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Nutrición Hospitalaria

On-line version ISSN 1699-5198Print version ISSN 0212-1611

Nutr. Hosp. vol.24 n.3 Madrid May./Jun. 2009




Under nutrition - a major health problem in Europe

Desnutrición, un problema sanitario de gran magnitud en Europa






El presidente de ESPEN (Sociedad Europea de Nutricion Parenteral y Enteral), Dr. Olle Ljungqvist, se dirige a los miembros de SENPE para informar sobre las acciones que, inspiradas por ESPEN, se van a emprender desde la presidencia de la Comunidad Europea al objeto de combatir la malnutrición en los hospitales y entre los ancianos, un problema que no por pasar desapercibido deja de ser de gran magnitud. El tema será motivo de un encuentro de ministros de Sanidad de la Comunidad Europea durante el mes de Junio de 2009. Desde la presidencia de ESPEN se propone un plan de accion que consta de seis puntos que la SENPE hace suyos.

Dear Editor,
Dear members of SENPE,


Under nutrition, poor nutritional status or as it is commonly phrased malnutrition is Europe's hidden major health problem. This week, the EU presidency of the Czech Republic invites all health ministries and world experts to a two-day conference aimed at tackling this major problem.

In Spain and in Europe, the world's richest region, disease related malnutrition is a major health problem for society and for health care. This fact has recently been identified in the EU. In 2003 the Council of Europe published the "Resolution on food and nutritional care in hospitals" and is recently followed by a similar resolution for care homes. Last autumn, the European Parliament decided that malnutrition in hospitals and other care situations was to be a central feature in the coming five year 'Together for Health' strategy for the entire European Union. The present Czech EU Presidency now responds to this call by inviting the Health Ministries of all EU countries to meet with the European expertise on nutrition to find ways to jointly tackle this major health problem in Prague later this week. In the presidency to follow, in Sweden, an upcoming conference on the elderly should be an important follow up since malnutrition is particularly common, with 10-20% of this age group affected by malnutrition.


The tip of the ice berg

Malnutrition does not show up in the streets in Europe. Instead malnutrition is a hidden health problem, residing at home or in care homes. At least 25% of all patients admitted to hospitals are malnourished or at risk for malnutrition. Overall, five per cent of the population in Europe is estimated to be at risk for malnutrition. Substantially higher figures have repeatedly been reported from every kind of care situation, in particular in the elderly where at least 10% have malnutrition or are at risk of developing malnutrition. Very recent figures from Sweden show that 15% of the individuals' ages 75-80+ living at home are at risk for malnutrition. Malnutrition associated with disease is associated with markedly higher risks for complications/comorbidity, poor quality of life, increased need for care both as out patients and in hospitals and care institutions. Malnourished patients have a higher mortality compared to well nourished patients. In the UK shows 3 million citizens suffer from malnutrition. The situation is similar all over Europe with regard to malnutrition as shown by studies performed in 70 000 patients and individuals in care homes performed by the European Society for Clinical Nutrition and Metabolism (ESPEN). Hence, the UK situation then transforms to at least 33 million Europeans suffering from malnutrition. The cost for disease related malnutrition in the UK was estimated to about 15 billion euro. Again on a European scale this transforms to at least 170 billion euro annually.


A call for joint action

Numerous studies have shown that nutritional treatment to the malnourished patient improves outcomes, reduces the cost for care and improves quality of life. In the UK the cost spent on nutritional treatment is only about 2,5% of the cost for malnutrition. Other studies show that the average net savings from oral nutritional supplements in hospital costs is about 1,000 euros per patient, mainly related to shorter length of stay an less need for care.

The main obstacles to improving nutritional care lies in the lack of awareness for the problem among the general public, but also among decision makers and even care providers. To battle this major problem a global effort is needed involving all stakeholders. ESPEN, in association with their respective national society for clinical nutrition and metabolism alongside the European Nutrition for Health Alliance has initiated a major effort to improve nutritional care. The targets for improvements in the care of the malnourished includes:

- Public awareness and education
- Guideline development and implementation.
- Training in nutritional care.
- Mandatory screening for malnutrition.
- National nutritional care plans for nutrition.
- Research on malnutrition.

With the upcoming conference in Prague organised by the EU presidency, we are ready to launch this pan European movement to minimize the impact of malnutrition in Europe. We invite all health ministers and their ministries to join us and place our experiences and expertise at their disposal to tackle this major health problem.


O. Ljungqvist1 and F. de Man2

1Professor of Surgery. Nutrition and Metabolism. Karolinska Institutet. Stockholm. Sweden. Chairman ESPEN. Co-Chairman, European Nutrition for Health Alliance ENHA.
2General Secretary. ENHA. Sweden.



O. Ljungqvist.
Karolinska Institutet, Stokholm, Sweden

Recibido: 01-VI-2009.
Aceptado: 01-VI-2009.

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