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