Ministers' Deputies
    CM Documents

    CM(2003)127 15 October 2003
    ——————————————

    860 Meeting, 12 November 2003
    6 Social Cohesion


    6.1 Public Health Committee (Partial Agreement) (CD-P-SP) -

    Abridged Report of the 71st Session (Strasbourg, 6 June 2003)

    ——————————————

    RESTRUCTURING OF DG III

    1. The Committee stated that in the light of the importance of the future of the public health sector, the discussions held and decisions taken at the 70th session should have been reflected in a more accurate way by the Secretariat in the abridged report of the 70th Session (CM (2003)17).

    2. In particular, delegations underlined the fact that it had been a unanimous decision of all delegations to discuss this item in the absence of the Secretariat, since no effort had been made by the Secretariat to share budgetary questions and other information available at that date and related to the important question of the possibility of convergence of activities of the CD-P-SP with the inter-governmental programme of the CDSP.

    3. The Committee was of the opinion that the text as presented in the above report under item “I. Restructuring of DGIII” was not understandable for the Committee of Ministers.

    4. The Committee also complained that no follow-up had been given by the Secretariat to the letter addressed by the Committee to Mrs Battaini-Dragoni concerning the CD-P-SP's views in reaching decisions on future working arrangements and review of all options around the possibility of convergence of activities of the CD-P-SP with the inter-governmental programme and which set a clearly identified time-scale for resolving budgetary, legal and staffing issues, particularly through any transition period, as set out in Appendix 2 to the above mentioned abridged report.

    5. If the content of the letter was considered unclear by the Secretariat, the Secretariat should have addressed delegations.

    6. The Committee was of the opinion that there should be full transparency from the Secretariat to the CD-P-SP with regard to all aspects related to the future working arrangements and around the possibility of convergence of the work of both sectors of the Partial Agreement.

    7. Furthermore the Committee underlined the need for full reports.

    8. Mrs Podestà Le Poittevin informed the Committee of the announcement by the Secretary General in his welcome address at the Second European Conference of Ministers Responsible for Integration Policies for People with Disabilities, Malaga, 7-8 May 2003, of his intention to extend the activities of the public health sector undertaken within the framework of the Partial Agreement in the social and public health field to all 45 Council of Europe member states. This transition will be done on a three years period, as from 2004.

    9. The Secretary General had said that “within a three-year period, in which the Partial Agreement remains intact, I would like to extend its activities to all Council of Europe member states. I do hope that this extension will start in 2004 with the disability sector by gradually transforming the multidisciplinary Partial Agreement Committee CD-P-RR into a fully-fledged Council of Europe Steering Committee, directly responsible to the Committee of Ministers”.

    10. Mrs Podestà Le Poittevin added that the Secretary General's wish was to start the extension of the public health sector in 2005.

    Decisions

    12. The Committee:

    1. asked the Secretariat to provide full reports which should accurately reflect the discussions and decisions taken by the Committee in particular with respect to all aspects related to the future working arrangements and the possibility of convergence of the work of both sectors of the Partial Agreement and the inter-governmental work programme;

    2. asked the Secretariat to keep it clearly informed about the internal review of the links between the Partial Agreement in the Social and Public Health Field and the intergovernmental programme in the field of health and in the field of people with disabilities, in particular with regard to budgetary, legal and staffing issues;

    3. decided that draft versions of the abridged and the full reports should be submitted for comments to delegations of the CD-P-SP;

    4. asked the Secretariat to apply transparency with regard to links between the Partial Agreement work sectors and inform delegations in future.

    DECISIONS OF THE COMMITTEE OF MINISTERS

    13. The Committee was informed of the decisions taken by the Ministers' Deputies at the 833rd meeting concerning the 69th session of the CD-P-SP.

