Nutrition support in Brazil: past, present, and future perspectives.

The history of nutrition support in Brazil is parallel to its development in the world. Inspired by the publications of the surgical group headed by Professor Rhoads at the University of Pennsylvania, a group of Brazilian physicians pioneered the beginning of parenteral nutrition (PN) therapy. The Brazilian Society of Parenteral and Enteral Nutrition (SBNPE) was officially founded in 1975. Soon, scientific contributions started to appear, reflected by articles in the Journal of Parenteral and Enteral Nutrition and other journals and by books. In many states of Brazil, nutrition support services were created to carry out scientific and educational activities. The relationship with the American Society of Parenteral and Enteral Nutrition was fundamental in the development of clinical nutrition in Brazil because of the strong scientific exchange between the United States and Brazil. However, after the stimulating initial launching, momentum slowed because of the lack of medical awareness and inadequate reimbursement. In Brazil, the federal government is responsible for the majority of health care, but enteral nutrition was not reimbursed. In response to this situation, a study in 4000 hospitalized patients was undertaken in Brazil. It was reported that nearly half of them presented with malnutrition, and > 12% had severe malnutrition. These alarming results were decisive in persuading the Brazilian government to begin reimbursement for enteral nutrition. Today, Brazilian hospitals that assist public health system patients receive reimbursement for enteral nutrition. However, it is required to have an officially registered nutrition support team and a certified and approved facility for enteral feeding preparation. Considering that low nutrition prescription in Brazil could be the result of lack of nutrition education (not required in most medical schools), the SBNPE participated in the creation of 2 very effective, practical, and dynamic courses for the basic teaching of clinical nutrition. These courses were created by the Latin American Federation of Parenteral and Enteral Nutrition: the TNT (Total Nutrition Therapy) Course and the CINC Course (Interdisciplinary Course in Clinical Nutrition). These 2 courses are available to members of all Latin American countries and are regularly offered by the SBNPE to its members all over Brazil. Altogether, > 4000 physicians, dietitians, nurses, and pharmacists have been introduced to the basic principles and practice of clinical nutrition. It is clear that the outstanding ideas of Professors Rhoads, Dudrick, and Wilmore and other collaborators from this group in the field of clinical nutrition have grown and flourished in Brazil.