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Objective: We describe the status of medical nutrition therapy in adult patients in several hospitals in Latin America in 2023. with the aim of deepening understanding of its implementation and thus, in turn, contributing to the advancement of future guidelines., Materials and Methods: This is a descriptive, multicenter, cross-sectional study. An electronic questionnaire was applied, containing screening, nutritional therapy, multidisciplinary nutritional support, and monitoring indicators. Descriptive statistics were used in data processing., Results: A total of 132 hospitals from 14 Latin American countries participated; 68.2% were state-owned with a median of 23,804 patients. In 66% of hospitals (n = 87) nutritional screening is systematically implemented; NRS-2002 (n = 66; 75.9%) applied mostly by dietitians. Median malnutrition at admission was 33% (IQR = 30.8). Median indication for diet therapy was 54.4% (IQR = 44.3); oral supplementation 13.6% (IQR = 18), and enteral and parenteral nutritional support 14.6% (IQR = 10.2). Indication is carried out mostly by dietitians (n = 78; 59.1%). 29.5% (n = 39) of hospitals count on multidisciplinary nutritional support. 75% (n = 99) use industrialized formulas, mostly in closed systems (n = 53; 40.2%). For parenteral nutrition, individually compounded and preprepared solutions are used (n = 71; 53.8%) generally administered by central catheters. Most frequently cited monitoring indicators were hemodynamic instability, metabolic complications, abdominal distension, and gastric residue., Conclusion: There are still low implementation percentages of nutritional screening, formation of nutritional therapy teams, and use of oral supplements. Malnutrition upon admission is within the expected range., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Introduction: The Latin American Federation of Nutritional Therapy, Clinical Nutrition, and Metabolism - FELANPE, was founded in 1988. It brings together interdisciplinary societies and associations in Clinical Nutrition and Nutritional Therapy from Latin America and the Caribbean, as well as Spain and Portugal. Currently, it comprises representations from 18 countries. The objectives of the Federation are described, taking into account the assumed commitment. This is an observational cross-sectional, multicenter study that included 132 hospitals with more than 100 beds, of high complexity, both state-owned and private, from 14 countries in Latin America that are members of FELANPE. The study assessed hospital characteristics, implementation of nutritional assessment, nutritional diagnosis of patients, the team responsible for nutritional therapy, nutritional therapy (oral, enteral, and parenteral), monitoring, and nutritional follow-up. For this purpose, a digital questionnaire and an explanatory video were designed and validated to ensure the quality of the collected data. Validation was carried out through a pilot study conducted in Paraguay, approved by the Ethics Committee for Research at the Faculty of Medical Sciences of the National University of Asunción. The current research has the approval of the Research Ethics Committee of the Faculty of Chemical Sciences of the National University of Asunción and the Ethics Committee of FELANPE. The results presented at the XVIII Latin American Congress of FELANPE in Asunción, Paraguay, on October 12, 2023, serve as a basis for characterizing the implementation of Parenteral and Enteral Nutritional Therapy (medical nutritional therapy) in hospitals in Latin America and are used as technical support for the present Asunción Commitment.

Based on current scientific literature, gastrostomy tube (G-tube) placement or other long-term enteral access devices should be withheld in patients with advanced dementia or other near end-of-life conditions. In many instances healthcare providers are not optimally equipped to implement this recommendation at the bedside. Autonomy of the patient or surrogate decision maker should be respected, as should the patient's cultural, religious, social, and emotional value system. Clinical practice needs to address risks, burdens, benefits, and expected short-term and long-term outcomes in order to clarify practice changes. This paper recommends a change in clinical practice and care strategy based on the results of a thorough literature review and provides tools for healthcare clinicians, particularly in the hospital setting, including an algorithm for decision making and a checklist to use prior to the placement of G-tubes or other long-term enteral access devices. Integrating concepts of patient-centered care, shared decision making, health literacy, and the teach-back method of education enhances the desired outcome of ethical dilemma prevention. The goal is advance care planning and a timely consensus among health team members, family members, and significant others regarding end-of-life care for patients who do not have an advance directive and lack the capacity to advocate for themselves. Achieving this goal requires interdisciplinary collaboration and proactive planning within a supportive healthcare institution environment., (© 2014 American Society for Parenteral and Enteral Nutrition.)