Ethical imperatives in global nutrition care: reducing inequities in gastroenterology

Malnutrition is a major concern in patients with digestive disorders. This review examines the ethical imperatives for addressing inequities in nutritional care, specifically focusing on disease-related malnutrition (DRM). It explores the implementation of a human rights-based approach to clinical practice to bridge the gaps between duty-bearers and rights-holders in the management of malnutrition.

DRM persists as a neglected crisis affecting 30-50% of hospitalized patients, particularly those with gastrointestinal and oncological conditions. Recent research identifies educational attainment as a super-determinant of diet quality, exerting a more powerful influence than income alone. Systemic barriers remain significant: mandatory screening is frequently unavailable across care settings, and a widespread knowledge gap persists among healthcare professionals. However, the emergence of the Cartagena and Vienna Declarations has established nutritional care as a human right, providing a new legal and ethical paradigm to tackle these disparities.

Reducing inequities requires integrating nutritional care into Universal Health Coverage and mandating standardized screening and diagnosis using Global Leadership Initiative on Malnutrition (GLIM) criteria. Strategic alternatives include educational reform, interdisciplinary support teams, and patient empowerment. Ensuring equitable access to medical nutrition is essential to uphold human dignity and fulfill the right to health.