C
ROATIAN
M
EDICAL
A
SSOCIATION
C
ROATIAN
S
OCIETY OF
C
LINICAL
N
UTRITION
Chair: Anne de Looy
Group 1: Croatia and Poland
Croatian activities in Optimal Nutritional Care for All

C ROATIAN S OCIETY OF C LINICAL N UTRITION , CMA
1. Education activities a) Incorporation of clinical nutrition in study curriculum of:
• School of Medicine
• School of Food and TechnologyNutritionists
• Nursing study b) Different postgraduate courses (Medicine, Nutrition, Pharmacy) c) Postgraduate Study of Nutrition (Medicine & Nutrition) c) Local LLL courses in cooperation with local MNI d) Congresses and Symposia e) Adriatic Club of Clinical Nutrition (ACCN)

Warsaw Declaration
ACCN Declaration

C ROATIAN S OCIETY OF C LINICAL N UTRITION , CMA
2. National Nutrition Guidelines
• Croatian Guidelines For Use Of Eicosapentaenoic Acid And Megestrol Acetate In
Cancer Cachexia Syndrome (2007)
• Croatian guidelines for use of enteral nutrition in Crohn's disease (2010)
• Internal Guidelines at University Hospital Centre Zagreb (2011)
• Nutrition Guidelines for GERD and Gastritis, IBD, Hypertriglyceridemia and
Hypercholesterolemia
• Croatian guidelines for treatment of diabetes mellitus type 2 (2011)
• Chapter: Guidelines for usage of enteral nutrition DM2
• Croatian guidelines for nutrition in the elderly (2011)
• Croatian guidelines for the management of pancreatic
exocrine insufficiency (2012)

C ROATIAN S OCIETY OF C LINICAL N UTRITION
3. Public Campaigns
Organization of public campaigns to raise awareness on proper nutrition and malnutrition:
- Diet, Nutrition and IBD
- Nutrition Day
- Hospital Nutrition Days

C ROATIAN S OCIETY OF C LINICAL N UTRITION
4. Nutrition Risk Screening Tool Implementation
• Fighting against malnutrition in Croatia – Study 2013 ESPEN
• gastroenterology departments of 9 hospitals in Croatia conducted a multicentric study; NRS 2002 used to evaluate 1.786 patients
Projects in process:
• Implementation of NRS 2002 into Hospital information system – nutritional risk screening to become obligatory upon hospital admission
• Implementation of NRS 2002 in general practice

C ROATIAN S OCIETY OF C LINICAL N UTRITION , CMA
5. Local Health Economic Studies
• Cost of disease related malnutrition in Croatia – a hidden cost in the health care closet–
2012
• The economic burden of disease-related undernutrition in selected chronic diseases – 2013
Clinical Nutrition
• Economic impact of enteral and parenteral nutrition usage on healthcare costs – 2015
• collaboration of key stakeholders in order to obtain local data on cost of malnutrition and economic impact of enteral and parenteral nutrition usage on healthcare costs

Optimal nutritional care for all
Where are we in Croatia?
Routine screening policy
Hospital Care home Community
Prevalence DRM
Evidence
Cost of DRM
Economic benefits of nutritional care
Other
Stakeholders
Multi-stakeholder platform
Industry group
PEN
Geriatric Soc
Patient associations
Other
Guidelines and standards
Nutrition guidelines
National nutrition plan
Quality standards
Audit of quality standards
Other
Education and training
Postgraduate nutrition training MDs
Screening implementation nurses
Other
Awareness programmes
Nutrition Day
Other
Gold
Good
Silver
Medium
Bronze
Low
?
Don’t know
ONS
Tube
PN
Reimbursement
Hospital Care home Community
Implementation
Screening
Hospital Care home Community
Care
Plan
Other

• Country wide nutrition policy – obligatory nutritional screening /GP’s collecting professional credits by routine screening/
• Implementation of nutrition support in all hospitals, care homes and community
• Continous work on raising public awareness
– Getting the right message to the right people
(patients,…,government)

• Standardization of the best pratice screening tool, concordance with ICD-10
• Diagnose of malnutrition?
• Lack of knowledge on clinical nutrition in hospital settings
• Lack of dietititians and specific competences
• Focus of the industry
• Cost-saving issues

1. Obligatory nutritional screening & implementation of specific algorythms for nutritional support
2. Development of „Multi stakeholder platform”
3. Availability of support (in all settings)
4. Public awareness