Spain has the dubious honor of being the only country in the European Union that does not include dietitians and dietitians-nutritionists (DN) within the National Health System (SNS) in most of its autonomous communities. Dietitians are nutrition technicians (TSD) and dietitians-nutritionists are graduates or graduates in nutrition, to clarify and to use the acronyms during the article, not for any purpose. securitist.
In 2003, the European Union developed, through the Council of Europe, the need for compulsory nutritional care in the hospital setting. Fundamentally, to prevent and identify the causes of malnutrition, in addition to a nutritional assessment of patients. The obligation that both nutrition and artificial nutrition (enteral and parenteral) be carried out by TSD and DN. So much so that the European Nutrition for Health Alliance (ENHA) was founded with the objective of focusing on malnutrition, and for this purpose it was proposed to establish a joint agenda of the countries of the European Union to develop health strategies around malnutrition and its prevention and treatment. This strategy is Together for Health: a Strategic Approach for the EU 2007-2013 and, once again, emphasis was placed on the need to systematize mandatory nutritional screening as an indisputable step in the fight against malnutrition.
In Spain, as established by Royal Decree 184/2015 of March 13, DNs are statutory health professionals with category A2 and DSTs with category C1. This is what the law says. Another thing is the presence we have in public hospitals and primary care.
The main causes of death in the world are chronic non-communicable diseases (ENTs), due to the greater life expectancy that has ended up causing an aging population. According to the World Health Organization (WHO), these claim 74% of deaths worldwide. Among the most common NCDs are cardiovascular diseases, chronic respiratory diseases and diabetes mellitus (DMII). By not integrating the figure of TSD and DN in primary care, these diseases are treated from pharmacology, that is, an interventional and non-preventive approach is made, instead of tackling it from an adequate diet. Drug treatment is not associated with increased survival and exposes patients to complications and adverse effects such as malnutrition.
Most of the medications that are prescribed are related to pathologies that would improve with an adequate nutritional regimen. The most common diseases that are medicated are hypertension, hypercholesterolemia and type II diabetes. In addition to the improvement of having a healthier and non-polymedicated population, it would mean economic savings. In general terms, the insertion of the TSD and DN can mean a saving of up to €99 for each euro invested in dietary treatment.
The latest data in Spain indicate that one in four hospitalized patients is at risk of malnutrition or is malnourished (23.7%) and that this percentage increases to 37% if the patients are over 70 years of age. The most affected are those with neoplastic (35%), cardiovascular (29%) and respiratory (28%) diseases.
Cancer is already the second cause of death in Spain in the general population, according to data from the Spanish Society of Medical Oncology (SEOM). In addition, one in two cancer patients will suffer from malnutrition on their own hospital admission. Malnutrition alters the properties of drugs and their action, which is why the dose is increased and this produces greater toxicity, which is why treatment cycles are increased or even abandoned due to ineffectiveness. Carrying out a prior nutritional screening would reduce economic costs, decrease the days of admission, the possibility of readmission and, above all, the better efficacy of the treatments suffered by the patients.
If a nutritional status screening were carried out at the time of hospital admission, malnutrition could be prevented or treated, and treatment approached in a more comprehensive and effective way. Additionally, the standards proposed by the WHO and the EU would be met.
The insertion of the figure of the TSD and the DN, in addition to giving us the place that belongs to us, would mean access for the entire population, since, not being within public health, we are forced to practice privately and it is precisely the less wealthy who are most likely to develop inadequate eating habits and, therefore, to develop chronic pathologies. Health depends on many factors and the socioeconomic context is one of them. As Rafael Cofino Fernandez, who was the Health Minister in Asturias, says, “your postal code is more important for your health than your genetic code”.
In communities such as Catalonia, Valencia, the Balearic Islands, Navarra, Murcia, Castilla-Leon, La Rioja, Aragon, the Basque Country and, recently, Galicia, professional categories for DSTs and DNs have already been created, and we hope that little by little more communities and nutrition professionals will join them. It is necessary for health to stop having a paternalistic approach, and for it to be preventive and accessible to all, regardless of purchasing power.
NUTRITION WITH SCIENCE It is a section on nutrition based on scientific evidence and the knowledge contrasted by specialists. Eating is much more than a pleasure and a necessity: diet and eating habits are right now the public health factor that can most help us prevent numerous diseases, from many types of cancer to diabetes. A team of dieticians-nutritionists will help us to better understand the importance of food and to demolish, thanks to science, the myths that lead us to eat badly.
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Source: EL PAIS