RESUMEN
La Canasta Alimentaria Normativa (CAN) es un instrumento estratégico de planificación y seguimiento, que impacta el ámbito económico (fijación del salario mínimo SM y del umbral de la pobreza relativa), la seguridad alimentaria y la salud pública. El objetivo fue describir la evolución histórica de la CAN en Venezuela, contrastando su valoración económica respecto al SM durante el período 1990 2023. Tipo de estudio: Descriptivo. Se empleó la CAN del Instituto Nacional de Estadísticas/Instituto Nacional de Nutrición (INE/INN) y su comparación con la canasta del Centro de Documentación y Análisis Social de la Federación Venezolana de Maestros(CENDAS FVM). Los valores mensuales de la CAN y del SM se recalcularon a dólares USA, de acuerdo a la tasa de cambio oficial. No se incluyó evaluación de la estructura interna, ni sus expresiones en términos de aporte de energía y nutrientes. Resultados: Desde 1990 hasta el año 2015, se requirieron entre1,0 y 1,8 SM y entre 0,6 y 1,7 Ingresos Mínimos Legales (IML)para acceder a la CAN. Para el año 2023 se requirieron hasta 78,3SM y 51,6 IML. El valor promedio de la canasta del CENDAS-FVM fue superior al valor de la CAN INE/INN, en una proporción de 1,7: 1. Conclusiones: la CAN resultó sensible en identificar los cambios y tendencias de su estimación económica, en el ambiente inflacionario venezolano. El uso de sus resultados está sujeta a cierto grado de discrecionalidad política. El costo de la CAN, expresa una contracción del poder de compra de los hogares venezolanos con potenciales impactos sobre la nutrición y la salud física y mental a corto y largo plazo.
The Normative Food Basket (NFB) represents astrategic planning and monitoring instrument, which impactsthe economic sphere (setting of the minimum wage (MW) andthe relative poverty threshold), food security and public health.The objective was to describe the historical evolution of the NFB in Venezuela, contrasting its economic valuation with respect to the MW during the period 1990 2023. Type of study: Descriptive. The NFB of the National Institute of Statistics/National Institute of Nutrition (NIS/NIN) was used and itscomparison with the basket of the Center for Documentationand Social Analysis of the Venezuelan Federation of Teachers (CENDAS FVM). The monthly values of the NFB and theMW were recalculated into dollars (US$), according to theofficial exchange rate. No evaluation of the internal structurewas included, nor its expressions in terms of energy and nutrientcontribution. Results: From 1990 to 2015, between 1.0 and1.8 MW and between 0.6 and 1.7 Minimum Legal Income(MLI) were required to access the NFB. By 2023, up to 78.3MW and 51.6 MLI were required. The average value of the CENDAS-FVM basket was higher than the value of the NFBNIS/NIN, in a proportion of 1.7: 1. Conclusions: As a statistical operation, the NFB was sensitive in identifying changes andtrends in its estimate economic, in the Venezuelan inflationaryenvironment. The use of its results is subject to a certain degree ofpolitical discretion. The cost of CAN expresses a contraction inthe purchasing power of Venezuelan households with potentialimpacts on nutrition and physical/mental health in the shortand long term.
Asunto(s)
Humanos , Masculino , Femenino , Salud Pública , Desnutrición/economía , Abastecimiento de Alimentos/estadística & datos numéricos , Abastecimiento de Alimentos/normas , Abastecimiento de Alimentos/estadística & datos numéricos , Factores Socioeconómicos , Costos y Análisis de Costo/estadística & datos numéricos , Servicios Básicos de Salud , Conducta Alimentaria , Inflación EconómicaRESUMEN
BACKGROUND & AIMS: Between 30 and 50% of Colombian patients are malnourished or at-risk of malnutrition on hospital admission. Malnutrition is associated with poor outcomes and increased costs. We used cost modeling to estimate savings that could be derived from implementation of a nutrition therapy program for patients at malnutrition risk. METHODS: The budget impact analysis was performed using previously-published outcomes data. Outcomes included length of stay, 30-day readmissions, and infectious/non-infectious complications. We developed a Markov model that compared patients who were assigned to receive early nutrition therapy (started within 24-48 h of hospital admission) with those assigned to receive standard nutrition therapy (not started early). Our model used a 60-day time-horizon and estimated event probabilities based on published data. RESULTS: Average total costs over 60 days were $3770 US dollars for patients with delayed nutrition therapy vs $2419 for patients with early nutrition therapy-a savings of $1351 (35.8% decrease) per nutrition-treated patient. Cost differences between the groups were: $2703 vs $1600 for hospital-associated costs; $883 vs $665 for readmissions; and $176 vs $94 for complications. Taken broadly, the potential costs savings from a nutrition care program for an estimated 638,318 hospitalized Colombian patients at malnutrition risk is $862.6 million per year. CONCLUSIONS: Our budget impact analysis demonstrated the potential for hospital-based nutrition care programs to improve health outcomes and reduce healthcare costs for hospitalized patients in Colombia. These findings provide a rationale for implementing comprehensive nutrition care in Colombian hospitals.