    TERMS OF REFERENCE OF SUBSIDIARY BODIES

    Decisions

    14. The Committee decided that in the light of a possibility of convergence of the public health sector (CD-P-SP) with the inter-governmental work programme of the European Health Committee (CDSP), the terms of reference of the subsidiary bodies of the Public Health Committee (CD-P-SP) should be discussed by the European Health Committee (CDSP) at its next meeting in November 2003.

    COMMITTEE OF EXPERTS ON PHARMACEUTICAL QUESTIONS

    Decisions

    15. The Committee:

    1. approved the record of the 51st session of the Committee of experts on pharmaceutical questions;

    2. noted the subsequent action plan related to the activities on medication safety and medicines and the Internet;

    3. requested the submission of a project proposal on strategies against health risks by counterfeit medicines for its next session;

    4. recalled the written approval to granting the observer status to the Committee of experts on pharmaceutical questions and its subordinate committee to Bulgaria;

    5. approved the modification of the name of the 'Committee of experts on medicines subject to prescription' as follows 'Committee of experts on the legal classification of medicines as regards their supply'.

    COMMITTEE OF EXPERTS ON NUTRITION, FOOD SAFETY AND CONSUMER HEALTH

    Decisions

    16. The Committee:

    1. approved the record of the 7th session of the Committee of experts on nutrition, food safety and consumer health;

    2. amended the draft resolution on food and nutritional care in hospitals and approved it as set out in Appendix 2 to the report and submitted it for follow-up to the Committee of Ministers for adoption;

    3. postponed the discussion concerning the inclusion of a new activity on nutrition in nursing homes and home-care to its next session.

    COMMITTEE OF EXPERTS ON MATERIALS COMING INTO CONTACT WITH FOOD

    Decisions

    17. The Committee welcomed the initiative of the Secretariat to postpone the 2003 spring session for operational and budgetary reasons to December 2003.

    COMMITTEE OF EXPERTS ON FLAVOURING SUBSTANCES

    Decisions

    18. The Committee:

    1. approved the record of the 51st session of the Committee of experts on flavouring substances;

    2. noted that a 2nd report of evaluated natural sources of flavourings and of active principles was under preparation.

    COMMITTEE OF EXPERTS ON COSMETIC PRODUCTS

    Decisions

    19. The Committee:

    1. approved the record of the 39th session;

    2. noted the subsequent action programme in the field of tattoos and permanent make-up, the cosmetovigilance, the safety assessment of ingredients used in cosmetics.

    AD HOC GROUP OF EXPERTS ON HEALTH PROTECTION AGAINST DANGERS OF ASBESTOS

    20. The item was not discussed.

    OTHER BUSINESS

    21. None.

    DATE AND VENUE OF THE NEXT SESSION

    22. The Committee:

    1. agreed to hold its 72nd session on Thursday 27 November 2003 (8.30 am to 10.55 am) in conjunction with the CDSP's meeting;

    2. elected Ms Taru Koivisto, delegate of Finland, Chairperson of the 72nd session of the
    CD-P-SP.

    Appendix 1

    PRELIMINARY DRAFT AGENDA FOR THE 72nd SESSION

    1. ADOPTION DE L'ORDRE DU JOUR

    2. DECISIONS OF THE COMMITTEE OF MINISTERS

    3. RESTRUCTURING OF DG III

    4. TERMS OF REFERENCE OF SUBSIDIARY BODIES

    5. COMMITTEE OF EXPERTS ON PHARMACEUTICAL QUESTIONS (P-SP-PH)

    6. COMMITTEE OF EXPERTS ON NUTRITION, FOOD SAFETY AND CONSUMER HEALTH
    (P-SP-NU)

    7. COMMITTEE OF EXPERTS ON MATERIALS COMING INTO CONTACT WITH FOOD (P-SP-CDA)

    8. COMMITTEE OF EXPERTS ON FLAVOURING SUBSTANCES (P-SP-AR)

    9. COMMITTEE OF EXPERTS ON COSMETIC PRODUCTS (P-SP-CO)

    10. AD HOC GROUP OF EXPERTS ON HEALTH PROTECTION AGAINST DANGERS OF ASBESTOS (P-SP-AMI)

    11. OTHER BUSINESS

    12. DATES AND VENUE OF THE NEXT SESSION

    Appendix 2

    Draft Resolution AP (2003) ..
    on food and nutritional care in hospitals

    (adopted by the Committee of Ministers on … 2003
    at the … meeting of the Ministers' Deputies)

