Bermúdez C, et al. Rev. Nutr. Clin. Metab. 2019;2(Supl.1):8-9.





Cartagena Declaration: Date with a dream

Declaración de Cartagena: cita con un sueño

Declaração de Cartagena: encontro com um sonho


Charles E. Bermúdez Patiño1*


https://doi.org/10.35454/rncm.v2supl1.026



1 President ACNC 2017-2021

*Corresponding author: Charles E. Bermúdez Patiño

presidencia@nutriclinicacolombia.org


When we took on the challenge, as the Board of Directors, of leading the course of the Colombian Clinical Nutrition Association, we established pillars on which we would work in the following years: education, research, creation and strengthening of networks, and dissemination strategies. The Declaration of Cartagena is a convincing example of the union of these four paths to fulfill the mission and vision of our Association, also succeeding in influencing the rest of Latin America in the quest to achieve a higher good, a timely medical nutritional therapy, adequate, fair, equitable and in conditions of human dignity, recognizing the patient as a fragile person with rights and committing the health team as guardians of these rights.

Taking as a reference the Declaration of Cancun, signed in 2008, a document that for the first time in Latin America proclaimed “the human right of the sick to receive timely and optimal nutritional therapy wherever they are(1)”; malnutrition in its various forms, as the most common disease, and in the clinical area related to inadequate intake, increased nutritional requirements due to disease, poor absorption of nutrients, excessive nutrient loss; or a combination of all these factors(2), becomes a global problem, with figures around 50 % of patients hospitalized according to the series studied(3-5).

If we review the nutritionDay figures in Colombia we find that the malnutrition rate in 7,994 patients evaluated from 2009 to 2015 is 38 %. Despite this data, in 2018 only 27.2% of the patients studied underwent nutritional screening, showing that there is still a long way to go in the timely detection of the risk of malnutrition. When reviewing nutritional interventions we found that by 2018 the use of nutritional supplementation was 9.9%, enteral nutrition 5.3% and parenteral nutrition 2.2%(6), remembering that malnutrition figures are around 40 % of hospitalized patients, it is pertinent to think that ultimately, something is wrong with the nutritional intervention.

The consequences of malnutrition are widely described and can be summarized as slow healing, altered immunity, increased mortality, increased hospital stay, and the direct and indirect costs of health care.

It has been documented in multiple publications that the percentage of complications is higher in malnourished patients: Waitzberg et al. in 2001, quantified this higher rate of complications in malnourished patients in 27% different from 16.8% of incidence in well-nourished patients(3); Correia et al. in 2003, indicated that in malnourished patients mortality increased by 8 % and hospital stay increased by up to 3 days(7).

Once the problem was identified, and the adverse outcomes that the problem entails, the next step, in this particular case of the Societies, Colleges and Associations belonging to FELANPE, was to assume the challenge, and the implications of declaring “Nutritional Care as a human right, and to guarantee to all persons, especially to the sick with or at risk of malnutrition, access to nutritional care and in particular to optimal and timely nutritional therapy, in order to, among others, reduce the high rates of hospital malnutrition and associated morbidity-mortality”(8). The Declaration of Cartagena establishes 13 Principles, but I consider that the most important thing is to establish an action plan that allows us to move from words to deeds, from discourse to action, committing governments to the integral treatment of our patients, understanding nutritional therapy as a human right(9) and the key to an effective and sustainable health system.

Finally, this is the moment to publicly express my gratitude to my family for their help, support and generosity with their time and in particular to Valeria Bermúdez Garzón, my daughter, who is in 11th grade at the Angloamericano School, and who despite her school obligations, decided to accompany me to achieve my dreams, to support me not only from the heart but through admirable physical work, advice, recommendations, she has walked with me these years, we have grown together, always remember “Close your eyes, focus, imagine, dream, make a wish”.

Thank you, daughter!!!


References

  1. Castillo Pineda JC, Figueredo Grijalva R, Dugloszewski C, Diaz R, Reynoso JAS, Spolidoro Noroña JV, Matos A, et al. Declaración de Cancún: declaración internacional de Cancún sobre el derecho a la nutrición en los hospitales. Nutr Hosp. 2008;23(5):413-7.
  2. Loch SH, Allison SP, Meier R, Pirlich M, Kondrup J, Shneider S, ven der Berghe G, Pichard C. Introductory to the ESPEN Guidelines on Enteral Nutrition: Terminology, Definitions and General Topics. Clin Nutr. 2006;5:180-6.
  3. Waitzberg D, Caiaffa WT, Correia MI. Hospital Malnutrition: The Brazilian National Survey (IBRANUTRI): A Study of 4000 Patients. Nutrition. 2001;17(7-8):573-80.
  4. Cruz V, Bernal L, Buitrago G, Ruiz AJ. Frecuencia de riesgo de desnutrición según la Escala de Tamizado para Desnutrición (MST) en un servicio de Medicina Interna. Rev Med Chile. 2017; 145: 449-57.
  5. Bermudez CH, Henao A, Rodriguez P, Veloza A. Por una clínica sin malnutrición: Modelo de atención nutricional en la Clínica la Colina. Revista Médica. 2016;6(1):12-5.
  6. nutritionDay reports.[Internet] (Consultado el 20 de octubre de 2019). Available: https://www.nutritionday.org/en/about-nday/national-reports/index.html
  7. Correia MI, Waitzberg DL. The impact of malnutrition on morbidity, mortality, length of hospital stay and costs evaluated through a multivariate model analysis. Clin Nutr. 2003;22:235-9.
  8. Cardenas D, Bermúdez CH, Echeverri S, Perez A, Puentes M, Lopez M, et al. Declaración de Cartagena. Declaración Internacional sobre el Derecho al Cuidado Nutricional y la Lucha contra la Malnutrición. Nutr Hosp. 2019;36(4):974-98. http://dx.doi.org/10.20960/nh.02701.
  9. Cardenas D, Bermúdez CH, Echeverri S. Is nutritional care a human Rigth?. Clin Nutr Exp. 2019; 26: 1-7. https://doi.org/10.1016/j.yclnex.2019.05.002