Asunto(s)
Hospitalización/estadística & datos numéricos , Desnutrición/prevención & control , Desnutrición/terapia , Terapia Nutricional/métodos , Colombia , Ahorro de Costo , Análisis Costo-Beneficio , Costos de la Atención en Salud , Costos de Hospital/estadística & datos numéricos , Hospitalización/economía , Humanos , Tiempo de Internación , Desnutrición/economía , Terapia Nutricional/economía , Estado Nutricional , Readmisión del Paciente/economía , Readmisión del Paciente/estadística & datos numéricos , QuinolinasRESUMEN
BACKGROUND: Childhood stunting is the most common manifestation of chronic malnutrition. A growing body of literature indicates that stunting can have negative repercussions on physical and cognitive development. There are increasing concerns that low- and middle-income countries (LMICs) are particularly susceptible to adverse consequences of stunting on economic development. The aim of this review is to synthesize current evidence on interventions and policies that have had success in reducing stunting and explore the impact of successes on economic indicators. METHODS: This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Articles were searched through MEDLINE via PubMed and Ovid, Cochrane Library, Web of Science and ProQuest. Only articles that addressed the effects of nutrition and cash-based interventions and/or policies on stunting and reported effects on childhood mortality and/or human capital indicators were included. Two reviewers independently abstracted data and assessed quality. RESULTS: Seventeen studies from Africa (47%), South America (41%), and South Asia (12%) met the eligibility criteria: 8 cohort studies, 4 case studies, 4 Randomized Control Trials (RCTs) and 1 quasi-trial. Three types of interventions/policies were evaluated: multisectoral policies, nutritional supplementations and cash-based interventions (CCT). Overall, 76% of the included studies were successful in reducing stunting and 65% of interventions/policies reported successes on stunting reductions and economic successes. Five of the 11 successful studies reported on nutritional supplementation, 4 reported on multisectoral policies, and 2 reported on CCT interventions. Average Annual Rate of Reduction (AARR) was calculated to assess the impact of multisectoral policies on childhood mortality. AARR for under 5 mortality ranged from 5.2 to 6.2% and all countries aligned with the global target of 4.4% AARR. Quality assessment yielded positive results, with the biggest concerns being attrition bias for cohort studies, blinding for trials and generalizability of results for case studies. CONCLUSIONS: Evidence suggests that investment in fighting chronic malnutrition through multisectoral policies, multi-year nutritional supplementation (protein or multiple micronutrient supplementation) and possibly CCTs can have a long-term impact on economic development of LMICs. More evidence is needed to inform practices in non-represented regions while prioritizing standardization of economic indicators in the literature.
Asunto(s)
Países en Desarrollo , Desarrollo Económico , Asistencia Alimentaria/economía , Trastornos del Crecimiento/prevención & control , Desnutrición , Estado Nutricional , Políticas , África , Asia , Niño , Países en Desarrollo/economía , Dieta , Suplementos Dietéticos , Trastornos del Crecimiento/economía , Trastornos del Crecimiento/etiología , Humanos , Desnutrición/complicaciones , Desnutrición/dietoterapia , Desnutrición/economía , Pobreza , América del SurRESUMEN
As Venezuela's economic and political crises continues to evolve, hyperinflation, declining food production and food shortages are contributing to the deterioration of the food and nutrition situation. While official data is largely unavailable, food security and nutrition data from a variety of sources suggest that nearly the entire population is food insecure and that prevalence of acute malnutrition among children is reaching crisis levels in vulnerable populations. In the most recent national survey, 80% of households were food insecure and most households receiving government food assistance reported only occasional receipt. Prevalence of acute malnutrition among children under five increased in vulnerable communities across many states, surpassing serious or critical thresholds in multiple states. Hospitals across the country are reporting increases in both the number and proportion of pediatric consultations and admissions with acute malnutrition, and malnutrition deaths are increasingly common. Declining food security, increases in prevalence of acute malnutrition among children in vulnerable communities, rising pediatric hospital admissions with acute malnutrition and clinician reports of child deaths due to acute malnutrition are indicative of a crisis. The response to the nutrition and food security crisis to date has been limited. There is an urgent need to begin taking steps to address widespread food insecurity and to support treatment for children with acute malnutrition.
Asunto(s)
Recesión Económica/estadística & datos numéricos , Abastecimiento de Alimentos/normas , Fenómenos Fisiológicos de la Nutrición/fisiología , Abastecimiento de Alimentos/métodos , Humanos , Desnutrición/economía , Desnutrición/epidemiología , Desnutrición/etiología , Prevalencia , Venezuela/epidemiología , Poblaciones Vulnerables/estadística & datos numéricosRESUMEN
BACKGROUND & AIMS: Hospitalized patients show a high rate of malnutrition, which is associated with poor patient outcomes and high healthcare costs. However, relatively few studies have investigated the association between clinical and economic outcomes and malnutrition in hospitalized patients, particularly those with cardiac and pulmonary conditions. METHODS: This multicenter prospective observational cohort study included 800 patients hospitalized at four Colombian hospitals with a diagnosis of congestive heart failure, acute myocardial infarction, community-acquired pneumonia, or chronic obstructive pulmonary disease. All patients were screened for malnutrition using the Malnutrition Screening Tool (MST). A descriptive analysis of baseline variables was followed by multivariate analysis and inverse probability weighting (IPW) to compare the clinical outcomes, i.e., length of stay (LOS), mortality, and readmission, and hospital costs associated with a positive MST result. RESULTS: The prevalence of a positive MST result was 24.62% (n = 197) and was more common in patients with older age and greater comorbidities. Multivariate analysis controlling for age, gender, healthcare plan, university degree, hospitalization, entrance disease and Charlson co-morbidity index showed that a positive MST result was associated with increased LOS (1.43 ± 0.61 days) and both in-hospital mortality (odds ratio, 2.39) and global mortality (odds ratio, 2.52). IPW analysis confirmed the association between a positive MST result and increased hospital LOS and 30-day mortality, as well as a relative increase of 30.13% in the average cost associated with hospitalization. CONCLUSIONS: This study of hospital inpatients demonstrated a high burden of malnutrition at the time of hospital admission, which negatively impacted LOS and mortality and increased the costs of hospitalization. These findings underscore the need for improved diagnosis and treatment of hospital malnutrition to improve patient outcomes and reduce healthcare costs.
Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Costos de Hospital/estadística & datos numéricos , Hospitalización/economía , Pacientes Internos/estadística & datos numéricos , Desnutrición/economía , Desnutrición/epidemiología , Factores de Edad , Anciano , Estudios de Cohortes , Colombia/epidemiología , Femenino , Humanos , Masculino , Estudios Prospectivos , Factores de RiesgoRESUMEN
Child malnutrition is an important public health problem in Argentina, both as a primary cause of mortality/morbidity and associated with different pathologies that affect children. However, little is known about its magnitude, trends and spatial distribution. This article seeks to detect such situations considering different geographic scales. A quantitative approach was applied, systematizing vital statistics (mortality), hospital discharges (morbidity), and low birth weight (natality) in children 0-4 years of age. Accordingly, the information sources used were mortality statistics (1999-2013), hospital discharge statistical records (2000, 2005-2011) and live birth statistics (1999-2012) provided by the Office of Statistics and Health Information (DEIS) [Dirección de Estadísticas e Información de Salud] of the National Ministry of Health. The results show differences according to the scale considered. The conclusions highlight the necessity of integrating the different sources of information analyzed in order to provide a more general overview of a problem that, albeit in decline, still registers high magnitudes in the most vulnerable areas. In this way, certain areas of northern Argentina evidence worse conditions, requiring immediate attention be paid to issues of poverty and child health.
La desnutrición en la niñez conforma un importante problema de salud pública en Argentina, ya sea como causa básica de mortalidad/morbilidad o asociada a distintas patologías que inciden sobre la población infantil. Sin embargo, poco se conoce sobre su magnitud, tendencias y su distribución espacial. Este artículo procuró detectar estas situaciones considerando diferentes escalas geográficas. Se propuso un abordaje cuantitativo mediante la sistematización de estadísticas vitales (mortalidad), egresos hospitalarios (morbilidad), y de bajo peso al nacimiento (natalidad), sobre una población objetivo de 0 a 4 años de edad. Las fuentes de información utilizadas fueron las estadísticas de mortalidad (1999-2013), estadísticas de egresos hospitalarios (2000, 2005-2011) y estadísticas de nacidos vivos (1999-2012) provistos por la Dirección de Estadísticas e Información de Salud (DEIS) del Ministerio de Salud de la Nación. Los resultados advierten comportamientos diferenciados según la escala considerada. Como conclusión, se destaca la necesidad de integrar las vertientes de información analizadas para brindar un panorama más general sobre un problema que, si bien tiende a descender, alcanza magnitudes altas en las zonas más vulnerables. Ciertas áreas del norte presentan las peores condiciones y precisan un abordaje inmediato en materia de pobreza y salud infantil.
Asunto(s)
Desnutrición/epidemiología , Argentina/epidemiología , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Desnutrición/diagnóstico , Desnutrición/economía , PobrezaRESUMEN
AIM: Disease-related malnutrition (DRM) is a prevalent condition that significantly increases the risk of adverse outcomes in hospitalized patients, particularly those with critical illness. Limited data is available on the economic burden of DRM and the cost-benefit of nutrition therapy in high-risk populations in Latin America. The aims of the present study were to estimate the economic burden of DRM and evaluate the cost-benefit of supplemental parenteral nutrition (SPN) in critically ill patients who fail to receive adequate nutrient intake from enteral nutrition (EN) in Latin America. METHODS: Country-specific cost and prevalence data from eight Latin American countries and clinical data from studies evaluating outcomes in patients with DRM were used to estimate the costs associated with DRM in public hospitals. A deterministic decision model based on clinical outcomes from a randomized controlled study and country-specific cost data were developed to examine the cost-benefit of administering SPN to critically ill adults who fail to reach ≥60% of the calculated energy target with EN. RESULTS: The estimated annual economic burden of DRM in public hospitals in Latin America is $10.19 billion (range, $8.44 billion-$11.72 billion). Critically ill patients account for a disproportionate share of the costs, with a 6.5-fold higher average cost per patient compared with those in the ward ($5488.35 vs. $839.76). Model-derived estimates for clinical outcomes and resource utilization showed that administration of SPN to critically ill patients who fail to receive the targeted energy delivery with EN would result in an annual cost reduction of $10.2 million compared with continued administration of EN alone. LIMITATIONS: The cost calculation was limited to the average daily cost of stay and antibiotic use. The costs associated with other common complications of DRM, such as prolonged duration of mechanical ventilation or more frequent readmission, are unknown. CONCLUSIONS: DRM imposes a substantial economic burden on Latin American countries, with critically ill patients accounting for a disproportionate share of costs. Cost-benefit analysis suggests that both improved clinical outcomes and significant cost savings can be achieved through the adoption of SPN as a therapeutic strategy in critically ill patients who fail to receive adequate nutrient intake from EN.