    1. The Committee of Ministers, in its composition restricted to the Representatives of Austria, Belgium, Cyprus, Denmark, Finland, France, Germany, Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Slovenia, Spain, Sweden, Switzerland and the United Kingdom, member states of the Partial Agreement in the Social and Public Health Field,

    2. Recalling Resolution (59) 23 of 16 November 1959 on the extension of the activities of the Council of Europe in the social and cultural fields;

    3. Having regard to Resolution (96) 35 of 2 October 1996, whereby it revised the structures of the Partial Agreement and resolved to continue, on the basis of revised rules replacing those set out in Resolution (59) 23, the activities hitherto carried out and developed by virtue of that resolution; these being particularly aimed at:

    a. raising the level of health protection of consumers in its widest sense, including a constant contribution to harmonising – in the field of products having a direct or indirect impact on the human food chain as well as in the field of pesticides, pharmaceuticals and cosmetics – legislation, regulations and practice governing, on the one hand, quality, efficiency and safety controls for products and, on the other hand, the safe use of toxic or noxious products;

    b. integrating people with disabilities into the community: defining and contributing to the implementation at European level of a model of coherent policy for people with disabilities taking into account the principles of full citizenship and of independent living; contributing to the elimination of all barriers to integration, whether psychological, educational, family-related, cultural, social, professional, financial or architectural;

    4. Considering that the aim of the Council of Europe is to achieve a greater unity between its members for the purpose of facilitating their economic and social progress;

    5. Considering that access to a safe and healthy variety of food is a fundamental human right;

    6. Bearing in mind the beneficial effects of proper food service and nutritional care in hospitals on the recovery of patients and their quality of life;

    7. Bearing in mind the unacceptable number of undernourished hospital patients in Europe;

    8. Bearing in mind the fact that undernutrition among hospital patients leads to extended hospital stays, prolonged rehabilitation, diminished quality of life and unnecessary costs to health care;

    9. Bearing in mind the Parliamentary Assembly Recommendation 1244 (1994) on food and health;

    10. Having regard to the First Action Plan for Food and Nutrition Policy of the WHO European Region (2000 – 2005);

    11. Recommends that the governments of the member states of the Partial Agreement in the Social and Public Health Field, having due regard to their specific constitutional structures, national, regional or local circumstances, as well as economic, social and technical conditions:

    a. draw up and implement national recommendations on food and nutritional care in hospitals based on the principles and measures set out in the appendix to this resolution;

    b. promote the implementation and take steps towards the application of the principles and measures contained in the appendix, in fields where these are not the direct responsibility of governments but where public authorities have a certain power or play a role;

    c. ensure the widest possible dissemination of this resolution among all parties concerned, particularly public authorities, hospital staff, primary health care sector, patients, researchers and non-governmental organisations active in this field.

    Appendix to Resolution AP (2003) ..

    1. Nutritional assessment and treatment in hospitals

    1.1 Nutritional risk screening

    i. The assessment of nutritional risk should take into account nutritional status and the severity of disease.

    ii. The nutritional risk screening method should be evidence based, in order to secure the identification of patients who may benefit from nutritional support.

    iii. The nutritional risk screening method should be easy to use and simple to understand.

    iv. The influence of age, growth and sex should be taken into consideration when the nutritional risk of the patient is determined.

    v. The nutritional risk of all patients should be routinely assessed either prior to or at admission.
    This assessment should be repeated regularly (intervals depending on the level of nutritional risk) during hospital stay.

    vi. Studies should be undertaken to develop and validate simple screening methods, aimed for use in hospitals and primary health care sector.

    vii. Identification of a patient at nutritional risk should be followed by a thorough nutritional assessment, a treatment plan including dietary goals, monitoring of food intake and body weight, and adjustment of treatment plan.

    viii. Standards of practice for assessing and monitoring nutritional risk/status should be developed at a national and European level.

