AREA OF SPECIFIC TRAINING IN NUTRITION AND DIETETICS
Nutrition is a relatively young Science in continuous process of development and expansion.His interest has been fostered by the direct relationship with health and disease, highlighted by the progress made by scientific knowledge of nutritional processes in the multiple studies carried out over recent years.
The WHO within the political framework of Health for all, Salud XXI, reflects in its objective 11, that by 2015 all population groups must have adopted healthier life models, and among the strategies to achieve it, it proposes actions that facilitate healthy choices in relation to nutrition and physical exercise.
Maintaining an adequate nutritional status has contributed to the decline in infectious diseases since the beginning of the century, as a cause of increased morbidity and mortality associated with the prevalence of malnutrition. However, at the end of the 20th century, in developed countries and as a consequence of abandonment in the consumption of traditional foods that have been replaced by hypercaloric diets, with a high content of fat and sugars, and poor in complex carbohydrates and fiber , chronic diseases have increased.
Modern society is characterized by having more food than it is possible to consume; In it, primary malnutrition due to insufficient food supply has given way to other health problems derived from the characteristic overfeeding of industrialized societies, such as the increase in cardiovascular diseases, obesity, diabetes, cancer, osteoporosis and even eating disorders, which begin to acquire a worrying relevance. All of them constitute the so-called diseases of the society of abundance.
When analyzing the causes of mortality in our country, we find that eight out of ten are related to food and alcohol intake. As the first cause, we found 40% of cardiovascular diseases, followed by 25% of cancer, 9% of respiratory diseases and 5.6% of digestive diseases.
In 1997 Van Weel, analyzed the most prevalent chronic diseases in primary care while calculating the morbidity “sensitive nutrition” in which it included all those diseases in which the council, nutritional treatment or both were important. The three pathologies with the highest prevalence, within a list of ten, were: arterial hypertension (54%), obesity (42%) and ischemic heart disease (37%). From the morbidity analysis “sensitive nutrition” in a list of 26 pathologies we highlight: overweight (78.8%), dermatitis (64.3), high blood pressure (56%), obesity (42.8%), gastroenteritis (30 , 9%), angorpectoris (21.6%), hypercholesterolemia (19.4%).
- The cardiovascular disease whose most frequent cause is atherosclerosis, since the fifties it is known, by epidemiological studies, the direct relationship between the amount and type of fat in the diet and plasma cholesterol levels. Between 90-95% of its levels are directly related to intake, while genetics occupies a much less relevant place. In Europe, cardiovascular diseases re-present the leading cause of death at the present time, above cancer and traffic accidents.
- Cancer is the second cause of death in developed countries and has been increasing in recent years. Breast, colon and prostate cancers are more frequent in developed countries, with saturated fat consumption related to the risk of suffering from these malignancies. Epidemiological studies show that a diet rich in vegetables and fruit has protective effects on cancer of epithelial origin. It is considered that more than 95% of cancers are due to environmental factors and of them the diet would be responsible for more than a third of them. Of the ten recommendations that make up the “European Decalogue Against Cancer”, two of them, are nutritional recommendations, reflecting the important relationship between food and cancer.
Once cancer is established, some degree of malnutrition often develops, which in many cases will condition the response to treatment, the evolution of the disease and with it a greater increase in morbidity and mortality.
- Type 2 diabetes mellitus, a disease traditionally associated with old age and the way of life of industrialized countries, is characterized by chronic hyperglycemia, often associated with overweight and obesity. The latest studies carried out in Spain, place the prevalence between 2-6% of the general population, around 1.5 million diabetics, 90% of them type2. These same investigations reveal that another million and a half of Spaniards suffer from the disease but without knowing it. According to the WHO, in the last 10 years, the number of people affected by this disease has increased fivefold and it is estimated that by 2010 there will be 250 million diabetics in the world.
Sedentary lifestyle and a high fat diet, accompanied by obesity, are decisive. New technologies have seated millions of workers in front of computer screens and children have changed the traditional games in which they exercised for video games: The explosion of diabetes among young people is favored by “junk food” and games electronic Therefore, it is essential to start early childhood education programs, in order to establish healthy habits and lifestyles.
Dietary modifications, physical activity and patient self-control are the basis of treatment, along with medication if necessary.
- Obesity is the most frequent metabolic disease in developed countries and will be one of the great epidemics of the 21st century, along with diabetes. It currently represents a health problem of enormous importance as it increases the risk of arterial hypertension, atherosclerosis and ischemic heart disease, depression, biliary lithiasis, sleep apnea, and a long etcetera, which significantly decreases the quality of life of the obese and increases considerably the morbidity and mortality of the population.
In its development, environmental factors (diet and lifestyle) are involved, which has guided the therapeutic approach towards a change in lifestyle, which must be maintained over time, and which implies the adoption of healthy habits based on a balanced diet hypocaloric, and regular practice of moderate physical exercise. The levels of inactivity in most of the population are so important that it is not possible to maintain an adequate diet in micronutrients without this fact causing excess body weight.
The obese is a sick individual who becomes an example of what should not be, since it contradicts one of the most important slogans of today’s society:“beauty, aesthetics, body worship”. The social condemnation of the obese is complemented by the generalization of an aesthetic model based on thinness. The thin, culturally accepted canon is formalized and when it spreads it generates discontent and anxiety among individuals who are not within the formal limits.
Not only is treatment important but also prevention, which should be directed towards the primary prevention of obesity itself, to prevent weight recovery in subjects who have lost weight and future weight increases in those obese who have been unable of reducing your weight
- Eating disorders are characterized in that there is a serious distortion of the body’s self-image that results in pathological changes in the eating pattern. Recent studies reveal that in Spain almost 6% of the young population (about 350,000 people) suffer from eating disorders, either anorexia nervosa or bulimia and every year about 6,000 new cases are registered. Many experts agree that there is always a diet at the origin of these disorders. Performing a regimen increases the chances of developing any of these disorders 18 times. Mortality from these disorders is between 5-10% of cases.