Asunto(s)
Enfermedad Crítica , Hospitales Públicos/economía , Desnutrición/economía , Nutrición Parenteral/economía , Análisis Costo-Beneficio , Técnicas de Apoyo para la Decisión , Ingestión de Energía , Femenino , Humanos , América Latina , Masculino , Desnutrición/dietoterapia , Modelos Econométricos , Nutrición Parenteral/métodosRESUMEN
RESUMEN La desnutrición en la niñez conforma un importante problema de salud pública en Argentina, ya sea como causa básica de mortalidad/morbilidad o asociada a distintas patologías que inciden sobre la población infantil. Sin embargo, poco se conoce sobre su magnitud, tendencias y su distribución espacial. Este artículo procuró detectar estas situaciones considerando diferentes escalas geográficas. Se propuso un abordaje cuantitativo mediante la sistematización de estadísticas vitales (mortalidad), egresos hospitalarios (morbilidad), y de bajo peso al nacimiento (natalidad), sobre una población objetivo de 0 a 4 años de edad. Las fuentes de información utilizadas fueron las estadísticas de mortalidad (1999-2013), estadísticas de egresos hospitalarios (2000, 2005-2011) y estadísticas de nacidos vivos (1999-2012) provistos por la Dirección de Estadísticas e Información de Salud (DEIS) del Ministerio de Salud de la Nación. Los resultados advierten comportamientos diferenciados según la escala considerada. Como conclusión, se destaca la necesidad de integrar las vertientes de información analizadas para brindar un panorama más general sobre un problema que, si bien tiende a descender, alcanza magnitudes altas en las zonas más vulnerables. Ciertas áreas del norte presentan las peores condiciones y precisan un abordaje inmediato en materia de pobreza y salud infantil.
ABSTRACT Child malnutrition is an important public health problem in Argentina, both as a primary cause of mortality/morbidity and associated with different pathologies that affect children. However, little is known about its magnitude, trends and spatial distribution. This article seeks to detect such situations considering different geographic scales. A quantitative approach was applied, systematizing vital statistics (mortality), hospital discharges (morbidity), and low birth weight (natality) in children 0-4 years of age. Accordingly, the information sources used were mortality statistics (1999-2013), hospital discharge statistical records (2000, 2005-2011) and live birth statistics (1999-2012) provided by the Office of Statistics and Health Information (DEIS) [Dirección de Estadísticas e Información de Salud] of the National Ministry of Health. The results show differences according to the scale considered. The conclusions highlight the necessity of integrating the different sources of information analyzed in order to provide a more general overview of a problem that, albeit in decline, still registers high magnitudes in the most vulnerable areas. In this way, certain areas of northern Argentina evidence worse conditions, requiring immediate attention be paid to issues of poverty and child health.
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Desnutrición/epidemiología , Argentina/epidemiología , Pobreza , Estudios Transversales , Desnutrición/diagnóstico , Desnutrición/economíaRESUMEN
INTRODUCTION: Malnutrition in hospitalized patients is not evaluated frequently. However, it is a critical issue given that it has been related to a high rate of infectious complications and increased mortality rates. There is a high prevalence of patients with nutritional impairment in the home environment, which favors their clinical worsening, the increase of re-hospitalizations and, consequently, the increase in public health expenditures. OBJECTIVE: Nutrition experts have thoroughly discussed and written this positioning paper on hospital and homecare malnutrition to describe the prevalence of malnutrition in Brazil. Best practice recommendations for nutrition therapy of patients in hospital and homecare, in particular the use of oral nutritional supplements (ONS), to those who are at risk of malnutrition or malnourished were evaluated, and the impact on clinical and economic data were assessed. In addition, they emphasize that investments in oral nutritional supplementation are also important in the homecare environment (home or nursing homes). MATERIALS AND METHODS: Selected scientific articles on disease-related malnutrition, especially those carried out in Brazil, were assessed. Data on prevalence, clinical outcomes, and economic burdens were reviewed. RESULTS AND CONCLUSION: Several studies have shown the importance of in-hospital nutritional assessment for early detection of malnutrition and early intervention with nutrition therapy, in particular with oral nutritional therapy. Unfortunately, hospital malnutrition remains high in Brazil, with severe consequences for patients. The implementation of universal nutritional screening and diagnosis as well as the therapeutic approach of malnutrition, particularly with the use, when possible, of oral nutrition supplements as the first step to address this condition is still low, and demands the investment in educational resources to change practices. Routine use of nutritional therapy in hospital and homecare settings improves clinical outcomes, is cost effective, and would be expected to help reduce healthcare costs.
