Over 250 thousand Italians suffer from Mice, chronic inflammatory intestinal diseases such as Crohn’s and ulcerative colitis which affect young people, between 15 and 30 years old, and in 20% of cases they already appear as children. When this happens, the first question is dismissed – what do I have? – the second question that all patients ask themselves is: what can I eat? The question is crucial, if you consider that 27% of MIT patients are malnourished; 40% are sarcopenic, meaning they lose muscle mass and strength, and over 70% have deficiencies in essential vitamins and minerals. Deficits that worsen the underlying disease and compromise response to drugs. A known problem, the malnutrition from Mici, but not enough. Because even today just 1 in 2 patients receives a nutritional screening: a quarter in the public center that assists them and another quarter privately, paying for it out of their own pocket.
It was discussed in Milan at the conference ‘The new era of medical nutrition in Ibd’, a 2-day discussion between the top experts in the sector gathered with the aim of building together an interdisciplinary work model, studying solutions to improve both screening and treatment of patients at risk of malnutrition or already malnourished. “In addition to an assessment of the patients’ nutritional status, followed by a personalized dietary program – the specialists explain – it is important the Afmsfoods for special medical purposes prescribed by specialists”. Among the innovations presented at the meeting there is “a new Afms, the only high-protein one”, with “antioxidant and anti-inflammatory properties”. It is called LH Viola, it has the symbolic color of World Mice Day and was developed by the Italian start-up LionHealth Società Benefit starting from a formula developed by researchers at the Irccs Policlinico Gemelli in Rome, to accompany its launch, scheduled for 18 October, 11 recipes in which to include it, signed by chef Viviana Varese.
“Bitis or Ibd (Inflammatory bowel disease) is a term that includes various disorders characterized by inflammation of the tissues of the digestive tract, with a chronic and recurrent pattern, which present with periods of exacerbation alternating with phases of remission – recalls Alessandro Armuzzi, head of the Ibd Mici Irccs Humanitas Rozzano operational unit (Milan) and full professor of Gastroenterology Humanitas University – Crohn’s disease and ulcerative colitis fall within this definition, but there are also less common forms such as microscopic colitis”. At the origin of these pathologies, the expert describes, there is certainly a genetic component, with “more than 250 genes involved”. A predisposition which at a certain point in life – for reasons probably linked to “an alteration of the microbiota”, the army of microorganisms that colonizes our digestive system – results in “an aberrant immune response at the level of the intestinal wall” home of the absorption of nutrients. This leads to “deficiencies of micro and macronutrients, associated with weight loss”.
However, a problem persists regarding the malnutrition of Mici patients cultural problemspecialists report. “Very few centres, even among those of excellence, carry out nutritional screening”, highlights Armuzzi, although it has been demonstrated that “correct nutrition can provide benefits in addition to those of drugs”. While “enormous progress has been made on the front of oncological nutritional therapies – observes Riccardo Caccialanza, head of the Irccs clinical nutrition area at the San Raffaele hospital in Milan – now we must also make them in IBD which cause even more subtle problems. We know that the results of the therapies are very linked to the body composition of patients, especially muscle mass”, and that patients with malnutrition “return to hospital more often and have longer hospital stays”. Today “the first problem is cultural”, insists the expert. If it is true that according to the Espen Mici guidelines there is no ‘Ibd Diet’, “patients must be followed from a nutritional point of view, they need specialized points of reference”, specifies Caccialanza, hoping for the birth of “a network”, with “clinical nutrition experts and dieticians” permanently included in the multidisciplinary teams caring for people with Myths.
“On the part of the political class, administrators, citizens and even health workers themselves – reflects the San Raffaele specialist – there is probably still a lack of effective awareness that medical nutrition is a branch of fundamental importance for improving health of the population and the quality of care, for which the right investments must be made in training, communication and economic terms”.