The best treatment is prevention from childhood, and school education is basic since the beginning in most cases occurs in adolescence. The nurse when performing health checks routinely is the health professional best placed to perform an early detection, in situations of low weight, significant self-induced significant weight loss, non-acceptance of her body image, delayed puberty development , etc.
Eating habits are a determining factor in the state of health of the population and are the result of the geographical and economic framework in which the life of man is developed, reinforced by tradition, the cultural pattern and the social environment where he lives, and influenced by Advertising and marketing. They are configured in childhood and develop and settle throughout the life of the subject, being able to influence them through educational programs that reinforce appropriate eating behavior patterns that help the individual maintain their health.
Advertising and the media have been producing in our country some 100,000 spots per year, of which around 25% correspond to the promotion of food and beverages, not always of true nutritional value that influence, on the one hand, the canons of aesthetics and health, changing the tastes and preferences of consumers towards supposedly healthy products, and on the other, in response to commercial interests that advertise as appealing products of doubtful nutritional quality, influencing to a greater extent the lower critical capacity It presents the potential consumer.
New lifestyles, such as the incorporation of women into the world of work and their change in the social role, which requires a quick preparation of meals, forcing a consumption of semi-prepared foods, with excess of preservatives, sodium and Saturated fats. The increase in the distance between the workplace or the school and the home has led to the proliferation of collective catering and fast food establishments, especially attractive to children and young people, but in some cases they offer food of doubtful nutritional quality and high palatability and easy consumption, which can be ingested anywhere, even while simultaneously performing another activity.
Nutritional health is usually maintained, through a balance between food intake and nutrient utilization in each pathophysiological situation. But food is not only a preventive weapon, but also has definite therapeutic effects in certain biological disorders. The therapeutic diets that, in some cases constitute the only possible or effective treatment before a specific disease, and in others, contribute to the better evolution of the patient, collaborating in its cure, being currently a general and basic measure of treatment, both in Hospitals as in Primary Care.
A therapeutic diet is a food plan that involves food modifications, based on knowledge for the treatment of a disease. The most common diseases whose precise treatment of a dietary plan are gastrointestinal pathologies (gastroesophageal reflux, diarrhea, constipation, flatulence, gastric and intestinal resections, liver disease, pancreatitis, all types of food allergies and intolerances, etc.), the patient with alteration of renal function, in hemodialysis or in peritoneal dialysis, metabolic syndromes (obesity, diabetes, hyperlipemias), and problems in chewing and / or swallowing, which affect the latter, a large number of patients with various pathologies (diseases neurological, neoplasms, etc.).
When a patient cannot be fed in a conventional way, either because he has difficulties swallowing or because he has some digestive or absorptive disability, one must resort to artificial nutrition, either enteral, when the supply of nutrients is done through the digestive tract by means of a nasal or percutaneous or parenteral catheter, if the administration of nutrients is carried out directly through a venous route to the bloodstream, with the objective of maintaining or restoring nutritional status, preserving health status and maintaining The patient’s quality of life.
In recent years, the existence of patients with artificial home nutrition is increasingly frequent, given that their hospital stay should not be conditioned by artificial nutrition. For this to be possible, the creation of multidisciplinary teams has been necessary, in which nurses are responsible for training patients and / or families candidates for this type of treatment, teaching them the use and maintenance of all nutritional material and formulas, as well as the care of the access road, before the patient leaves the hospital.
To ensure the effectiveness of home artificial nutrition, a patient monitoring and follow-up program is also necessary, in which specialized care and primary care nurses are involved, with specific knowledge in this type of nutritional treatment.
The increased demand for health care in the field of Nutrition and Dietetics, the recognition of the need to control the diet of patients and human groups in special physiological situations, and the frank expansion and improvement of artificial nutrition , both enteral and parenteral, have led to the development of new knowledge, activities and care. (…… ..)
All this has resulted in many nursing professionals, self-taught, have been trained in both the area of Nutrition and Dietetics, to meet the needs so far greater in the hospital, but growing in Primary Care given the increase in the demand for nutritional care of the healthy population, much more than that which presents some type of chronic pathology, the increase in patients in home hospitalization, the elderly, terminal patients and / or those who require artificial nutrition for long periods of Time, among others.
Nowadays most of the hospitals have Nutrition and Dietetics Units and the nurses are integrated in the multidisciplinary teams that compose them, contributing to these teams their knowledge expertise in care. These professionals have a wealth of knowledge, both related to the practical application of nutritional principles and the resolution of practical and habitual situations arising from a wide variety of health problems.
In the curriculum of the Diploma in Nursing, the subject of Nutrition and Dietetics is a core subject with a number of credits ranging between 4 and 5, according to the different Universities, which prepare the future professional to have general knowledge. But broader and more developed training, and updating in new knowledge, justify the creation of a Specific Training Area.
What do the nurses with Specific Training in Nutrition and Dietetics offer the population, both from Primary and Specialized Care, that cannot be provided by other professionals who already have training in Nutrition and Dietetics, either in the FPII branch or in the Diploma in Nutrition and Dietetics?
As highlighted by the National Institute of Health in its publication: “Nursing. Caring: a profession.” Your present and your future go through the comprehensive care of the patient, his family and the community wherever he needs it. Stresses as its main objective: To ensure that people achieve the highest level of self-care and one of their main tasks is education, without forgetting, the identification of needs, information, management and providing the necessary care in a professional and personalized way .