and diagnostic tools, can predict patient's hospitalisation costs and (ii) to provide an updated economic analysis of undernutrition burden. METHODS: A prospective study was conducted in a university hospital. Participants' (n = 637) nutritional risk was evaluated within 72 h of admission using the Nutritional Risk Screening (NRS-2002) and the Malnutrition Universal Screening Tool ('MUST'). Undernutrition status was determined by Academy of Nutrition and Dietetics (AND) and American Society for Parenteral and Enteral Nutrition (ASPEN) recommended clinical characteristics and by the Patient Generated Subjective Global Assessment (PG-SGA). The hospitalisation cost was calculated for each inpatient using the diagnosis-related group system. Multivariable linear regression analysis was conducted to identify predictors of hospitalisation costs via percentage deviation from the mean cost, after adjustment for patients' characteristics and comorbidities. RESULTS: Undernutrition risk according to NRS-2002 and high undernutrition risk according to 'MUST' increased patient's costs, respectively, by 21.1% [95% confidence interval (CI) = 9.0-33.2%] and 28.8% (95% CI = 13.7-39.9%). Severe undernutrition by AND-ASPEN recommended clinical characteristics and by PG-SGA was also associated with higher hospitalisation costs, respectively 19.4% (95% CI = 7.3-31.5%) and 27.5% (95% CI = 14.0-41.1%). The cost of a nutritionally-at-risk or undernourished patient is between €416 (95% CI = €156-675) and €617 (95% CI = €293-855) higher than the average of the respective diagnosis-related group. CONCLUSIONS: Undernutrition is a predictor of hospitalisation costs, increasing costs by between 19% and 29%. Undernutrition screening tools have an ability for predicting hospitalisation costs similar to that of diagnostic tools. An updated analysis of undernutrition associated costs was provided, highlighting the economic burden of undernutrition.

Malnutrition coding 101: financial impact and more.

Recent articles have addressed the characteristics associated with adult malnutrition as published by the Academy of Nutrition and Dietetics (the Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). This article describes a successful interdisciplinary program developed by the Department of Food and Nutrition at New York-Presbyterian Hospital to maintain and monitor clinical documentation, ensure accurate International Classification of Diseases 9th Edition (ICD-9) coding, and identify subsequent incremental revenue resulting from the early identification, documentation, and treatment of malnutrition in an adult inpatient population. The first step in the process requires registered dietitians to identify patients with malnutrition; then clear and specifically worded diagnostic statements that include the type and severity of malnutrition are documented in the medical record by the physician, nurse practitioner, or physician's assistant. This protocol allows the Heath Information Management/Coding department to accurately assign ICD-9 codes associated with protein-energy malnutrition. Once clinical coding is complete, a final diagnosis related group (DRG) is generated to ensure appropriate hospital reimbursement. Successful interdisciplinary programs such as this can drive optimal care and ensure appropriate reimbursement.

New insights into the role of anabolic interventions in dialysis patients with protein energy wasting.

PURPOSE OF REVIEW: Patients on maintenance dialysis commonly develop protein-energy wasting (PEW), which is associated with poor survival. There have been several advances in anabolic interventions aimed at improving PEW in these patients in recent years. RECENT FINDINGS: Oral or parenteral nutritional supplementation, especially if administered during dialysis, improves net protein anabolism in chronic hemodialysis patients. These beneficial effects have been extended to long-term benefits in recent clinical trials. Resistance exercise, alone or combined with intradialytic oral nutrition supplementation, also improves net protein balance in the acute setting although recent studies indicated a limited beneficial effect of long-term exercise alone on muscle protein accretion in chronic hemodialysis patients. Anabolic agents such as growth hormone and androgens have been shown to exert significant benefits on visceral protein stores, muscle mass and strength. Ghrelin, a hormone with combined orexigenic and anti-inflammatory effects, is a potential new nutritional intervention in maintenance dialysis patients. SUMMARY: Existing anabolic therapeutic strategies have proven to be effective in improving PEW in maintenance dialysis patients. Combined anabolic interventions and several new and established anabolic hormones represent further promising nutritional interventions. Large-scale randomized controlled trials examining the effects of anabolic interventions on mortality and morbidity are still lacking.

Tobacco expenditures and child health and nutritional outcomes in rural Bangladesh.

