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Ensuring healthy lives and promoting wellbeing across the age spectrum are essential to sustainable development. Nutrition is at the heart of the World Health Organization (WHO) Sustainable Development Goals, particularly for Sustainable Development Goal 2/Subgoal 2, which is to End all forms of malnutrition by 2030. This subgoal addresses people of all ages, including targeted groups like young children and older adults. In recent decades, there have been marked advances in the tools and methods used to screen for risk of malnutrition and to conduct nutritional assessments. There have also been innovations in nutritional interventions and outcome measures related to malnutrition. What has been less common is research on how nutritional interventions can impact healthy aging. Our Perspective article thus takes a life-course approach to consider what is needed to address risk of malnutrition and why, and to examine how good nutrition across the lifespan can contribute to healthy aging. We discuss broad-ranging yet interdependent ways to improve nutritional status worldwide—development of nutritional programs and policies, incorporation of the best nutrition-care tools and methods into practice, provision of professional training for quality nutritional care, and monitoring health and economic benefits of such changes. Taken together, our Perspective aims to (i) identify current challenges to meeting these ideals of nutritional care, and to (ii) discover enabling strategies for the improvement of nutrition care across the lifespan. In harmony with the WHO goal of sustainable development, we underscore roles of nutrition to foster healthy human development and healthy aging worldwide.

Funding Information: grant money, not related to this project, from Nestle Health Science and Abbott. The institution of ZS received speaking honoraria and research support from Nestle Health Science, Abbott Nutrition and Fresenius Kabi. SS and CB are employees and stockholders of Abbott. S Walzer and L Vollmer received funding for the model development from Abbott. S Walzer has also received funding from Nestle Health Science and Fresenius Kabi for other health economic studies. All other authors report no conflicts of interest. Publisher Copyright: © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. Nutritional support improves clinical outcomes during hospitalisation as well as after discharge. Recently, a systematic review of 27 randomised, controlled trials showed that nutritional support was associated with lower rates of hospital readmissions and improved survival. In the present economic modelling study, we sought to determine whether in-hospital nutritional support would also return economic benefits. The current economic model applied cost estimates to the outcome results from our recent systematic review of hospitalised patients. In the underlying meta-analysis, a total of 27 trials (n=6803 patients) were included. To calculate the economic impact of nutritional support, a Markov model was developed using transitions between relevant health states. Costs were estimated accounting for length of stay in a general hospital ward, hospital-acquired infections, readmissions and nutritional support. Six-month mortality was also considered. The estimated daily per-patient cost for in-hospital nutrition was US$6.23. Overall costs of care within the model timeframe of 6 months averaged US$63 227 per patient in the intervention group versus US$66 045 in the control group, which corresponds to per patient cost savings of US$2818. These cost savings were mainly due to reduced infection rate and shorter lengths of stay. We also calculated the costs to prevent a hospital-acquired infection and a non-elective readmission, that is, US$820 and US$733, respectively. The incremental cost per life-day gained was −US$1149 with 2.53 additional days. The sensitivity analyses for cost per quality-adjusted life day provided support for the original findings. For medical inpatients who are malnourished or at nutritional risk, our findings showed that in-hospital nutritional support is a cost-effective way to reduce risk for readmissions, lower the frequency of hospital-associated infections, and improve survival rates. publishersversion published

Suela Sulo,1 Leah Gramlich,2 Jyoti Benjamin,3 Sharon McCauley,4 Jan Powers,5 Krishnan Sriram,6 Kristi Mitchell7 1Global Health Economics & Outcomes Research, Abbott, Chicago, IL, USA; 2Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; 3Nutrition, Kaiser Permanente, Bellevue, WA, USA; 4Quality Management, Academy of Nutrition and Dietetics, Chicago, IL, USA; 5Nursing Research & Professional Practice, Parkview Health, Indianapolis, IN, USA; 6eICU, Advocate Health Care, Downers Grove, IL, USA; 7Health Policy, Avalere Health, Washington, DC, USACorrespondence: Suela SuloAbbott Nutrition, Abbott Park, Chicago, IL 60064, USATel +1 224-668-1377Fax +1 224-668-8355Email suela.sulo@abbott.comAbstract: Value is a key guiding principle in healthcare, yet value is defined in varying ways by different stakeholders. In this paper, we review evidence of the health and financial tolls of malnutrition or poor nutrition, report positive results from recent nutrition-focused quality improvement programs in hospitals, and discuss clinical and policy implications of realizing best-practice nutrition care. Hospitalized patients with malnutrition diagnoses have up to two-fold greater hospital costs for care compared to inpatient stays for adequately nourished patients. By contrast, implementation of nutrition care programs for hospitalized adults (nutrition status screening, assessment and diagnosis of malnutrition, oral nutritional supplements provided when indicated) is associated with substantial per-patient, per-episode healthcare savings approaching $4,000. Improved nutrition care has also been associated with fewer complications and faster recovery (shortened lengths of stay, lower readmission rates). Nutrition care thus delivers value, which is evidenced by better patient outcomes at cost savings to healthcare systems.Keywords: nutrition, value, healthcare, real-world evidence, quality improvement programs