title: Economy matters to fight against malnutrition: Results from a multicenter survey.
abstract: Malnutrition represents a serious health care threat, as it increases morbidity, mortality and health care cost. The effective screening and treatment with enteral (EN) or parenteral (PN) nutrition are the key elements of the policy called Optimal Nutrition Care for All (ONCA). The study tried to analyze the impact of the state's economy on the implementation of EN and PN to define its role in ONCA.
  
  
  
  an international survey in twenty two European countries was performed between January and December 2014. An electronic questionnaire was distributed to 22 representatives of clinical nutrition (PEN) societies. The questionnaire comprised questions regarding country economy, reimbursement, education and the use EN and PN. Return rate was 90.1% (n = 20).
  
  
  
  EN and PN were used in all countries surveyed (100%), but to different extent. The country's income significantly influenced the reimbursement for EN and PN (p < 0.05). It was also associated with the overall use of tube feeding and PN (p = 0.05), but not with the use of oral nutritional supplements (p = 0.165). The use of both, EN and PN at hospitals was not depended on the economy (p > 0.05). Education was actively carried out in all countries, however the teaching at the pre-graduate level was the least widespread, and also correlated with the country income (p = 0.042).
  
  
  
  Results indicated that economic situation influences all aspects of ONCA, including education and treatment. The reimbursement for EN and PN seemed to be the key factor of effective campaign against malnutrition.
authors.affiliation: Stanley Dudrick's Memorial Hospital, General Surgery Unit, Skawina, Poland. Electronic address: klek@poczta.onet.pl.
authors.forename: Stanislaw
authors.initials: S
authors.lastname: Klek
authors.affiliation: School of Medicine, Aristotle University of Thessaloniki, Greece.
authors.forename: Michael
authors.initials: M
authors.lastname: Chourdakis
authors.affiliation: Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Bischoff
authors.affiliation: National O. Bohomolets Medical University, Department of Anesthesiology and Intensive Care, Kyiv, Ukraine.
authors.forename: Sergiej
authors.initials: S
authors.lastname: Dubrov
authors.affiliation: Norwich Medical School, University of East Anglia, Norwich, UK.
authors.forename: Alastair
authors.initials: A
authors.lastname: Forbes
authors.affiliation: Jagiellonian University Medical College, Chair of Epidemiology and Preventive Medicine, Department of Epidemiology, Krakow, Poland.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Galas
authors.affiliation: Clinical Nutrition, University Hospital, Geneva, Switzerland.
authors.forename: Laurence
authors.initials: L
authors.lastname: Genton
authors.affiliation: General Surgery and Gastrointestinal Surgery Atatürk Teaching and Research Hospital, Ankara, Turkey.
authors.forename: Haldun R
authors.initials: HR
authors.lastname: Gundogdu
authors.affiliation: Gastrosurgery Research Group, UiT The Arctic University of Norway and Division of Surgery, Oncology and Women's Health, University Hospital of North Norway, Norway.
authors.forename: Oivind
authors.initials: O
authors.lastname: Irtun
authors.affiliation: The Riga East Clinical University Hospital, Riga, Latvia.
authors.forename: Ilze
authors.initials: I
authors.lastname: Jagmane
authors.affiliation: Tartu University Hospital, Anaesthesiology and Intensive Care Clinic, Tartu, Estonia.
authors.forename: Triin
authors.initials: T
authors.lastname: Jakobson-Forbes
authors.affiliation: Kralovske Vinohrady University Hospital, Internal Medicine Department, Prague, Czech Republic.
authors.forename: Adam
authors.initials: A
authors.lastname: Jirka
authors.affiliation: Trinity College Dublin, Dublin, Ireland.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Kennedy
authors.affiliation: Vilnius University, Medical Faculty, Clinic of Anaesthesiology and Reanimatology, Vilnius, Lithuania.
authors.forename: Andrius
authors.initials: A
authors.lastname: Klimasauskas
authors.affiliation: North-Western State Medical University named after I.I.Mechnikoff, Saint-Petersburg, Russian Federation.
authors.forename: Igor
authors.initials: I
authors.lastname: Khoroshilov
authors.affiliation: Servicio de Endocrinologia y Nutrition, Hospital Universitatrio 12 de Octubre, Madrid, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Leon-Sanz
authors.affiliation: Department of Clinical Medicine, Sapienza, University of Rome, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Muscaritoli
authors.affiliation: Medical Academy University Clinic for General Surgery Department for Perioperative Nutrition, Belgrade, Serbia.
authors.forename: Marina
authors.initials: M
authors.lastname: Panisic-Sekeljic
authors.affiliation: Laiko General Hospital, Athens, Greece.
authors.forename: Kalliopi Anna
authors.initials: KA
authors.lastname: Poulia
authors.affiliation: Gastroenterology and Nutrition, Archet University Hospital, Nice, France.
authors.forename: Stephane
authors.initials: S
authors.lastname: Schneider
authors.affiliation: Tampere University Hospital, Nutrition Unit, Tampere, Finland.
authors.forename: Ulla
authors.initials: U
authors.lastname: Siljamäki-Ojansuu
authors.affiliation: Ege University Hospital, Department of Anesthesiology and Intensive Care, Izmir, Turkey.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Uyar
authors.affiliation: Radboud University Medical Center, Nijmegen, The Netherlands.
authors.forename: Geert
authors.initials: G
authors.lastname: Wanten
authors.affiliation: School of Medicine, University of Zagreb, Croatia.
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Krznaric
mesh_terms: D004750:Enteral Nutrition / Q000191:economics; D005060:Europe; D006761:Hospitals; D006801:Humans; D007902:Length of Stay; D044342:Malnutrition / Q000191:economics* / Q000517:prevention & control*; D010288:Parenteral Nutrition / Q000191:economics; D011795:Surveys and Questionnaires
keywords: Disease-related malnutrition; Enteral nutrition; Parenteral nutrition; Reimbursement