The patient community confirms the need for a cultural change. From a survey by Amici Italia, reports the general director of the association Salvo Leone, “large gaps” emerged in the so-called ‘food literacy’, the ability to search, obtain and understand food information, using it to make appropriate choices. “The majority struggle.” And there is one fact that stands out among all: “Six out of 10 patients have never turned to a dietician”, reports Leone. Instead, IBD are “diseases that can be treated with a combination of medical therapies, lifestyle changes and adequate dietary strategies, therefore a correct assessment of the nutritional status and support for the correct dietary indications are essential”, warns the General Manager of Italian friends. “There is a need for specialized assistance – he points out – as well as personalized approaches based on the patient’s age, stage of illness, ethnicity in an increasingly multicultural society”. An intervention that could make a difference in MICs – “diseases from which one does not die, but with which one lives very badly” -. Changing the quality of life of people who too often isolate themselves within the “non-visible disability” caused by “symptoms that they are still ashamed to talk about today”.
IN THE KITCHEN WITH THE KITTENS
Appetizer bouquet of salad with pistachios; first course light pesto for pasta or risotto with roasted red pepper extract, parsley and anchovy sauces, anchovies, capers and olives; for the second course amberjack ceviche with peppers, onion and tomato; dark chocolate mousse dessert. These are just some of the creations that chef Viviana Varese dedicated to those who suffer from Mici, chronic inflammatory intestinal diseases such as Crohn’s or ulcerative colitis, burdened by malnutrition that worsen the pathology and compromise the effectiveness of treatments. Common thread between 11 signature recipes a new ingredient: LH Violathe new food for special medical purposes developed by LionHealth Società Benefit starting from a formula ‘made in Gemelli’.
Afms are food products under the responsibility of the Ministry of Health, different from supplements as they are “designed to meet the specific nutritional needs of patients suffering from acute and chronic diseases – explains Antonio Gasbarrini, professor of Internal Medicine at the Catholic University, director of the ‘digestive system-Cemad Agostino Gemelli University Polyclinic Foundation Irccs – They are formulated taking into account the metabolic alterations and particular needs that arise in pathologies such as Mici” or Ibd, “diabetes, renal, oncological or neurodegenerative diseases in the fact that”, taken under medical supervision “in combination with drug therapy and an adequate lifestyle” and diet, they can support the patient in improving the effectiveness of the treatment, reducing complications and optimizing the quality of life in short, an indispensable adjuvant for the therapeutic process, helping to fill specific nutritional deficiencies or to modulate the body’s response to diseases”.
LH Viola, explains Paola Lanati, president of LionHealth SB, “is the first Afms studied for patients at risk of malnutrition or with caloric-protein malnutrition associated with IBD, or with sarcopenia, based on the most recent scientific literature and international guidelines on theme, designed for different types of malnutrition needs including micronutrient deficiencies such as vitamins D and B12, specific to these diseases.” To suggest how to use it, so that taking it is also a joy for the palate, “we thought of a recipe book studied with chef Viviana Varese in collaboration with some dieticians”.
It all begins in 2022, when LionHealth SB acquired the Gemelli Health System (Ghs) company from the Fondazione Policlinico Gemelli Irccs, which had developed 13 patented vegetal-matrix Afms formulas. One of these became LH Viola, a nutritionally complete product – as LionHealth describes it – suitable for the different malnutrition needs in every stage of Mici. A high-protein Afms characterized by a patented blend of plant extracts and inulin with antioxidant and anti-inflammatory activity, purple in color (symbol of World Cat Day) thanks to the presence of red fruits. The special food also contains maldodextrins as a source of carbohydrates, Mct fats (medium chain triglycerides) which help to counteract the malabsorption of lipids, minerals and vitamins including D and B9. Neutral taste, therefore suitable for consumption with food; no casein or preservatives, colourings, emulsifiers or gluten, practically zero lactose.
“The availability of an Afms specifically created for patients with Mici, listening to their needs, can be a precious help both to prevent and combat malnutrition”, comments Leone. But today in our country who pays for AFSMs? “While for some pathologies these foods are reimbursed at a national level – the experts reply – for others such as IBD they are distributed free of charge to patients only in some regions”. According to Iqva 2022 data, “the market for Afms paid by the patient in all diseases amounts to approximately 150 million euros, compared to 100 million paid by the National Health Service” and “against an expense of almost 5 billion euros in supplements”. Data to reflect on, the specialists point out. “In a healthcare system with growing demand for health and increasingly scarce resources – concludes Caccialanza – having nutritional aids of proven effectiveness, of low cost and capable of bringing savings to other items of healthcare spending, allows for an efficient allocation of resources and an increase in the level of health of patients who benefit from a complete treatment integrated with other therapies”.
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