J Korean Med Assoc.  2014 Jun;57(6):491-495. 10.5124/jkma.2014.57.6.491.

Nutritional therapy in hospital

• Baik HW

• KMID: 1958085
• DOI: http://doi.org/10.5124/jkma.2014.57.6.491

Abstract

Globally, the prevalence of malnutrition in hospitals is high. In Korea, a recent national survey in which 28 general hospitals throughout the country participated showed a 22% prevalence of hospital malnutrition. Malnutrition is associated with adverse outcomes including immune suppression, muscle wasting, delayed wound healing, infectious complications, longer hospital stays, high medical costs, and even increased mortality. Early implementation of nutritional therapy might improve medical outcomes. For early recognition of malnutrition and early nutritional intervention, a qualified nutrition support team (NST) is necessary. In Korea, 110 NSTs were at work as of 2013, mostly affiliated with large high-ranking hospitals. Since the activity of an NST and enteral formula are not reimbursed by the National Health Insurance Corporation, the potential for expansion of NSTs to rather small hospitals remains limited. To improve the quality of care for hospitalized patients and reduce medical expenses nationally, it is time to reform the system for alleviating in-hospital malnutrition.

Keyword

Malnutrition; Nutrition therapy; Health insurance reimbursement

MeSH Terms

Hospitals, General
Humans
Insurance, Health, Reimbursement
Korea
Length of Stay
Malnutrition
Mortality
National Health Programs
Nutrition Therapy
Prevalence
Wound Healing

Reference

1. Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, Jeejeebhoy KN. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr. 1987; 11:8–13.

2. Correia MI, Campos AC. Prevalence of hospital malnutrition in Latin America: the multicenter ELAN study. Nutrition. 2003; 19:823–825.

3. Waitzberg DL, Caiaffa WT, Correia MI. Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients. Nutrition. 2001; 17:573–580.

4. Aapro M, Arends J, Bozzetti F, Fearon K, Grunberg SM, Herrstedt J, Hopkinson J, Jacquelin-Ravel N, Jatoi A, Kaasa S, Strasser F. Early recognition of malnutrition and cachexia in the cancer patient: a position paper of a European School of Oncology Task Force. Ann Oncol. 2014; 05. 02. [Epub]. http://dx.doi.org/10.1093/annonc/mdu085.

5. Mason JB. Nutritional assessment and management of the malnourished patient. In : Sleisenger MH, Fordtran JS, Feldman M, Friedman LS, Brandt LJ, editors. Sleisenger and Fordtran's gastrointestinal and liver disease. 9th ed. Philadelphia: Saunders;2010. p. 47–75.

6. Mcclave SA. Enteral nutrition. In : Cecil RL, Goldman L, Schafer AI, editors. Goldman's Cecil medicine. 24th ed. Philadelphia: Elsevier;2012. p. 1301–1394.

7. Wilmer A, Van Den Berghe G. Parenteral nutrition. In : Cecil RL, Goldman L, Schafer AI, editors. Goldman's Cecil medicine. 24th ed. Philadelphia: Elsevier;2012. p. 1394–1397.

8. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003; 22:235–239.

9. Kennedy JF, Nightingale JM. Cost savings of an adult hospital nutrition support team. Nutrition. 2005; 21:1127–1133.

10. Tucker HN, Miguel SG. Cost containment through nutrition intervention. Nutr Rev. 1996; 54(4 Pt 1):111–121.

11. Hassell JT, Games AD, Shaffer B, Harkins LE. Nutrition support team management of enterally fed patients in a community hos-pital is cost-beneficial. J Am Diet Assoc. 1994; 94:993–998.

12. Smith PE, Smith AE. High-quality nutritional interventions reduce costs. Healthc Financ Manage. 1997; 51:66–69.

13. Trujillo EB, Young LS, Chertow GM, Randall S, Clemons T, Jacobs DO, Robinson MK. Metabolic and monetary costs of avoidable parenteral nutrition use. JPEN J Parenter Enteral Nutr. 1999; 23:109–113.

14. Kang JH, Baik HW, Shin DW, Shin DH, Son HJ, Chang SH, Seo YS, Min JH, Lee YA, Mo YH, Kim MY. The outcomes of critically ill patients after following the recommendations of the nutritional support team. J Korean Soc Parent Enter Nutr. 2010; 3:40–44.

15. Matarese LE, Gottschlich MM. Contemporary nutrition sup-port practice: a clinical guide. 2nd ed. Philadelphia: Saunders;2002.