This study examined the relationship between tobacco prices and child health outcomes so as to assess the potential of improved child health outcomes resulting from less tobacco expenditure. In part, this paper was motivated by a study by. Efroymson et al. [(2001). Hungry for tobacco: An analysis of the economic impact of tobacco consumption on the poor in Bangladesh. Tobacco Control, 10, 212-217] suggesting that for the poorest households in Bangladesh, amongst whom malnutrition is widespread, shifting tobacco expenditures to expenditures on food would significantly improve the nutritional status of the household. We used data from a survey of 956 households conducted in rural Bangladesh between June 1996 and September 1997. The households were surveyed four times at approximately 4-month intervals during the 16-month period. We restricted our sample to households with children aged 2-10, and 600 households satisfied this criterion. The primary dependent variables for this study are three anthropometric indicators of child health and nutritional status: a standardized measure of height for age, a standardized measure of weight for height, and a standardized measure of weight for age. We also used measures of self-reported morbidity, including the incidence and duration of respiratory illness. We used regression methods on data averaged across survey rounds to estimate the relationship between tobacco prices and the outcome variables. Tobacco prices were found to be a significant determinant of height for age and weight for height for both boys and girls. Furthermore, the price of tobacco products is a significant predictor of weight for age for girls and the pooled sample. Our results suggest that higher tobacco prices would, for the most part, improve child health.

Does economic inequality affect child malnutrition? The case of Ecuador.

Economic inequality has been hypothesized to be a determinant of population health, independent of poverty and household income. We examined the association between economic inequality and child malnutrition in Ecuador. Economic inequality was measured by the Gini coefficient of household per capita consumption, estimated from the 1990 Census. Childhood stunting, assessed from height-for-age z scores, was obtained from the 1998 Living Standards Measurement Survey (LSMS). We controlled for a range of individual and household covariates, including per capita food consumption, education, housing, ethnicity, fertility, access to health services, diarrhea morbidity, child care, mother's age and diet composition. Stunting still affects 26% of children under five in Ecuador, with higher prevalence in the rural Highlands and among indigenous peoples. Maternal education, basic housing conditions, access to health services, ethnicity, fertility, maternal age and diet composition were independently associated with stunting. However, after controlling for relevant covariates, economic inequality at the provincial scale had a statistically significant deleterious effect on stunting. At municipal or local levels, inequality was not associated with stunting.

Use of oral supplements in malnourished elderly patients living in the community: a pharmaco-economic study.

BACKGROUND & AIMS: Inadequate nutritional support in elderly patients is likely to be responsible for increased morbidity and increased associated costs. Conversely prescribing oral supplements to ensure sufficient protein and energy intake should be beneficial. Even though this claim makes sense there is a lack of objective data to support the evidence. The objective of the present study was to assess the cost of malnutrition and related comorbidities among elderly patients living in the community and to determine the impact of nutritional support practice on these outcomes. METHODS: Observational, prospective, longitudinal, cohort study with a 12 months follow-up conducted with 90 general practitioners in France. Two groups of physicians were selected based on historical prescribing practice: group 1 with rare and group 2 with frequent prescription of oral nutrition supplements. The resulting study population was 378 elderly malnourished patients aged over 70, living in the community, either at home or in institutions. Nutritional status at baseline was determined using the Mini Nutritional Assessment (MNA) scale. Main outcome measures were nutritional status, malnutrition-related comorbidities and medical care consumption. RESULTS: Populations in the two groups of patients were balanced for age, gender, weight and body mass index but differed significantly in terms of housing status (P < 0.005) and nutritional status (P < 0.001). After adjustment for baseline characteristics, MNA improved within both groups over time but improvement was significantly higher in group 2 than in group 1 (P < 0.01). The adjusted cost per patient of hospital care (EUR -551), nursing care (EUR -145) and other medical care was significantly reduced in group 2 as compared to group 1, with cost savings of EUR -723 per patient (90% CI: EUR -1.444 to EUR -43). Including the costs related to nutritional products, the total cost savings per patient attributable to nutrition support were EUR -195 (90% CI: EUR -929 to EUR +478). CONCLUSION: Appropriate nutrition support can address the problem of malnutrition among elderly individuals living in the community and may contribute to reduce the costs of health care.

Cost-effectiveness of an interdisciplinary intervention in geriatric inpatients to prevent malnutrition.

