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This commentary represents a dialogue on key aspects of Disease Related Malnutrition (DRM) from leaders and experts from academia, health across disciplines and from several countries across the world. The dialogue illuminates the problem of DRM, what impact it has on outcome, nutrition care as a human right, and practice, implementation and policy approaches to address DRM. The dialogue allowed the germination of an idea to register a commitment through the Canadian Nutrition Society(CNS) and the Canadian Malnutrition Task Force (CMTF)in the UN/WHO Decade of Action on Nutrition to advance policy based approaches for DRM. This commitment was successfully registered in October of 2022 and is entitled CAN DReaM (Creating Alliances Nationally for Policy in Disease Related Malnutrition). This commitment details five goals that will be pursued in the Decade of Action on Nutrition. The intent of this commentary is to record the proceedings of the workshop as a stepping-stone to establishing a policy-based approach to DRM that is relevant in Canada and abroad.

Background: Addressing the high prevalence of disease-related malnutrition (DRM) requires political will. The aim of this study is to define DRM as a health public policy issue from the point of view of the stakeholders. Methods: We conducted a qualitative phenomenological study consisting of grey data search and individual semi-structured in-depth interviews with stakeholders (policy-makers, academics, and civil society organization representatives) from 17 Latin American countries. The analyzed themes reflected ideas repeatedly found across the interviews. Results: 26 respondents were interviewed (5 policy-makers, 18 academics, 3 civil society organizations representatives). The grey data research and interviews showed that Brazil and Costa Rica were the only countries in the Region that had developed a specific public health policy addressing DRM and nutrition care issues. The rest of the Latin American countries had a nutrition policy which neither addressed DRM specifically nor included nutrition care, with important heterogeneity existing in terms of national regulation of selected nutritional care categories. Stakeholder opinions allowed to identify heterogeneity in the understanding of the nature and causes of DRM, confusing DRM with malnutrition caused by food insecurity and lack of food availability. Policy in the field of clinical nutrition can be addresses from two approaches: interdisciplinarity and a human rights-based approach. Conclusion: DRM is an unaddressed problem by health policy. Due to internal and external factor related to the health systems DRM has not been able to become a public policy issue. The study highlights the need for the development of public policy in clinical nutrition aimed at improving access to nutrition care. © 2021 European Society for Clinical Nutrition and Metabolism Background: Addressing the high prevalence of disease-related malnutrition (DRM) requires political will. The aim of this study is to define DRM as a health public policy issue from the point of view of the stakeholders. Methods: We conducted a qualitative phenomenological study consisting of grey data search and individual semi-structured in-depth interviews with stakeholders (policy-makers, academics, and civil society organization representatives) from 17 Latin American countries. The analyzed themes reflected ideas repeatedly found across the interviews. Results: 26 respondents were interviewed (5 policy-makers, 18 academics, 3 civil society organizations representatives). The grey data research and interviews showed that Brazil and Costa Rica were the only countries in the Region that had developed a specific public health policy addressing DRM and nutrition care issues. The rest of the Latin American countries had a nutrition policy which neither addressed DRM specifically nor included nutrition care, with important heterogeneity existing in terms of national regulation of selected nutritional care categories. Stakeholder opinions allowed to identify heterogeneity in the understanding of the nature and causes of DRM, confusing DRM with malnutrition caused by food insecurity and lack of food availability. Policy in the field of clinical nutrition can be addresses from two approaches: interdisciplinarity and a human rights-based approach. Conclusion: DRM is an unaddressed problem by health policy. Due to internal and external factor related to the health systems DRM has not been able to become a public policy issue. The study highlights the need for the development of public policy in clinical nutrition aimed at improving access to nutrition care. © 2021 European Society for Clinical Nutrition and Metabolism

