Spain has the dubious honor of being the only country in the European Union that does not include dietitians and dietician-nutritionists (DN) in the National Health System (SNS) in most of its autonomous communities. Dieticians are Nutritional Technologists (TSD) and Dietitians-Nutritionists are Graduates or Graduates in Nutrition Science for clarity and use of acronyms in the article, not for titular purposes.
In 2003, the European Union, through the Council of Europe, developed the need for mandatory nutritional care in hospital settings. Essentially, it is about the prevention and determination of the causes of malnutrition as well as a nutritional assessment of the 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 formed with the aim of focusing on malnutrition. To this end, it was proposed to establish a common agenda for the countries of the European Union to develop health strategies around malnutrition, its prevention and treatment. This strategy is called ‘Together for Health: A Strategic Approach for the EU 2007-2013’ and re-emphasised the need to systematize mandatory nutritional screening as an undeniable step in the fight against malnutrition.
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In Spain, as established by Royal Decree 184/2015 of March 13, DNs are A2 category Statutory Health Professionals and C1 category DSTs. That’s what the law says. Another thing is the presence we have in public hospitals and primary care.
The leading causes of death worldwide are chronic noncommunicable diseases (ENT) as life expectancy increases and the population ages. According to the World Health Organization (WHO), they are responsible for 74% of all deaths worldwide. The most common noncommunicable diseases include cardiovascular diseases, chronic respiratory diseases and diabetes mellitus (DMII). Since TSD and DN figures are not integrated into primary care, these diseases are treated pharmacologically, i. Drug treatment is not associated with increased survival and exposes patients to complications and side effects such as malnutrition.
Most prescribed medications are related to medical conditions that would improve with proper diet. The most common medically treated diseases are hypertension, hypercholesterolemia and type II diabetes. In addition to improving a healthier and non-polymedicated population, it would also mean economic savings. Generally speaking, the inclusion of TSD and DN can save up to €99 for every euro invested in a dietary treatment.
The latest data in Spain shows that one in four hospitalized patients is at risk of malnutrition or is malnourished (23.7%), and that this percentage rises to 37% when patients are over 70 years old. People with neoplastic (35%), cardiovascular (29%) and respiratory (28%) diseases are most affected.
According to the Spanish Society for Medical Oncology (SEOM), cancer is already the second leading cause of death in the general population in Spain. In addition, every second cancer patient suffers from malnutrition during their own hospital stay. Malnutrition alters the properties of drugs and their effects, leading to increased doses and consequent greater toxicity, which is why treatment courses are lengthened or even discontinued due to ineffectiveness. Performing prior nutritional screening would reduce economic costs, shorten admission days, decrease the possibility of readmission, and most importantly, improve the effectiveness of patients’ treatments.
If nutritional status screening were performed at the time of hospital admission, malnutrition could be prevented or treated and treatment addressed more comprehensively and effectively. In addition, the standards proposed by the WHO and the EU would be met.
The inclusion of the figures of the TSD and DN would not only give us the space that is ours, but also mean access for the entire population since, not being part of the public health system, we are forced to practice privately and it is precisely the less affluent who are most likely to develop inappropriate eating habits and therefore develop chronic diseases. Health depends on many factors and the socio-economic context is one of them. Rafael Cofiño Fernández, former health minister of Asturias, says: “Your zip code is more important for your health than your genetic code.”
Professional categories for DSTs and DNs have already been created in communities such as Catalonia, Valencia, Balearic Islands, Navarre, Murcia, Castilla y León, La Rioja, Aragón, the Basque Country and more recently Galicia, and we hope that other communities and nutrition professionals will gradually join them. It is necessary that health no longer adopts a paternalistic approach, but that it is 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 compared by specialists. Eating is much more than a pleasure and a necessity: diet and eating habits are currently the public health factor that can help us the most to prevent numerous diseases, from many types of cancer to diabetes. A team of dieticians and nutritionists will help us to better understand the importance of food and, thanks to science, to shatter the myths that lead us to eat the wrong foods.
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