Tackling disease-related malnutrition in resource-limited settings: An international position paper

Abstract

Background: Considering the challenges of providing nutritional care in resource-limited settings (RLS), the International Working Group for Patients' Right to Nutritional Care (WG) organized and expert meeting to propose recommendations and strategies to promote access to nutritional care and address disease-related malnutrition (DRM).

Methods: During the ESPEN Congress in Milan, September 9 2024, a panel of 30 experts discussed the results of an online survey, and built consensus statements aimed at defining strategies and recommendations required to address barriers to accessing nutrition care in RLS. The online survey was developed to assess barriers to providing nutrition care in RLS and was completed by 58 respondents based in Low- and Middle-income Countries (LMIC), between July and August 2024.

Results: Barriers to delivering quality nutrition care in these settings included low medical awareness and lack of the following: patient and family knowledge about DRM and its impact; nutrition risk screening and care implementation protocols; adequate reimbursement; medical nutrition dispositive; adapted diets; nutrition protocols; access to home medical and nutrition therapy. Gaps identified included: a) epidemiological data and evidence for best practices, b) education, training and capacity building and c) strengthening health systems.

Conclusions: Tackling DRM in resource-limited settings is challenging due to the high burden of malnutrition and the fact that current guidelines may not be fully applicable. The WG recommend a three-step strategy to promote access to nutrition care culminating in the development and implementation of resource -stratified guidelines.

Keywords: Malnutrition; Nutritional care; Resource-limited settings.