Asunto(s)
Servicios de Atención de Salud a Domicilio , Hospitalización , Desnutrición/terapia , Terapia Nutricional/métodos , Brasil/epidemiología , Humanos , Desnutrición/economía , Desnutrición/epidemiología , Evaluación Nutricional , Terapia Nutricional/economía , Prevalencia , Salud PúblicaAsunto(s)
Salud Ambiental , Helmintiasis/epidemiología , Parasitosis Intestinales/epidemiología , Infecciones por Protozoos/epidemiología , Condiciones Sociales , Adolescente , Región del Caribe , Niño , Preescolar , Diarrea/economía , Diarrea/epidemiología , Diarrea/etiología , Escolaridad , Eficiencia , Femenino , Helmintiasis/complicaciones , Helmintiasis/economía , Humanos , Renta , Lactante , Parasitosis Intestinales/complicaciones , Parasitosis Intestinales/economía , América Latina , Masculino , Desnutrición/economía , Desnutrición/epidemiología , Desnutrición/etiología , Organización Panamericana de la Salud , Infecciones por Protozoos/complicaciones , Infecciones por Protozoos/economíaAsunto(s)
Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Infecciones por Protozoos/epidemiología , Condiciones Sociales , Salud Ambiental , Helmintiasis/epidemiología , Parasitosis Intestinales/epidemiología , Organización Panamericana de la Salud , Infecciones por Protozoos/complicaciones , Infecciones por Protozoos/economía , Región del Caribe , Desnutrición/economía , Desnutrición/etiología , Desnutrición/epidemiología , Diarrea/economía , Diarrea/etiología , Diarrea/epidemiología , Escolaridad , Eficiencia , Helmintiasis/complicaciones , Helmintiasis/economía , Renta , Parasitosis Intestinales/complicaciones , Parasitosis Intestinales/economía , América LatinaRESUMEN
BACKGROUND: In Mexico, despite that the fact that several social programs have been implemented, chronic undernutrition is still a public health problem affecting 1.5 million children of <5 years. Chiapas ranks first in underweight and stunting at national level with a stunting prevalence of 31.4 % whereas for its rural population is 44.2 %. The purpose of this paper is to determine if the nutritional status of a cohort of children living in poor rural communities under Oportunidades has changed. We were interested in assessing the nutrition evolution of the children who were initially diagnosed as stunted and of those who were diagnosed as normal. Oportunidades is an anti-poverty program of the Mexican government consisting mainly in monetary transfers to the families living in alimentary poverty. METHODS: A 9-year cohort prospective study was conducted with nutritional evaluations of 222 children. Anthropometric indices were constructed from measurements of weight, height, and age of the children whose nutritional status was classified following WHO standards. RESULTS: The results showed that although these children were Oportunidades beneficiaries for 9 years and their families improved their living conditions, children still had a high prevalence of stunting (40.1 %) and 69.6 % had not recovered yet. Children who were initially diagnosed with normal nutritional status and became stunted 2 years later had a higher risk (relative risk (RR) 5.69, 2.95-10.96) of continuing stunted at school age and adolescence. CONCLUSIONS: Oportunidades has not impacted, as expected, the nutritional status of the study population. These findings pose the question: Why has not the nutritional status of children improved, although the living conditions of their families have significantly improved? This might be the result of an adaptation process achieved through a decrease of growth velocity. It is important to make efforts to watch the growth of the children during their first 3 years of age, to focus on improving the diet of women at fertile age and pay special attention to environmental conditions to break the vicious cycle of malnutrition.
Asunto(s)
Fenómenos Fisiológicos Nutricionales Infantiles , Dieta/efectos adversos , Trastornos del Crecimiento/etiología , Desnutrición/fisiopatología , Estado Nutricional , Asistencia Pública , Salud Rural , Desarrollo Infantil , Fenómenos Fisiológicos Nutricionales Infantiles/etnología , Preescolar , Estudios de Cohortes , Dieta/economía , Dieta/etnología , Femenino , Estudios de Seguimiento , Trastornos del Crecimiento/epidemiología , Trastornos del Crecimiento/etnología , Trastornos del Crecimiento/prevención & control , Humanos , Lactante , Perdida de Seguimiento , Masculino , Desnutrición/dietoterapia , Desnutrición/economía , Desnutrición/etnología , México/epidemiología , Encuestas Nutricionales , Estado Nutricional/etnología , Prevalencia , Estudios Prospectivos , Riesgo , Salud Rural/economía , Salud Rural/etnología , Condiciones Sociales/economíaRESUMEN
Alarmingly high rates of disease-related malnutrition have persisted in hospitals of both emerging and industrialized nations over the past 2 decades, despite marked advances in medical care over this same interval. In Latin American hospitals, the numbers are particularly striking; disease-related malnutrition has been reported in nearly 50% of adult patients in Argentina, Brazil, Chile, Costa Rica, Cuba, Dominican Republic, Ecuador, Mexico, Panama, Paraguay, Peru, Puerto Rico, Venezuela, and Uruguay. The tolls of disease-related malnutrition are high in both human and financial terms-increased infectious complications, higher incidence of pressure ulcers, longer hospital stays, more frequent readmissions, greater costs of care, and increased risk of death. In an effort to draw attention to malnutrition in Latin American healthcare, a feedM.E. Latin American Study Group was formed to extend the reach and support the educational efforts of the feedM.E. Global Study Group. In this article, the feedM.E. Latin American Study Group shows that malnutrition incurs excessive costs to the healthcare systems, and the study group also presents evidence of how appropriate nutrition care can improve patients' clinical outcomes and lower healthcare costs. To achieve the benefits of nutrition for health throughout Latin America, the article presents feedM.E.'s simple and effective Nutrition Care Pathway in English and Spanish as a way to facilitate its use.