    1.2 Identification and prevention of causes of undernutrition

    i. The multiple causes of disease-related undernutrition should always be considered for every patient.

    ii. The use of medications and combinations with side effects of anorexia, nausea and other gastrointestinal symptoms, drug-nutrient interactions or alterations of taste and smell should be well grounded and avoided as much as possible while physicians and nurses should be aware of these side effects.

    iii. “Nil-by-mouth” regimes, overnight fasting and bowel-cleansing protocols with dietary restrictions should not be used routinely; the literature should be reviewed in order to assess which procedures may require such regimes and for those investigations/procedures requiring dietary restriction the exact period of restriction should be determined.

    iv. The definition of disease-related undernutrition should be universally accepted and used as a clinical diagnosis and hence treated as such.

    1.3 Nutritional support

    i. Nutritional support as part of the treatment of patients should be considered systematically.

    ii. The nutritional treatment plan should be reviewed and adjusted if appropriate on at least a weekly basis, by means of information about the patient's nutritional intake, weight change and other relevant nutritional and clinical variables.

    iii. Nutritional support should be properly targeted to the individual patient. The volume of artificial nutrition infused and any discarded should be carefully documented.

    iv. No patient should receive artificial nutritional support without proper evaluation of indications, risks and benefits, informed consent of the patient as well as close supervision of side effects.

    v. Specific immune-modulating formulas should be limited to those patients who may benefit from them in the light of available randomised trials.

    vi. Patients in need of nutritional support should receive such treatment before admission (where possible), at the earliest opportunity during hospital stay and after discharge.

    vii. Medical and nursing admission, discharge and outpatient records should contain information about each patient's nutritional status, and physical and mental condition in relation to food intake.

    viii. Randomised trials and systematic reviews by specialists in clinical nutrition should be performed to evaluate the effect of nutritional support on nutritional status, clinical outcome, and physical and mental condition.

    ix. Randomised trials evaluating the effect of ordinary food on clinical outcome should be given high priority.

    x. Standards of practice for the assessment and dietary management of patients with dysphagia should be developed at national levels as appropriate. National descriptors for texture modification should be developed.

    1.4 Ordinary food

    i. Ordinary food by the oral route should be the first choice to correct or prevent undernutrition in patients.

    ii. Good practice to ensure the intake of ordinary food by the patients should be studied and documented. The practice of documenting and assessing intake of ordinary food by the patients identified as at nutritional risk is essential.

    iii. Sip feedings should not be used as a substitute for the adequate provision of ordinary food, and should only be used where there are clear clinical indications.

    iv. Artificial nutritional support should only be started when the use of ordinary food fails or is inappropriate.

    1.5 Artificial nutritional support

    i. Standards of practice established and implemented for initiation, safe delivery, aseptic handling techniques, line care, monitoring and termination of all artificial nutritional support should be developed at national and European level.

    ii. Standards of practice should be developed for the initiation, preparation, education, equipment provision, and safe delivery and monitoring of patients discharged on home nutritional support.

    2. Nutritional care providers

    2.1 Distribution of responsibilities for nutritional care in hospitals

    i. The Department of Health, Regional Authorities and each Hospital management should acknowledge their responsibility with regard to nutritional care and support, and food service systems.

    ii. Hospital management, physicians, pharmacists, nurses, dieticians and food service staff should work together in providing nutritional care, while the hospital management should give due attention to such co-operation.

    iii. The responsibility of different staff categories with respect to nutritional care and support, and food service should be clearly assigned.

    iv. Hospitals should develop appropriate structures to set standards for nutritional care and support especially in relation to costs, contract specifications, nutritional risk screening and audits, and to implement these standards through the control, supervision and audit of nutritional care and support.

    v. Nutritional risk screening, assessment and monitoring should be included in the accreditation standards for hospitals.

