Malnutrition and Nutrition-Therapy: Our Neglected Responsibility

Around 30% of hospitalized patients in Europe are malnour-ished, and the figures for the community are also alarming. In certain diseases the proportion of malnourished patients can go up to 60%. The consequences of malnutrition are still neglected. The levels of knowledge and awareness of nutritional problems are low among all caregivers. Malnutrition is a heavy burden for the society, leading to increased morbidity, longer hospital stays, increased complications, decreased quality of life for the patients, and higher costs. Interventions to ensure appropriate nutritional care would be cost-effective. The impact of nutritional support is well known from many clinical trials. For each patient group specific nutritional recommendations are published in several reviews and guidelines. Although it is known how to do better, the nutritional support is often not regarded as an important therapeutic tool of the patients. In this issue several interesting papers summarize different important aspects related to malnutrition and nutritional support. The first paper describes the mechanism of cancer cachexia and the clinical implication and helps to understand why nutrition should be a central part in the management of cancer patients. It is well known that with an adequate nutritional support an increase of the quality of life can be achieved. Two further papers are dealing with nutritional aspects in the elderly. A large survey in Germany confirms the high prevalence of malnutrition in nursing homes. A significant number of orally and tube-fed patients were malnourished. The most important factors leading to malnutrition were analysed. Oropharyngeal dysphagia is a high prevalent problem in the elderly and is a leading factor for malnutrition and aspiration. The paper in this issue gives important information for diagnosing and the treatment for this clinically relevant problem. Three papers are related to surgical and ICU patients. Too often malnutrition is neglected in surgical patients. The clinical outcome is significantly different in malnourished patients compared to well-nourished controls. The paper on malnutrition in surgery wards confirms the importance of screening all surgical patients. 1/3 of the reported patients were malnourished, and the outcome was not as good compared to the patients not at nutritional risks. Elective surgery should be avoided until the nutritional deficits are corrected. In a further paper the perioperative nutritional support is described. Enteral nutrition was not given for long time to patients with acute pancreatitis because of the fear of worsening the outcome. This opinion has changed in the last …