CONCLUSIONS

1
MULTIDISCIPLINARY CONSENSUS ON HOSPITAL
MALNUTRITION IN SPAIN A step forward of the
Spanish Society for Parenteral and Enteral
Nutrition (SENPE) to its compromise on the fight
against malnutrition Dr. Abelardo García de
Lorenzo SENPE President
BACKGROUND

2009
2010
2011

• The Consensus paper position statements to
  fight against hospital malnutrition endorsed by
  several medical and scientific Spanish societies
  has established recommendations to facilitate
  the prevention, screening, diagnostic-therapeutic
  approach and evaluation of results of clinical
  intervention in patients with hospital
  malnutrition-related disease.
• Herewith, we describe the results of a
  multisciplinary approach aimed to develope the
  Consensus Paper .

plt0.05 (except A vs B and B vs C)
PROJECT METHODS

• In 2010, a nationwide, cross-sectional study (the
  PREDyCES study) estimated the burden of
  disease-related malnutrition in 1,597 patients
  recruited in 31 randomly selected hospitals one
  fourth of hospitalized patients were fount to be
  malnourished, and they were associated to a 50
  additional cost for the National Health System
  (NHS)1.
• The results of the PREDyCES study helped to
  define further actions within the SENPE
  continuous improvement process. The development
  of an inter-speciality consensus paper to address
  hospital nutrition was the main project to be
  completed during 2011.

• In 2009, the Spanish Society for Parenteral and
  Enteral Nutrition (SENPE) set-up a continuous
  improvement process with a final objective to
  ameliorate malnutrition and achieve better
  outcomes in hospitalized patients.

1 Planas Vila M, Álvarez Hernández J, García de
Lorenzo A, Celaya Pérez S, León Sanz M, García
Lorda P, Brosa M. The burden of hospital
malnutrition in Spain methods and development of
the PREDyCES study. Nutr Hosp 2010251020-1024.
SPANISH RECOMMENDATIONS FOR PREVENTION, DIAGNOSIS
AND TREATMENT OF MALNUTRITION

Recommendations outside hospital setting
Recommendations during hospitalization
Recommendations at hospital admission

• SCREENING
• Universal screening at 24-48 hours of admission
  with the most feasible method
• Minimum BMI, involuntary weight changes and
  changes in normal intake
• Ideal NRS 2002.
• Assessment by health professionals involved in
  direct patient care.
• Re-evaluation of nutritional risk at least 1 time
  per week when initial screening is negative.
• Application of diagnostic-therapeutic protocol in
  patients with positive initial screening.

• INTERVENTION
• After diagnosis of malnutrition, nutritional
  requirements definition based on clinical
  condition and underlying pathology.
• Inadequate intakes causes evaluation, systematic
  inspection and adaptation of menu to personal
  needs.
• Prescription of treatment (oral supplements) if
  insufficient response to initial dietary
  intervention.
• Prescription of treatment (enteral nutrition)
  if it persists despite oral intake of dietary
  intervention and oral supplementation (requires
  confirmation of GI tract function unaltered).
• Parenteral nutrition is reserved if here is
  contraindication to enteral nutrition or it is
  insufficient.
• Compliance, tolerability and efficacy of
  treatment will be monitored and recorded

DIRECTIONS
CONCLUSIONS

• More than 20 medical societies have participated
  in a consensus process designed to establish
  recommendations on the prevention, screening,
  diagnosis, treatment and monitoring of hospital
  malnutrition-related disease.
• The implementation of the SIGN criteria ensures
  the formulation of recommen-dations based on the
  best available clinical evidence.
• The heterogeneity of participating organizations
  and their level of involvement will facilitate
  the successful implementation of the
  recommendations.
• The Consensus paper is a step forward in the
  deployment of the action plan to implement the
  continous improvement process of Spanish Society
  for Parenteral and Enteral Nutrition (SENPE) in
  its fight agains malnutrition.

The final version of the Consensus Paper was
formally presented at the Ministry of Health
Participating Societies
Sociedad Española de Medicina de Familia y
Comunitaria (SEMFyC) Sociedad Española de
Medicina Interna (SEMI) Sociedad Española de
Médicos de Atención Primaria (SEMERGEN) Sociedad
Española de Médicos de Residencias
(SEMER) Sociedad Española de Nefrología
(S.E.N) Sociedad Española de Neumología y Cirugía
Torácica (SEPAR) Sociedad Española de Nutrición
(SEN) Sociedad Española de Oncología Médica
(SEOM) Sociedad Española de Oncología
Radioterápica (SEOR) Sociedad Española de
Patología Digestiva (SEPD) Sociedad Española para
el Estudio de la Obesidad (SEEDO)
Asociación Española de Cirujanos (AEC) Asociación
Española de Dietistas-Nutricionistas
(AEDN) Asociación Española de Gastroenterología
(AEG) Foro español de pacientes Fundación
Española de la Nutrición (FEN) Sociedad Española
de Cardiología (SEC) Sociedad Española de
Documentación Médica (SEDOM) Sociedad Española de
Endocrinología y Nutrición (SEEN) Sociedad
Española de Farmacia Hospitalaria (SEFH) Sociedad
Española de Geriatría y Gerontología (SEGG)