Barazzoni R. Rev. Nutr. Clin. Metab. 2019;2(Supl.1):12-13.

Nutrition and Clinical Nutrition
as human rights

Nutrición y Nutrición Clínica como
derechos humanos

Nutrição e nutrição clínica como direitos humanos

Pr. Rocco Barazzoni1*

1 Chairman of ESPEN. Department of Medical, Surgical and Health Sciences, University of Trieste - Italy

*Corresponding author: Rocco Barazzoni

There is no doubt that human beings have a right to nutrition and hydration as a basic support for life. Prolonged deprivation of sufficient amounts of food results in development of malnutrition, which is incompatible with survival through deterioration of health. More specifically, disease (particularly infections through loss of immune defense), disabilities and ultimately death are common malnutrition consequences. There is strong general awareness that the right to be nourished is jeopardized by natural, social and economic hurdles that still affect a large, but fortunately decreasing proportion of humankind. Ensuring adequate food availability for all is therefore a strong priority in political agendas worldwide.

It is however much less recognized that deterioration of nutritional state and the onset of malnutrition are primarily associated with disease, independently of nutrient availability and even intake. As they become sick and vulnerable, humans often develop anorexia with reduced desire to eat, as well as profound metabolic derangements that impair the ability to utilize food and nutrients to store energy and preserve tissues and muscle mass. Most importantly, disease-related malnutrition is all the more dangerous for patient survival as it enhances disease-specific risks. The right to nutrition becomes therefore crucial in disease conditions, but nutritional components and complications of disease are unfortunately dramatically under-recognized. Food quality and food intake in hospital settings are often low due to organization choices and priorities that neglect nutritional needs, at a time when they should receive highest priority. Patients that are unable to eat adequate quantities of calories and protein could and should indeed be treated with supplemental nutrition to meet their needs and preserve nutritional status. Clinical nutrition protocols are available to this aim through oral, enteral and parenteral routes and techniques, which were introduced and refined over several decades. Clinical nutrition treatment is however dramatically under-recognized and under-implemented in all medical fields. Neglecting or even ignoring the therapeutic option of clinical nutrition is increasingly frustrating and ultimately unacceptable, since strong evidence is accumulating to show its effectiveness to reduce complications, mortality and save healthcare costs.

For these reasons, as the discipline of clinical nutrition is rapidly growing, scientific Clinical Nutrition Societies more and more recognize the need to extend their scopes beyond supporting and disseminating excellence in research, education and clinical practice. Indeed, they should increasingly promote action to enhance awareness on the importance of preventing malnutrition and its dramatic complications in all patients and clinical settings. Such actions should aim to reach not only health-care professionals but also patients, policymakers and the public at large through multi-stakeholder strategic campaigns. As this is increasingly occurring worldwide, the Latino-American Federation for Parenteral and Enteral Nutrition (FELANPE) implemented an important step that lead to the Cartagena Declaration this year, calling to formally recognize that clinical nutrition, no different from basic food, is a human right. The Cartagena Declaration was signed by all Presidents of Latino-American Parenteral and Enteral Nutrition Societies, and Presidents of the European and North-American Society were invited to Cartagena to sign as witnesses. The Cartagena Declaration also importantly provides indications to move towards implementation of its principles. Formal, widespread recognition of clinical nutrition as a fundamental human right could indeed play a relevant role in promoting awareness that disease-related malnutrition is a major clinical burden, reducing life expectancy, life quality and health-care resources in millions of patients worldwide.

The European Society for Clinical Nutrition and Metabolism (ESPEN) has recognized the need to promote initiatives to increase awareness and implementation of clinical nutrition treatment, which should also reach towards patients, public at large and policymakers. ESPEN strongly supports all efforts towards recognition of each patient’s right to nutrition and clinical nutrition, and it has therefore convincingly signed the Cartagena Declaration in its witness capacity.