Asunto(s)
Enfermedad Iatrogénica/epidemiología , Desnutrición/epidemiología , Costos de la Atención en Salud , Hospitalización , Hospitales , Humanos , Enfermedad Iatrogénica/prevención & control , Incidencia , América Latina/epidemiología , Tiempo de Internación , Desnutrición/economía , Desnutrición/prevención & control , Evaluación Nutricional , Terapia Nutricional , Estado Nutricional , Garantía de la Calidad de Atención de Salud , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
The Waterlow lecture was named to commemorate Professor John Waterlow, an eminent figure in nutrition during the last half of the 20th century. David Nabarro worked with Professor Waterlow for a period of his career and was invited to deliver the Waterlow lecture during the International Congress of Nutrition in Granada on 16 September 2013.
Asunto(s)
Desnutrición/prevención & control , Fenómenos Fisiológicos Nutricionales Infantiles , Preescolar , Dieta , Femenino , Organización de la Financiación , Asistencia Alimentaria/economía , Humanos , Lactante , Cooperación Internacional , Desnutrición/economía , Fenómenos Fisiologicos Nutricionales Maternos , PolíticaRESUMEN
OBJECTIVE: We characterized post-infancy child growth patterns and determined the incidence of becoming stunted and of recovery from stunting. DESIGN: Data came from Young Lives, a longitudinal study of childhood poverty in four low- and middle-income countries. SETTING: We analysed length/height measurements for children at ages 1, 5 and 8 years. SUBJECTS: Children (n 7171) in Ethiopia, India, Peru and Vietnam. RESULTS: Mean height-for-age Z-score (HAZ) at age 1 year ranged from -1·51 (Ethiopia) to -1·08 (Vietnam). From age 1 to 5 years, mean HAZ increased by 0·27 in Ethiopia (P < 0·001) and decreased among the other cohorts (range: -0·19 (Peru) to -0·32 (India); all P < 0·001). From 5 to 8 years, mean HAZ increased in all cohorts (range: 0·19 (India) to 0·38 (Peru); all P < 0·001). Prevalence of stunting (HAZ<-2·0) at 1 year ranged from 21 % (Vietnam) to 46 % (Ethiopia). From age 1 to 5 years, stunting prevalence decreased by 15·1 percentage points in Ethiopia (P < 0·001) and increased in the other cohorts (range: 3·0 percentage points (Vietnam) to 5·3 percentage points (India); all P ≤ 0·001). From 5 to 8 years, stunting prevalence decreased in all cohorts (range: 5·0 percentage points (Vietnam) to 12·7 percentage points (Peru); all P < 0·001). The incidence of becoming stunted between ages 1 to 5 years ranged from 11 % (Vietnam) to 22 % (India); between ages 5 to 8 years, it ranged from 3 % (Peru) to 6 % (India and Ethiopia). The incidence of recovery from stunting between ages 1 and 5 years ranged from 27 % (Vietnam) to 53 % (Ethiopia); between ages 5 and 8 years, it ranged from 30 % (India) to 47 % (Ethiopia). CONCLUSIONS: We found substantial recovery from early stunting among children in four low- and middle-income countries.