Introduction COVID-19 affects the hematologic system. This article evaluated the impact of hematologic involvement of different blood cell line parameters of white blood cells including absolute neutrophil count (ANC), hemoglobin, and platelets in COVID-19 patients and their association with hospital mortality and length of stay (LOS). Methods This was a retrospective study of 475 patients with confirmed positive COVID-19 infection and hematologic abnormalities in the metropolitan New York City area. Results Elevated absolute neutrophil count (OR: 1.20; 95% CI: 1.02–1.42; p < 0.05) increased days of hematologic involvement (OR: 4.44; 95% CI: 1.42–13.90; p < 0.05), and persistence of hematologic involvement at discharge (OR: 2.87; 95% CI: 1.20–6.90; p < 0.05) was associated with higher mortality. Higher hemoglobin at admission (OR: 0.77; 95% CI:0.60–0.98; p < 0.001) and platelets peak (OR: 0.995; 95% CI: 0.992–0.997; p < 0.001) were associated with decreased mortality. Patients with higher white blood cell peak (B = 0.46; SE = 0.07; p < 0.001) and higher hemoglobin at admission (B = 0.05; SE = 0.01; p < 0.001) were associated with higher LOS. Those with higher hemoglobin nadir (B = −0.06; SE = 0.01; p < 0.001), higher platelets nadir (B = −0.001; SE = < 0.001; p < 0.001), and hematologic involvement at discharge or death (B = −0.06; SE = 0.03; p < 0.05) were associated with lower LOS. Conclusions These findings can be used by clinicians to better risk-stratify patients with hematologic involvement in COVID-19 and tailor therapies potentially to improve patient outcomes.

We analyzed the National Inpatient Sample (NIS) database to study the sepsis-related outcomes in patients with Philadelphia negative myeloproliferative neoplasms (MPN). A total of 82,087 patients were included, most had essential thrombocytosis (83.7%), followed by polycythemia vera (13.7%), and primary myelofibrosis (2.6%). Sepsis was diagnosed in 15,789 (19.2%) patients and their mortality rate was higher than nonseptic patients (7.5% vs 1.8%; p < .001). Sepsis was the most significant risk factor of mortality (aOR, 3.84; 95% CI, 3.51–4.21), others included liver disease (aOR, 2.42; 95% CI, 2.11–2.78), pulmonary embolism (aOR, 2.26; 95% CI, 1.83–2.80), cerebrovascular disease (aOR, 2.05; 95% CI, 1.81–2.33), and myocardial infarction (aOR, 1.73; 95% CI, 1.52–1.96).

Study design: Expert opinion, feedback, revisions, and final consensus. Objectives: To update the International Spinal Cord Injury Pain Basic Data Set (ISCIPBDS version 2.0) and incorporate suggestions from the SCI pain clinical and research community with respect to overall utility. Setting: International Methods: The ISCIPBDS working group evaluated these suggestions and made modifications. The revised ISCIPBDS (Version 3.0) was then reviewed by members of the International SCI Data Sets Committee, the American Spinal Injury Association (ASIA) Board, the International Spinal Cord Society (ISCoS) Executive and Scientific Committees, individual reviewers and societies, and posted on the ASIA and ISCoS websites for one month to elicit comments before final approval by ASIA and ISCoS. Results: The ISCIPBDS (Version 3.0) was updated in order to make the dataset more flexible and useful: 1. The assessment can be based on the patient’s perception of several of his/her “worst” pain(s) or based on the International SCI Pain (ISCIP) Classification-defined or other pain types, depending on the specific research questions or clinical needs. 2. Pain interference should usually be rated for overall pain but may also be used for specific pain problems if needed. 3. An optional pain drawing was added to complement the check box documentation of pain location. 4. Data categories consistent with the Extended Pain Dataset list of current treatments were added. 5. Several new training cases were added.

La desnutrición es una enfermedad común en pacientes con enfermedades incurables que se benefician de cuidados paliativos. El cuidado nutricional, parte integral del tratamiento de estos pacientes, permite la administración adecuada de la terapia nutricional oral, enteral o parenteral. En este contexto, la terapia nutricional está indicada con el objetivo de aumentar la supervivencia y la calidad de vida en algunos pacientes, como aquellos con problemas neurológicos o cáncer. Sin embargo, existe gran controversia sobre sus indicaciones y los beneficios potenciales, en particular, los de la nutrición parenteral a domicilio. Por tanto, el objetivo de esta revisión es responder a dos preguntas: ¿Cuándo se debe iniciar y detener la terapia nutricional? ¿La terapia nutricional mejora la calidad de vida y prolonga la sobrevida de los pacientes en cuidados paliativos? Las sociedades científicas no recomiendan la introducción de la terapia nutricional en todos los casos de desnutrición, especialmente en pacientes hipofágicos, si su esperanza de vida es inferior a 2 meses. La nutrición parenteral puede beneficiar a algunos pacientes bien identifica-dos, al aumentar el tiempo de supervivencia, sin embargo, el impacto en la calidad de vida sigue siendo incierto. Las decisiones deben tomarse de manera individualizada y respetando la autonomía del paciente, evitando el encarnizamiento terapéutico. La investigación en este campo debe avanzar para poder determinar, con mayor certitud, la relación riesgo-beneficio de la terapia nutricional.