    2.2 Communication

    i. Organisational research should be conducted to assess and improve the co-operation between different staff groups.

    ii. Food service personnel, ward staff and patients should develop, test and implement forms for menu ordering.

    iii. Regular contacts between ward and food service personnel should be established.

    iv. One or more representatives in each ward and at the kitchen should be designated to have primary responsibility for communication and information in nutrition-related issues.

    v. Regular contacts between the hospital and the primary health care sector should be established.

    2.3 Education and nutritional knowledge at all levels

    i. A continuous education programme on general nutrition and techniques of nutritional support for all staff involved in the feeding of patients should be implemented.

    ii. Clinical nutrition should be included in under- and post-graduate education of physicians.

    iii. Chairs in clinical nutrition should be established.

    iv. Clinical nutrition for both adults and children should be recognised as a specialised discipline by medical schools. The teaching should cover preventive as well as therapeutic aspects of nutritional care and support.

    v. The education of nurses in clinical nutrition, with special emphasis on nutritional risk assessment, monitoring, and feeding techniques, should be improved.

    vi. The education of clinical and general dieticians at national levels should be set at the highest undergraduate level to enable all European dieticians to assume a more central role in nutritional care and support.

    vii. The education of administrative dieticians should be upgraded, especially in the field of management.

    viii. The education and training of hospital food service managers/supervisors should differ from hotel management by preparing them to cater for sick people

    ix. Special focus should be placed on the nutritional training of non-clinical staff members, e.g. part-time care assistants and ward housekeepers and the definitions of their area of responsibility.

    x. Special emphasis should be given to educating and informing the public (including patients) regarding the importance of good nutrition.

    xi. European initiatives on clinical nutrition education should be encouraged.

    xii. Co-operation between clinical nutrition societies in different countries should be expanded.

    3. Food service practices

    3.1 Organisation of hospital food service

    i. The responsibilities and accountabilities for hospital nutrition among health care professionals and hospital management should be clearly assigned.

    ii. A food service policy should be adopted and implemented at hospital or regional level.

    iii. Hospital managers should give proper attention to food service policy and nutritional support.

    iv. All hospital staff – clinical and non-clinical – should acknowledge food service as an important part of the treatment and care of patients.

    3.2 Contract food service

    i. Guidelines and standards for out-sourcing hospital food service should be developed.

    ii. Contracts should be sufficiently detailed and they should cover special diets on medical and personal indications, energy and protein dense menus and provision of snacks and/or meals at ward or near-ward level. They should also cover texture-modified menus for the management of dysphagia.

    iii. The cost for adequate contract monitoring should be built into the contract.

    iv. The Clinical Nutrition Service/Department, the Nutritional Steering Committee, the Nutritional Support Team or an adequately qualified person should be given the responsibility for ensuring that the contract reflects nutritional standards.

    3.3 Meal service and eating environment

    i. The serving system should be adjusted to the patients' needs taking into consideration their physical and mental condition. This often requires different serving systems.

    ii. All patients should have the possibility to choose their eating environment.

    iii. All patients should have the possibility to sit at a table when eating their main meals.

    iv. The hospital-eating environment should be improved with a focus on surroundings and the presence of personnel and free from unpleasant smell/odours.

    v. Adequately trained personnel should be available to assist patients with mental/physical feeding difficulties and suitable modified equipment should be available when required to aid/facilitate independent feeding.

    3.4 Food temperature and hygiene

    i. All patients should receive hospital food, which has been stored, prepared and transported in such a way as to ensure the hygiene, safety, palatability, gastronomy, and nutrient content of the food at a high level.

    ii. All hot meals should be served at temperatures around 60-70° C.

    iii. The Nutritional Steering Committee, the Nutritional Support Team or an adequately qualified person should be responsible for the hygienic aspects of food service.

    iv. The kitchen and ward staff should receive proper education in food hygiene while the hygienic control of hospital food production should be used to engage hospital management in the wider concept of hospital nutrition.

