CAN DReaM, Creating Alliances Nationally to address Disease Related Malnutrition

Background
The United Nations Decade of Action on Nutrition 2016-2025 is a commitment by United Nations Member States to undertake 10 years of sustained and coherent implementation of policies, programmes and increased investments to eliminate malnutrition in all its forms, everywhere, leaving no one behind. 

The Decade of Action on Nutrition provides an enabling environment for all countries, regardless of their income, the nature of their malnutrition challenges or the characteristics of their food and health systems, to ensure that action is taken by governments and stakeholders to develop and implement inclusive policies aimed at ending all forms of malnutrition. See details here (https://www.un.org/nutrition/)

CAN DReaM, Creating Alliances Nationally to address Disease Related Malnutrition
is a CNS-CMTF initiative that builds on the United Nations Decade of Action commitment by advancing policy around Disease Related Malnutrition (DRM).

Initials steps taken by CNS-CMTF to set the stage for this initiative are as follows:

• May 5, 2022: CNS-CMTF held the first ever Food for Health Workshop: Nutrition as a Human Right – Disease Related Malnutrition, at the annual CNS Conference in Gatineau, Quebec. Chaired by Dr. Leah Gramlich and Dr. Diana Cardenas, the workshop attracted nutrition, implementation and policy expert speakers from Japan, France, Brazil, Australia, US, and Canada and more than 90 attendees.   
• Sept 1, 2022: on behalf of CMTF, CNS registered a commitment with UN’s Decade of Action on Nutrition to work on policy around DRM. See commitment with United Nations here
• Sept 7, 2022: CMTF’s Dr. Leah Gramlich represented CNS at the International declaration on the Human Right to Nutritional Care held at the 44th ESPEN congress on Clinical Nutrition and Metabolism in Vienna, on September 5 2022. 

CAN DReaM Goals
To help understand and advance the current policy landscape around DRM and over the next three years (2023-2025), CAN DReaM is committed to achieving the following five goals: 

GOAL 1 – Undertake a scoping review to  identify gaps in existing policies related to DRM
GOAL 2 – Create a national alliance and set the foundation for a national coordination mechanism for improved DRM policy 
GOAL 3 - Develop a policy brief on DRM
GOAL 4 – Facilitate coordination / engagement for policies and practices to address DRM to happen on a global scale
GOAL 5 – Advocate  for national and provincial health policy(ies) to address DRM
 

Global collaboration 
CMTF/CNS have been recognized as leaders in addressing malnutrition in Canada and globally. This CMTF/CNS formal commitment to the Decade of Action on Nutrition aligns well with the United Nation’s goals of:

• Aligning Health Systems Providing Universal Coverage of Essential Nutrition Actions
  Our commitment will strengthen and enable more resilient health systems and will support the development of policies that will ultimately improve nutrition for the health of Canadians and citizens globally. 
• Strengthening Governance and Accountability for Nutrition
  Our commitment will allow more attention towards governance and coordination of multisectoral mechanisms for food and nutrition and the establishment of policies and programs related to nutrition. 

CNS and CMTF commit to the UN Decade of Action on Nutrition  
 

Why is CAN DReaM needed?

Addressing Disease Related Malnutrition is important 

Disease-Related Malnutrition (DRM) is a complex condition resulting from inadequate intake of energy and nutrients that do not fulfil the patient’s physiological requirement. DRM is present in up to half of Canadian adults and one third of Canadian children admitted to hospital.¹ Evidence demonstrating association between DRM and poor outcomes, including increased health care cost, hospital readmissions, mortality, functional decline and complications^2,3,4 has been accumulating in Canada and around the world over the last four decades. The burden of malnutrition also extends to the community, where it is estimated to affect 3-8.5%⁵ of the population and has a disproportionate effect on older adults and those in care homes^6,7,8. Further, pandemic measures have resulted in increased frailty and food insecurity⁹. 

