Tackling disease-related malnutrition in resource-limited settings: An international position paper based on expert consensus

Background: Considering the challenges of providing nutrition care in resource-limited settings (RLSs), the International Working Group for Patients' Right to Nutrition Care (WG) organized an expert meeting to propose recommendations and strategies to promote access to nutrition care and address disease-related malnutrition (DRM). Methods: An online survey was developed to assess barriers to providing nutrition care in RLSs and was completed by 58 respondents from low- and middle-income countries between July and August 2024. During the European Society for Clinical Nutrition and Metabolism (ESPEN) Congress in Milan on September 9, 2024, a panel of 30 experts discussed the results of the survey and built consensus statements aimed at defining strategies and recommendations required to address barriers to accessing disease-related nutrition care in RLSs. Results: The survey and expert consensus panel opinions indicated that there are barriers to delivering quality nutrition care in these settings including low or a lack of medical awareness, patient and family knowledge about DRM and its impact, nutrition risk screening and care implementation, reimbursement, medical devices, adapted diets, nutrition protocols, and access to home medical and nutrition therapy. Gaps identified included (1) epidemiological data and evidence for best practices; (2) education, training, and capacity building; and (3) strengthening health systems. Conclusion: Tackling DRM in RLSs is challenging because of the high burden of DRM and the fact that current guidelines from high-income countries may not be fully applicable. The WG recommend a three-step strategy to promote access to nutrition care.