    3.5 Specific improvements in food service practices to prevent undernutrition

    i. Standards for food service systems, based on patient needs rather than hospital needs, should be developed.

    ii. Regardless of which serving system is used, close collaboration between the patient, relatives and the nursing, dietetic and food service staff is required to get the patient to eat.

    iii. The provision of meals should be flexible and individualised. All patients should have the possibility to order food and extra food at any time and be informed of this possibility.

    iv. Menus should be specifically targeted to different patient categories.

    v. Proper feeding-aid should be provided.

    vi. Successful measures to prevent undernutrition should be given publicity.

    4. Hospital food

    4.1 Hospital menus and diets on medical indications

    i. Good practice should be established through the development of national guidelines and standards for food provision in hospitals to meet the needs of all categories of patients including diets on medical indications, and vegetarian, texture modified and energy and protein dense menus.

    ii. Studies should be undertaken to evaluate the effect of energy and protein dense menus on food intake and patient outcome.

    iii. A range of dishes enriched in energy and protein should be available in every hospital aimed at patients with disease-related undernutrition.

    iv. The physician should always be aware of the nutritional status of patients and only prescribe diets with scientifically documented effects.

    v. The health care personnel should be aware of the patient's use of “alternative diets” and the influence these might have on the nutritional status.

    vi. Immediate feedback from the patients to the kitchen and ward staff in relation to liking or disliking of the food served should be encouraged.

    vii. The nutrient content, the portion size of the food and food wastage should be audited annually.

    viii. The nutrient sufficiency of a menu should be documented already at the planning stage. The Clinical Nutrition Service/Department, the Nutritional Steering Committee, or the Nutritional Support Team or an adequately qualified person, should be given the responsibility for ensuring that the menu reflects nutritional standards.

    ix. A database on nutrient content of meals/menus and portion sizes should be established in each food service department to be made available for the purpose of assessing nutritional adequacy of menus and monitoring of patients' food intake.

    x. Research should be conducted to generate more reliable data on nutrient losses with different food service systems.

    4.2 Meal pattern

    i. Serving hours should be reviewed to ensure that there is sufficient time between each meal to allow for in-between snacks in the morning, afternoon and late evening.

    ii. Mealtimes should be spread out to cover most of the hours spent awake.

    iii. Interruption of patients' meal times by ward rounds, teaching and diagnostic procedures should be minimised.

    iv. Snacks and nourishing drinks between meals should be offered when appropriate and be available on every ward.

    v. The involvement of relatives in serving meals to patients should be encouraged, when appropriate.

    vi. The use of sip feedings should be properly targeted and a protocol for the distribution and supervision of sip feeds should be developed and implemented.

    4.3 Monitoring of food intake

    i. The personnel on the wards should be trained in how to monitor food intake.

    ii. The food intake of patients should be noted by means of a semi-quantitative system.

    iii. Tray collection should be supervised closely to enable monitoring of patients' food intake.

    iv. The level of food intake should be used to assess the patients' need for nutritional support.

    v. The food intake of patients at nutritional risk and receiving nutritional support should be registered by means of dietary records.

    vi. Information from the kitchen and the menu nutrient database regarding portion size and energy content of hospital food should be available to aid ward personnel in the monitoring of patients' food intake.

    vii. The information about patients' food intake should be used to develop appropriate, target group specific menus.

    viii. Studies should be undertaken to develop and validate simple food recording methods.

    4.4 Informing and involving the patient

    i. The positive role of nutrition as treatment should be made known to the public to engender general awareness and support.

    ii. On admission or before admission patients should be informed about the importance of good nutrition for their successful treatment.

    iii. Adequate information in written and oral form should be given to patients regarding available dishes and foods.

    iv. Dishes should be described accurately so that patients have a reasonable idea of what to expect.

    v. Patients should receive information regarding the nutrient composition of different foods and drinks.

    vi. Patients should receive help and guidance in ordering food by the ward staff.

    vii. Patients should be involved in planning their meals and have some control over food selection.

    viii. Patients should be able to receive a menu, which is in accordance with their age, religious, ethnic or cultural background.

    ix. Methods to assess patient satisfaction should be developed and implemented.