There is a lack of policy level action or policy frameworks in Canada specifically to address DRM. Current health policy is driven largely by conditions related to overnutrition, such as diabetes, obesity and coronary artery disease, and there is a dearth of health policy related to undernutrition and malnutrition in Canada. In addition, there is potential for overlap with Canada’s Food Policy's vision of improved food-related health outcomes¹⁰.  This situation is not unique to Canada, and many countries across the globe struggle with the absence of frameworks and/or policies to address DRM.

References 
1.    Allard JP, Keller H, Jeejeebhoy KN, Laporte M, Duerksen DR, Gramlich L, Payette H, Bernier P, Vesnaver E, Davidson B, Teterina A, Lou W. Malnutrition at Hospital Admission-Contributors and Effect on Length of Stay: A Prospective Cohort Study From the Canadian Malnutrition Task Force. JPEN J Parenter Enteral Nutr. 2016 May;40(4):487-97. doi: 10.1177/0148607114567902. Epub 2015 Jan 26. PMID: 25623481. 

2.    Allard JP, Keller H, Jeejeebhoy KN, Laporte M, Duerksen DR, Gramlich L, Payette H, Bernier P, Davidson B, Teterina A, Lou W. Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: A prospective cohort study. Clin Nutr. 2016 Feb;35(1):144-152. doi: 10.1016/j.clnu.2015.01.009. Epub 2015 Jan 21. PMID: 25660316.

3.    Jeejeebhoy KN, Keller H, Gramlich L, Allard JP, Laporte M, Duerksen DR, Payette H, Bernier P, Vesnaver E, Davidson B, Teterina A, Lou W. Nutritional assessment: comparison of clinical assessment and objective variables for the prediction of length of hospital stay and readmission. Am J Clin Nutr. 2015 May;101(5):956-65. doi: 10.3945/ajcn.114.098665. Epub 2015 Mar 4. PMID: 25739926.

4.    Curtis LJ, Bernier P, Jeejeebhoy K, Allard J, Duerksen D, Gramlich L, Laporte M, Keller HH. Costs of hospital malnutrition. Clin Nutr. 2017 Oct;36(5):1391-1396. doi: 10.1016/j.clnu.2016.09.009. Epub 2016 Sep 19. PMID: 27765524.

5.    Norman K, Haß U, Pirlich M. Malnutrition in Older Adults-Recent Advances and Remaining Challenges. Nutrients. 2021 Aug 12;13(8):2764. doi: 10.3390/nu13082764. PMID: 34444924; PMCID: PMC8399049.

6.    Wendland BE, Greenwood CE, Weinberg I, Young KW. Malnutrition in institutionalized seniors: the iatrogenic component. J Am Geriatr Soc. 2003 Jan;51(1):85-90. doi: 10.1034/j.1601-5215.2002.51015.x. PMID: 12534851. 

7.    Murphy J, Bracher M, Tkacz D, Aburrow A, Allmark G, Steward K, Wallis K, May C. Malnutrition in community-dwelling older people: lessons learnt using a new procedure. Br J Community Nurs. 2020 Apr 2;25(4):193-195. doi: 10.12968/bjcn.2020.25.4.193. PMID: 32267764. 

8.    Warren AM, Frongillo EA, Alford S, McDonald E. Taxonomy of Seniors' Needs for Food and Food Assistance in the United States. Qual Health Res. 2020 Jun;30(7):988-1003. doi: 10.1177/1049732320906143. Epub 2020 Feb 28. PMID: 32107976. 

9.    Huysentruyt K, Brunet-Wood K, Bandsma R, Gramlich L, Fleming-Carroll B, Hotson B, Byers R, Lovelace H, Persad R, Kalnins D, Martinez A, Marchand V, Vachon M, Hulst JM, On Behalf Of The Canadian Malnutrition Task Force-Pediatric Working Group. Canadian Nationwide Survey on Pediatric Malnutrition Management in Tertiary Hospitals. Nutrients. 2021 Jul 30;13(8):2635. doi: 10.3390/nu13082635. PMID: 34444796; PMCID: PMC8397996. 

10.    http://www.ncchpp.ca/docs/Guide_framework_analyzing_policies_En.pdf