Background Monitoring of adequate food intake is not a priority in hospital patients' care. The present study aimed to examine selective data from the nutritionDay survey to determine the impact of food intake during hospitalization on outcomes according to the nutrition risk status. Methods We conducted a descriptive analysis of selected data from 7 consecutive, annual, and cross-sectional nutritionDay samples from 2009 to 2015. The impact of food intake on outcomes was assessed by univariate and multivariate Cox models controlling for PANDORA scores. Results A total of 7994 adult patients from Colombia, 7243 patients from 9 Latin American countries, and 155,524 patients worldwid were included. Less than half of the patients worldwide consumed their entire meal on nutritionDay (41%). The number of reduced eaters is larger in the "no nutrition risk group" than in the "nutrition risk group" (30% vs 25%). Reduced eating is associated with higher mortality and delayed discharge in patients, regardless of the nutrition risk status. Patients without nutrition risk at the screening who ate "nothing, but were allowed to eat" had 6 times more risk of mortality (hazard ratio, 6.48; 95% CI, 3.5311.87). Conclusions This is the first large-scale study evaluating the relationship of food intake on clinical outcomes showing an increase of in-hospital mortality rates and a reduction in the probability of being discharged home regardless of the nutrition risk status. Traditional screening tools may not identify a group of patients who will become at risk because of reduced intake while in the hospital.

The aim of the study was to determine the prevalence of cancer cachexia according to the clinical stage and determine differences in body composition, usual energy intake, and proinflammatory profile between cachectic and non-cachectic patients newly diagnosed with head and neck squamous cell carcinoma (HNSCC). A cross-sectional study was conducted in adult patients diagnosed with HNSCC admitted to the oncology unit before starting cáncer treatment. Cancer cachexia was assessed according to Fearon criteria, and patients were divided into two groups: cachectic and non-cachectic patients. Body composition measured by bioelectrical impedance, energy intake, and biochemical and inflammatory markers were assessed. Comparative analyses were performed Student’s-T test, using one-way ANOVA, chi-square and Mann Whitney-U test. Of the 79 consecutive patients included in the analysis, 72% (n¼57; 61 ± 15 years) were classified as cachectic and 28% (n¼22;59 ± 10 years) as non-cachectic. According to clinical stage, the prevalence of cachexia was stage I¼8.8%, stage II ¼ 15.8%, stage III ¼ 33.3% and stage IV ¼ 42.1% (P¼0.564) and phase angle showed to be different between these groups (P

The unprecedented COVID-19 pandemic presents challenges for governments, health systems and society around the world. Organizations, scientific societies, and international experts have highlighted the importance of nutritional care in the treatment of COVID-19.

The World Health Orga-nization declared the disease COVID-19 caused by the SARS-CoV-2 virus as a pandemic on March 11, 2020. In Colombia, the first case was registered on March 6, 2020. Unprecedented, this pandemic presents challenges for patients and healthcare systems worldwide. The objective of this document is to offer recommendations on nutrition interventions in hospitalized patients with SARS-CoV-2 infection with special emphasis on the critically ill patient.