Asunto(s)
Desarrollo Infantil , Fenómenos Fisiológicos Nutricionales Infantiles , Trastornos del Crecimiento/prevención & control , Fenómenos Fisiológicos Nutricionales del Lactante , Desnutrición/dietoterapia , Estatura , Niño , Preescolar , Estudios de Cohortes , Etiopía/epidemiología , Femenino , Trastornos del Crecimiento/etiología , Humanos , Incidencia , India/epidemiología , Lactante , Estudios Longitudinales , Masculino , Desnutrición/economía , Desnutrición/epidemiología , Desnutrición/fisiopatología , Perú/epidemiología , Áreas de Pobreza , Prevalencia , Vietnam/epidemiologíaRESUMEN
OBJECTIVE: To identify and compare the sociodemographic determinants of stunting, wasting and overweight among infants of urban and rural areas in the Ecuadorian highlands. DESIGN: Cross-sectional study. SETTING: Nabon (rural) and Cuenca (urban) cantons, Azuay Province, Ecuador. SUBJECTS: A total of 703 children aged 0-24 months and their caregivers (227 rural and 476 urban) recruited during the period from June to September 2008. RESULTS: Stunting prevalence was significantly higher in the rural area (37·4 % v. 17·7 %; P < 0·001) while wasting (7·1 %) and overweight (17·1 %) prevalence were more similar between areas. Determinants of stunting for the pooled sample were male gender (OR = 1·43; 95 % CI 1·06, 1·92; P = 0·02), preterm delivery (OR = 1·65; 95 % CI 1·14, 2·38; P = 0·008), child's age (OR = 1·04; 95 % CI 1·01, 1·07; P = 0·011), maternal education (OR = 0·95; 95 % CI 0·92, 0·99; P = 0·025) and facility-based delivery (OR = 0·57; 95 % CI 0·45, 0·74; P < 0·001). The latter was also a determinant of overweight (OR = 0·39; 95 % CI 0·25, 0·62; P < 0·001). Rural determinants of stunting were maternal height (OR = 0·004; 95 % CI 0·00004, 0·39; P = 0·018), diarrhoea prevalence (OR = 2·18; 95 % CI 1·13, 4·21; P = 0·02), socio-economic status (OR = 0·79; 95 % CI 0·64, 0·98; P = 0·030) and child's age (OR = 1·07; 95 % CI 1·02, 1·11; P = 0·005). Urban determinants were: maternal BMI for stunting (OR = 0·91; 95 % CI 0·84, 0·99; P = 0·027), cough prevalence (OR = 0·57; 95 % CI 0·34, 0·96; P = 0·036) and facility-based delivery (OR = 0·25; 95 % CI 0·09, 0·73; P = 0·011) for overweight, and hygiene for wasting (OR = 0·57; 95 % CI 0·36, 0·89; P = 0·013). CONCLUSIONS: Infant malnutrition was associated with different sociodemographic determinants between urban and rural areas in the Ecuadorian highlands, a finding which contributes to prioritize the determinants to be assessed in nutritional interventions.
Asunto(s)
Desarrollo Infantil , Trastornos del Crecimiento/etiología , Fenómenos Fisiológicos Nutricionales del Lactante , Desnutrición/epidemiología , Salud Rural , Delgadez/etiología , Salud Urbana , Altitud , Estudios Transversales , Ecuador/epidemiología , Femenino , Humanos , Lactante , Fenómenos Fisiológicos Nutricionales del Lactante/economía , Fenómenos Fisiológicos Nutricionales del Lactante/etnología , Recién Nacido , Masculino , Desnutrición/economía , Desnutrición/etnología , Desnutrición/fisiopatología , Encuestas Nutricionales , Sobrepeso/economía , Sobrepeso/epidemiología , Sobrepeso/etnología , Prevalencia , Salud Rural/economía , Salud Rural/etnología , Factores Sexuales , Factores Socioeconómicos , Salud Urbana/economía , Salud Urbana/etnologíaRESUMEN
Objetivos. Estimar el impacto económico de la desnutrición crónica, aguda y global en el Perú. Materiales y métodos. El presente estudio estimó el impacto económico de la desnutrición infantil en dos horizontes temporales (incidental retrospectiva y prospectiva) para el año 2011, considerando los costos asociados a la desnutrición en salud, educación y productividad para la economía peruana. Se combinó la información proveniente de la Encuesta Demográfica de Salud Familiar, la Encuesta Nacional de Hogares, el Censo de Población y Vivienda de 2007 y la información presupuestal pública, así como estimados de los riesgos a los que un niño está expuesto a causa de la desnutrición que padece en sus primeros años de vida. Resultados. Se halló que a nivel nacional en la perspectiva retrospectiva el costo de la desnutrición infantil para el 2011, fue de 10 999 millones de soles, equivalentes al 2,2% del PBI de ese mismo año. Los costos prospectivos a nivel nacional, de quienes al 2011 tienen entre 0 y 59 meses, alcanzaron los 4505 millones de nuevos soles y representan el 0,9% del PBI del año 2011. La mayor parte de los costos provienen de las pérdidas de productividad en ambos casos. Además, la desnutrición afecta mucho más a la sierra y selva peruana. Conclusiones. El impacto económico de la desnutrición infantil representa una parte significativa del PBI, por lo que es necesario continuar invirtiendo equitativamente en su prevención con intervenciones de probada efectividad.
Objectives. To estimate the economic impact of chronic, acute and global malnutrition in Peru. Materials and methods. This study, through an econometric model, estimated the economic impact of child malnutrition in two time horizons (incidental retrospective and prospective) during 2011, considering malnutrition-associated costs of health, education and productivity for the Peruvian economy. Information collected is a combination of data coming from the Demographic Survey of Family Health, the National Survey of Homes, the 2007 Census of Population and Housing, and public budget information, as well as estimates of risks a child is exposed to due to malnutrition during their first years of life. Results. Nationwide it was found that in the perspective retrospective, the cost of child malnutrition in 2011 was 10,999 million soles, which was equal to 2.2% of GDP for that same year. Prospective costs nationwide, of those who by 2011 were 0 to 59 months, reached 4,505 million soles and represented 0.9% of GDP in 2011. Most cases stem from losses of productivity in both cases. Moreover, malnutrition affects much more both the Andes and jungle regions. Conclusions. The economic impact of child malnutrition represents a significant percentage of GDP, reason for which it is necessary to continue investing equitably in its prevention through participation with proven efficiency.
