“Medical Nutrition” Is Poorly Defined, Insufficiently Assessed
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Newswise — Lawrenceville, NJ, USA—February 11, 2019—Value in Health, the official journal of ISPOR—the professional society for health economics and outcomes research—announced today the publication of an ISPOR scoping review showing that “medical nutrition” terminology is not consistently defined, relevant European and US regulations are infrequently cited, and economic evaluations are infrequently conducted. The report, “Medical Nutrition Terminology and Regulations in the United States and Europe—A Scoping Review: Report of the ISPOR Nutrition Economics Special Interest Group,” was published in the January 2019 issue of Value in Health

ISPOR’s Nutrition Economics Special Interest Group conducted a scoping review of scientific literature on European and US medical nutrition terminology and regulations to ascertain how: 1) medical nutrition terms are defined, 2) relevant regulations are applied, and 3) medical nutrition is economically evaluated in the United States and Europe. In total, 459 records were included in the analysis, of which 308 used medical nutrition terms. 

The review identified very few medical nutrition definitions, most of which were heterogeneous. The terms most frequently defined were malnutrition (58 records), enteral nutrition (9), undernutrition (7), and parenteral nutrition (5). Likewise, relevant regulations were infrequently cited; overall, less than 5% of the records referenced any medical nutrition regulation. Finally, just 34 of the 459 records reported some type of economic data, and only 19 contained a full or partial health economic evaluation. 

“The integral role that food and nutrients play in the etiology and progression of disease is pushing healthcare decision makers to consider the cost and value of nutrition interventions,” said author Karen Freijer, PhD, RDN, School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands. “The current lack of consensus on medical nutrition terminology hampers research and analysis of its impact on health and economic outcomes in the management of disease- and condition-related nutrition therapy. To sustain value-based decisions within healthcare systems, establishing a common understanding of the terms and definitions surrounding medical nutrition is the critical first step to build the foundation of future nutrition economics research and evaluation of interventions.” 

The two major nutrition societies in Europe (ESPEN) and the United States (ASPEN) have prioritized, and are calling for, continuing constructive discussions to reach a consensus statement for the benefit of the global nutrition community. The authors note that the ISPOR Nutrition Economics Special Interest Group fully supports this ongoing initiative and emphasizes that adopting standardized medical nutrition terminology is essential to develop reliable and harmonized methodologies.