This article was submitted to Scientific Reports

Chapter submitted to the Routledge Encyclopedia of Psychology in the Real

Justificación: La brecha entre la educación nutricional proporcionada a los estudiantes de medicina y las competencias y actitudes nutricionales necesarias para que los médicos brinden una atención nutricional eficaz es una preocupación mundial. El objetivo de este estudio fue investigar el contenido curricular sobre educación nutricional en las facultades de medicina de América Latina y evaluar los conocimientos, las actitudes y las barreras autopercibidas para la práctica de la nutrición de los estudiantes de último año de medicina. Métodos: Se invitó a participar en el estudio a 85 facultades de medicina públicas y privadas de 17 países de América Latina. Se enviaron dos cuestionarios en línea cerrados que constaban de 25 y 43 preguntas a los directores de las facultades de medicina. Las variables cuantitativas se expresaron como frecuencias, porcentajes, media ± desviación estándar, medianas y rangos. Resultados: Respondieron un total de 22 (26%) directores de escuelas de medicina, de los cuales 11 escuelas (50%) ofrecían cursos de nutrición obligatorios independientes en años preclínicos y 8 (36%) en años clínicos. La media de horas dedicadas a la educación nutricional fue de 47 (rango: 0-150). Respondieron un total de 1530 de 1630 (94%) estudiantes de 12 países. La edad promedio de los estudiantes fue de 25 ± 3 años y el 59% eran mujeres. La mayoría de los estudiantes estuvo de acuerdo en que mejorar la salud de los pacientes a través de la nutrición (91 %) es importante y que el asesoramiento y la evaluación nutricional deben ser parte de la atención de rutina brindada por todos los médicos (89 %), pero carecen del nivel de educación y capacitación necesarios para abordar la nutrición. -asuntos relacionados. Conclusiones: La actitud positiva y el interés por la nutrición entre los estudiantes de último año de medicina es alto, pero la educación en nutrición no se percibe como suficiente para preparar adecuadamente a los médicos en el campo de la nutrición. Rationale: The gap between the nutrition education provided to medical students and the nutrition competences and attitudes needed for doctors to provide effective nutrition care is a global concern. The goal of this study was to investigate the curricular content on nutrition education in Latin American medical schools and to evaluate the self-perceived knowledge, attitudes, and barriers to nutrition practice of final-year medical students. Methods: Eighty-five public and private medical schools from 17 Latin American countries were invited to participate in the study. Two close-ended online questionnaires consisting of 25 and 43 questions were sent to medical school directors. Quantitative variables were expressed as frequencies, percentages, mean ± standard deviation, medians, and ranges. Results: A total of 22 (26%) medical school directors responded, of which 11 schools (50%) offered stand-alone mandatory nutrition courses in preclinical and 8 (36%) in clinical years. The mean hours dedicated to nutrition education was 47 (range: 0–150). A total of 1530 of 1630 (94%) students from 12 countries responded. Students’ average age was 25 ± 3 years, and 59% were female. Most students agreed that improving patients’ health through nutrition (91%) is important and that nutrition counseling and assessment should be part of routine care provided by all physicians (89%), but they lack the level of education and training required to address nutrition-related issues. Conclusions: Positive attitude and interest in nutrition among final-year medical students is high, but nutrition education is not perceived as sufficient to adequately prepare doctors in the field of nutrition.

With prolonged pandemic conditions, and emerging evidence but persisting low awareness of the importance of nutritional derangements, ESPEN has promoted in close collaboration with World Health Organization-Europe a call for papers on all aspects relating COVID-19 and nutrition as well as nutritional care, in the Society Journals Clinical Nutrition and Clinical Nutrition ESPEN. Although more COVID-related papers are being submitted and continue to be evaluated, ESPEN and WHO present the current editorial to summarize the many published findings supporting major interactions between nutritional status and COVID-19. These include 1) high risk of developing the disease and high risk of severe disease in the presence of pre-existing undernutrition (malnutrition) including micronutrient deficiencies; 2) high risk of developing malnutrition during the course of COVID-19, with substantial impact on long-term sequelae and risk of long COVID; 3) persons with obesity are also prone to develop or worsen malnutrition and its negative consequences during the course of COVID-19; 4) malnutrition screening and implementation of nutritional care may improve disease outcomes; 5) social and public health determinants contribute to the interaction between nutritional status and COVID-19, including negative impact of lockdown and social limitations on nutrition quality and nutritional status. We believe the evidence supports the need to consider COVID-19 as (also) a case of malnutrition-enhanced disease and disease-related malnutrition, with added risk for persons both with and without obesity. Similarities with many other disease conditions further support recommendations to implement standard nutritional screening and care in COVID-19 patients, and they underscore the relevance of appropriate nutritional and lifestyle prevention policies to limit infection risk and mitigate the negative health impact of acute pandemic bouts.