BACKGROUND: In order to reduce protein-energy malnutrition in older people during hospitalisation an early interdisciplinary intervention is needed. We developed a protocol which includes screening for malnutrition, dysphagia and dehydration on admission, followed by immediate interventions. OBJECTIVE: To assess effectiveness of the protocol on nutritional status, hospital-acquired infections and pressure sores, and to evaluate the protocol s economical feasibility. DESIGN: Prospective, controlled study. SETTING: The inpatient geriatric service of a university hospital (UMC Nijmegen) and a geriatric ward of a non-academic teaching hospital (Rijnstate Hospital, Arnhem). SUBJECTS: 298 older patients (>60 years). METHODS: One of the geriatric wards applied the protocol (N=140) while the other provided standard care (N=158). All non-terminally ill patients admitted for more than two days were included. Body mass was measured on admittance and discharge and hospital-acquired infections and pressure sores were scored and costs related to nutrition, infections and length of hospital stay were assessed. RESULTS: There was a 0.8 kg loss (SEM 0.3 kg) in average weight in the standard care group and a 0.9 kg gain (SEM 0.2 kg) in the intervention group (p<0.001). The number of hospital acquired infections was significantly lower in the intervention group (33/140 versus 58/158, p=0.01) but no significant difference in number of patients with pressure sores (23/140 versus 33/158) was found. Costs were not significantly different: 7516 versus 7908 Euro/patient for intervention versus controls, respectively. CONCLUSION: An early interdisciplinary intervention approach can be effective in reducing protein-energy malnutrition and related hospital-acquired infections and appears to be economically feasible.

Undernutrition in hospital patients.

Undernutrition is a serious condition affecting significant numbers of patients in hospital. It increases the risk of mortality, delays recovery and increases the cost of hospitalisation. The prevention of undernutrition in hospital patients should be a priority for all healthcare professionals and requires a collaborative multidisciplinary approach.

Insuficiência alimentar nas grandes regiöes urbanas brasileiras / Alimentary insufficiency in large Brazilian urban regions

Apresenta as estimativas de insuficiência da disponibilidade calórica e dos gastos com alimentaçäo das grandes regiöes urbanas do país. Coteja as despesas familiares e as quantidades consumidas de alimentos, nas onze regiöes metropolitanas pesquisadas, com o custo de aquisiçäo das cestas e com as recomendaçöes calóricas mínimas em cada uma delas. Verifica que as famílias de menor renda encontram-se em situaçäo de risco nutricional e que näo há relaçäo direta entre a insuficiência de disponibilidade calórica e a relativa aos gastos alimentares. Observa, em alguns estratos de renda, insuficiência calórica do consumo físico ainda que os gastos superem o custo da cesta normativa. Em algumas regiöes o consumo alimentar exibe comportamento peculiar diante do esperado, onde, famílias com renda mensal até oito salários mínimos apresentam disponibilidades calóricas inferiores às recomendaçöes mínimas. Apresenta hipóteses explicativas para o fato, tais como a emulaçäo do consumo das famílias de maior renda, a existência de redes de proteçäo sociais privadas e a importância do consumo alimentar institucional, seja na escola seja no local de trabalho.

The role of visceral protein markers in protein calorie malnutrition.

Despite substantial evidence of the crucial role protein calorie malnutrition (PCM) plays in the occurrence of complications, increased length of stay, and cost of care in hospitalized populations, no standard approach for screening and monitoring the nutritional status of patients initially and throughout admission currently exists. Recognizing that there is a growing public and professional recognition of the importance of malnutrition, a large patient population (30-55%) at risk for PCM, and an even larger population experiencing declining nutritional status during hospitalization, this study examined the feasibility of a full-scale study to assess the value of two biochemical markers, transthyretin and albumin, for detecting and monitoring PCM in hospitalized patients. It was demonstrated that these two markers do provide important information predictive of outcomes for those they identify at risk for PCM. The patients who entered the study with or developed low transthyretin and albumin experienced poorer health outcomes and higher costs of care. Their discharge occurred in an early phase of recovery, with significant implications for after-discharge care. The full-scale study must consider severity of illness and other confounders during randomization and, preferably, be conducted in institutions that currently do not use transthyretin for nutrition assessment.