Asunto(s)
Adolescente , Adulto , Niño , Preescolar , Humanos , Lactante , Persona de Mediana Edad , Adulto Joven , Costo de Enfermedad , Desnutrición/economía , Desnutrición/epidemiología , Enfermedad Aguda , Enfermedad Crónica , Perú/epidemiología , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
INTRODUCTION: Hospital malnutrition is a prevalent problem that cause higher morbidity and mortality, poorer response to treatment and higher hospital stay and cost. OBJECTIVES: To determine the prevalence and factors associated with hospital malnutrition in a peruvian General Hospital. METHODS: Cross-sectional study including 211 hospitalized patients in Medicine and Surgery wards. Demographic, clinical and anthropometrical indicators' data was collected. Multivariate analysis was binary logistic regression. All tests had a significance level of 5% (p < 0.05). RESULTS: Prevalence of hospital malnutrition was 46.9%. Prevalences of caloric and protein malnutrition were 21.3% and 37.5%, respectively. Bivariate analysis found that hospitalization in Surgery wards was associated with a major risk of caloric (OR = 4.41, IC 95% [1.65-11.78]) and protein malnutrition (OR = 2.52, IC 95% [1.297-4.89]). During the analysis of quantitative variables, significant associations between number of comorbidities and caloric malnutrition (p = 0.031) was found, and also between the beginning of food intake changes and the presence of protein malnutrition (p = 0.031). Multivariate analysis showed significant association between diagnosis of neoplasm and presence of caloric malnutrition (OR = 5.22, IC [1.43-19.13]). CONCLUSIONS: Prevalence of hospital malnutrition was near 50%, as in similar studies. Protein-caloric malnutrition prevalences obtained, differ from the ones in a previous study in this hospital, which is explained by the different diagnostic criteria and particular characteristics of groups of patients, such as procedence ward and comorbidities. An association between protein-caloric and hospitalization in a Surgery ward was found; the reasons should be investigated in further studies.
Introducción: La desnutrición hospitalaria es un problema prevalente que genera mayor morbi-mortalidad, peor respuesta al tratamiento, mayor estancia y costo hospitalario. Objetivos: Determinar la prevalencia y factores asociados a desnutrición hospitalaria en un hospital general peruano. Métodos: Estudio analítico transversal de 211 pacientes en servicios de Medicina y Cirugía. Se analizó variables demográficas, clínicas e indicadores antropométricos. El análisis multivariado fue de regresión logística binaria. El nivel de significancia fue 5% (p < 0,05). Resultados: La prevalencia de desnutrición hospitalaria fue 46.9% y las de desnutrición calórica y proteica fueron 21,3% y 37,5% respectivamente. En el análisis bivariado, estar hospitalizado en el servicio de Cirugía se asoció a un mayor riesgo de desnutrición calórica (OR = 4,41, IC 95% [1,65-11,78]) y proteica (OR = 2,52, IC 95% [1,30-4,90]). Hubo asociación significativa entre el número de comorbilidades del paciente y desnutrición calórica (p = 0,031), y el tiempo de cambio de ingesta alimentaria y presencia de desnutrición proteica (p = 0,031). El análisis multivariado mostró asociación significativa entre el diagnóstico de neoplasia y la presencia de desnutrición calórica (OR = 5,22, IC 95% [1,43-19,13]). Conclusiones: La prevalencia de desnutrición hospitalaria fue cerca del 50%, coincidiendo con estudios similares. Las prevalencias de desnutrición calórica/proteica halladas difieren de las de un estudio anterior en este hospital, explicándose por parámetros de diagnóstico diferentes y características particulares de las poblaciones, como el servicio de procedencia y comorbilidades. Se encontró asociación entre desnutrición proteica/calórica y estar hospitalizado en el servicio de Cirugía; las razones deben investigarse en estudios posteriores.
Asunto(s)
Hospitales Generales/estadística & datos numéricos , Desnutrición/epidemiología , Adulto , Anciano , Estudios Transversales , Femenino , Hospitales Generales/economía , Humanos , Tiempo de Internación , Masculino , Desnutrición/economía , Persona de Mediana Edad , Perú/epidemiología , Prevalencia , Desnutrición Proteico-Calórica/epidemiología , Factores SocioeconómicosRESUMEN
OBJECTIVES: To estimate the economic impact of chronic, acute and global malnutrition in Peru. MATERIALS AND METHODS: This study, through an econometric model, estimated the economic impact of child malnutrition in two time horizons (incidental retrospective and prospective) during 2011, considering malnutrition-associated costs of health, education and productivity for the Peruvian economy. Information collected is a combination of data coming from the Demographic Survey of Family Health, the National Survey of Homes, the 2007 Census of Population and Housing, and public budget information, as well as estimates of risks a child is exposed to due to malnutrition during their first years of life. RESULTS: Nationwide it was found that in the perspective retrospective, the cost of child malnutrition in 2011 was 10,999 million soles, which was equal to 2.2% of GDP for that same year. Prospective costs nationwide, of those who by 2011 were 0 to 59 months, reached 4,505 million soles and represented 0.9% of GDP in 2011. Most cases stem from losses of productivity in both cases. Moreover, malnutrition affects much more both the Andes and jungle regions. CONCLUSIONS: The economic impact of child malnutrition represents a significant percentage of GDP, reason for which it is necessary to continue investing equitably in its prevention through participation with proven efficiency.