Part 2 - On the Current Situation of Malnutrition

Actually it is never too early to take measures to prevent malnutrition. And special medical food with its excellent quality and reasonable price can be a good way.

However, the fact is pretty pitiful. ILSI Focal Point in China once organized a retrospective investigation on malnutrition rate, influence of nutritional therapy on malnutrition rate and cost-benefit of enteral nutrition of inpatients. The analysis to BMI, serum albumin, HGB and other indicators shows that although malnutrition rate decreases for those inpatients who are just hospitalized, it increases for those who are to leave hospital. The survey also indicates: Malnutrition rate increases because nutrition therapy is not applied or nutrition provided cannot meet requirements of metabolism.

In domestic hospitals, maybe no doctor will blame death of patients on malnutrition. However, if we ask doctors if any inpatient dies due to severe infection or multiple organ failure, they usually reply: “Yes, and the rate is pretty high.” In fact, malnutrition is hiding behind the two deathful reasons. A clinical nutrition worker once said sadly that many of their patients didn’t die of disease but typical malnutrition.

However, why cannot inpatients and the elderly get timely treatment on ubiquitous malnutrition. Several reasons can be concluded. Firstly, no particular indicator can be applied to screen malnutrition and its risks and factors accurately but quickly. Therefore, some opportunities of early prevention and treatment are missed. Secondly, people don’t have enough knowledge of importance and necessity. Even they are with malnutrition, they also lack treatment. Data shows that only less than 50% malnutrition sufferers receive relevant treatment.

Nowadays, many inpatients pay their attention to surgeon and operation. They usually ignore operation preparation and postoperative care, especially clinical nutrition. Actually, in many cases, nutrition support can bring those in need a number of benefits: adjusting unbalanced metabolism, preventing infection and other complications effectively, improve therapy effect, promoting rehabilitation, shorten time in hospital and better life quality of patients. For example, cachexia of cancer sufferers caused by malnutrition is the main death cause. Even it doesn’t threaten life, malnutrition will also have influence on curative effect of chemotherapy and operation. Proper nutrition support cannot converse development of cancer, but it can enhance physical fitness of patients, strengthen their resistance to chemotherapy or radiotherapy. Therefore, treatment can be finished and life can continue.

Besides patients, some medical staff don’t understand clinical nutrition correctly. They see it as nutrition supplement or nutrition support. However, modern concept of clinical nutrition is not limited to nutrition support but has been upgraded to nutrition treatment.

For instance, some diseases are particularly related to some food or its constituents. For the sufferers of these diseases, the diet excluding the food and constituents should be specially prepared. PKU is one of the examples. It is caused by congenital lack of phenylalanine hydroxylase. If the sufferers don’t get proper diet (of low phenylalanine), phenylalanine and its derivatives will accumulate and injure brain. An infant sufferer might performs normally at its birth. But it will perform lagging intelligence and motion development after 3-4 months. As it grows up, its low intelligence can be more and more obvious. About 60% of older child sufferers behave severe mental retardation. It cost certain time for phenylalanine and its derivatives to accumulate to harm brain. In the first two month after infant birth, concentration of these metabolites just increases but doesn’t cause irreversible harm. Therefore, if timely diagnose and effective treatment are taken in this period, injury to nervous system can be avoided.

Another example is premature baby. Many premature babies are weak. In a hospital of China, a premature baby hurried to the world after it grows for 25 weeks in uterus of its mother. Five days after its birth, its weight was only 505g and it’s short as a pen. Generally speaking, premature babies don’t grow completely in their functions of iron storage in liver, calcium storage in skeleton, digestion and immunity. They are more possible to infect diseases. Like PKU baby sufferers, they all cannot be fed with breastmilk or ordinary infant formula. Besides, special medical food can be their main nutrition source in their early life and even a long time after.

It can be seen that special medical food cannot only offer nutrition and maintain life, but also functions as treatment. But it never is luxury. In contrast, it can be a means to cut medical expenses.

QALY, an indicator indicating patients’ life quality, includes factors of patients’ quantity (life/death rate) and quality (diseases, mentality, functions, society and other factors). NICE (National Institute for Health and Clinical Excellence) used the cost economic model of QALY to evaluate the cost-benefit of oral nutrition supplements, which is a kind of special medical food of EU to improve energy and protein ingestion. Result shows that it acquires high cost-benefit and is of excellent quality and reasonable price. In addition, a global clinical experiment led by Abbott, Baxter, Brown and Nestle together also proves that nutrition support can greatly reduce cost of inpatients. Ministry of Health in Braze once made a sanitary economic evaluation and found that one dollar paid on nutrition support can decrease 8 dollars on overall treatment payment.