Costo de la desnutrición proteicocalórica para un país como Guatemala / Cost of proteic and caloric malnutrition for a country as Guatemala

A propósito de los casos recientes y graves de desnutrición aguda y crónica en el oriente de nuestro país (Camotán, Olopa, Chiquimula) es importante hacer mención que este problema representa un drenaje de alto costo en la economía de los paises no desarrollados, como el nuestro. Se han analizado los cambios biológicos que produce la desnutrición, sobre todo maternoinfantil, pero no así, los efectos económicos directos e indirectos en sociedades como la nuestra. Como por ejemplo, en algunos países similares al nuestro, el problema de la desnutrición puede afectar anualmente hasta el 10/100 de su producto nacional bruto (PNB), ocasionando pérdidas anuales de miles de dólares por niño enfermo o fallecido. Los hospitalarios, los gastos sociales y los gastos nacionales que representan la desnutrición en Guatemala son demasiados altos, lo que trata de abordar éste trabajo.

Health impacts of rapid economic changes in Thailand.

The economic crisis in Thailand in July 1997 had major social implications for unemployment, under employment, household income contraction, changing expenditure patterns, and child abandonment. The crisis increased poverty incidence by 1 million, of whom 54% were the ultra-poor. This paper explores and explains the short-term health impact of the crisis, using existing data and some special surveys and interviews for 2 years during 1998-99. The health impacts of the crisis are mixed, some being negative and some being positive. Household health expenditure reduced by 24% in real terms; among the poorer households, institutional care was replaced by self-medication. The pre-crisis rising trend in expenditure on alcohol and tobacco consumption was reversed. Immunization spending and coverage were sustained at a very high level after the crisis, but reports of increases in diphtheria and pertussis indicate declining programme quality. An increase in malaria, despite budget increases, had many causes but was mainly due to reduced programme effectiveness. STD incidence continued the pre-crisis downward trend. Rates of HIV risky sexual behaviour were higher among conscripts than other male workers, but in both groups there was lower condom use with casual partners. HIV serosurveillance showed a continuation of the pre-crisis downward trend among commercial sex workers (CSW, both brothel and non-brothel based), pregnant women and donated blood; this trend was slightly reversed among male STD patients and more among intravenous drug users. Condom coverage among brothel based CSW continued to increase to 97.5%, despite a 72% budget cut in free condom distribution. Poverty and lack of insurance coverage are two major determinants of absence of or inadequate antenatal care, and low birthweight. The Low Income Scheme could not adequately cover the poor but the voluntary Health Card Scheme played a health safety net role for maternal and child health. Low birthweight and underweight among school children were observed during the crisis. The impact of the crisis on health was minimal in some sectors but not in the others if the pre-crisis condition is efficient and healthy and vice versa. We demonstrated some key health status parameters during the 2-year period after the 1997 crisis but do not have firm conclusions on the impact of the economic crisis on health status, as our observation is too short and there is uncertainty on how long the crisis will last.

Impact of income growth on household protein and calorie intake in Addis Ababa.

OBJECTIVES: To estimate calorie-income elasticity and to determine calorie and protein intake levels of Addis Ababa population. DESIGN: Cross-sectional study with descriptive and analytical component. SETTING: Addis Ababa, Ethiopia. PARTICIPANTS: One thousand three hundred and fifty seven households. RESULTS: The mean monthly income and expenditure on food per household were 467.14 and 253.33 birr respectively. The mean calorie intake per adult equivalent was found to be 1952.71 Kcal and mean protein intake per capita was 48.51 gm. The estimated income elasticity for food expenditure was 0.52, while income elasticity for calorie availability was 0.51. Income elasticity for calorie availability was much higher in the low-income group (0.57) than the well-off group (0.16). CONCLUSION: These results suggest that increase in income, seems to be a sufficient condition for nutritional improvement among the low-income group.

Malnutrition: role of the TwoCal HN Med Pass program.

Malnutrition is common in older adults and is associated with poor outcomes. The causes and outcomes of malnutrition are discussed, and the TwoCal HN Med Pass program, designed to overcome poor dietary intake, is described. Benefits of the program, role of the pharmacist, identification of candidates for the TwoCal HN Med Pass program, and health care team roles and responsibilities are reviewed.

Programa de intervención alimentaria, nutrimental y metabólica del paciente hospitalizado / Food, nutritional and metabolic intervention program for hospitalized patients

Se presentan las políticas, acciones y procedimientos de intervención diagnóstica y terapéutica que dentro del Programa de Intervención Alimentaria, Nutrimental y Metabólica, están dirigidas a brindar un apoyo alimentario y nutrimental al paciente hospitalizado. El objetivo del programa es elevar la calidad de la atención médica recibida por el paciente, y reducir la morbilidad y la mortalidad intrahospitalaria dentro de una relación costo-efectividad que permita aliviar la sobrecarga financiera sobre los presupuestos de salud (AU)