    5. Health Economics

    5.1 Cost-effectiveness and cost-benefit considerations

    i. Calculations of cost-benefit and cost-effectiveness of nutritional support should also be made at hospital level.

    ii. Calculations of cost-benefit and cost-effectiveness of nutritional support should involve experts in health economics.

    iii. When estimating the cost-benefit and cost-effectiveness the choice of nutritional support should be considered.

    iv. When estimating the cost-benefit and cost-effectiveness of nutritional support, outcomes should include functional capability and life satisfaction of patients.

    5.2 Food service and food wastage costs

    i. The influence of food service practice on food wastage should be examined.

    ii. Flexibility with regard to the patient's menu choice and serving size should be ensured.

    iii. When assessing the cost of different food preparation systems, the patient's satisfaction with the food served should be considered.

    iv. The food budget should be valued as part of the budget spending on clinical support and treatment services.

    v. Hospital managers should take into account the potential cost of complications and prolonged hospital stay due to undernutrition when assessing the cost of nutritional care and support.

    vi. Steps should be taken to reduce documented wastage of food, sip feedings and artificial nutrition products.

    6. Definitions

    Artificial nutritional support
    Administration of specially formulated liquid nutrients through a tube directly into the gut (enteral nutrition) or into a vein (parenteral nutrition).

    Diets on medical indications
    A prescribed allowance of food or nutrients provided via the oral route and used in the treatment of specific diseases, e.g. lipid lowering diet, diabetic diet, and energy reduced diet.

    Disease-related undernutrition
    A state of insufficient intake, utilisation or absorption of energy and nutrients due to individual or systemic factors, which results in recent or rapid weight loss and change in organ function, and is likely to be associated with a worse outcome from the disease or the treatment. Undernourished patients can be overweight or obese according to their body mass index (BMI).

    Energy and protein dense menu
    A menu with a high nutrient density, due to use of food products with a high fat and protein content.

    Food service
    A system in which meals are produced and served for hospital patients, in a professional context. The system includes the food service premises, the production and distribution technology, and human resources involved in management, production, distribution and serving.

    Hospital food
    The meals served at hospitals – including diets on medical indications.

    Nutritional assessment
    A comprehensive evaluation of nutritional status, including one or more of these: medical history, dietary history, physical examination, anthropometrical measurements and laboratory data.

    Nutritional care
    The basic duty of providing adequate and appropriate food and drinks and/or artificial nutrition to the patient.

    Nutritional risk
    The risk for nutrition-related complications to the disease or the treatment.

    Nutritional risk screening
    The process of identifying characteristics known to be associated with nutrition-related complications. Its purpose is to detect patients at risk who may experience an improved clinical outcome when given nutritional support.

    Nutritional Steering Committee (NSC)
    An advisory committee consisting of staff from all disciplines, including the management involved in the nutritional care of the patient.

    Nutritional support
    Assessment of current nutritional status, estimation of nutritional requirements, prescription and delivery of appropriate energy, macro- and micro-nutrients, electrolytes and fluids (in the form of ordinary hospital food (first choice), sip feedings and/or artificial nutrition), monitoring the former in the context of clinical status and ensuring that the most optimal feeding route is used at all times. Nutritional support is part of the medical treatment and its purpose is to improve or maintain a patient's nutritional status and hasten and improve recovery.

    Nutritional support teams/units (NST)
    A multidisciplinary team/unit with expertise in nutrition, which is involved in nutritional support, whose remits varies according to local circumstances, interest and resource allocations. Usually takes active part in nutritional support, and serves in a quality control capacity, standardising practice, gathering new information and educating other health care professionals.



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