栄養ケア・マネジメントの進展

―医療，介護，障害福祉サービス制度における展開

Abstract

Nutrition forms the foundation of individual health and well-being and is a critical component of sustainable development and economic growth. At the Tokyo Nutrition for Growth Summit 2021, the Tokyo Compact on Global Nutrition for Growth was issued to promote policies to achieve the World Health Assembly’s Global Nutrition Goal 2025, the United Nations Decade of Action for Nutrition (2016?2025), and the Sustainable Development Goals, with the goal of “eradicating all forms of malnutrition.” In line with this declaration, the Government of Japan has committed to advancing inclusive nutrition policies domestically. Against the social backdrop of an aging population, efforts to address the protein-energy malnutrition of older adults and promote enjoyment of eating have accelerated. As part of these initiatives, Nutrition Care and Management (NCM) based on multidisciplinary collaboration among medical institutions, long-term care facilities, and facilities for individuals with disabilities has been introduced and promoted. This paper summarizes the philosophy of NCM and the development of its institutional design within the medical insurance, long-term care insurance, and disability welfare service systems. We also discuss the outcomes of research on the nutritional status of older adults and patients and the health and economic effects of nutritional care as background for the introduction of NCM. A significant milestone was the 2000 revision of the Dietitians Act, which expanded registered dietitians’ responsibilities and highlighted nutrition management services for patients, enhancing insurance services of NCM. Furthermore, in the aging society, strengthening medical and long-term care coordination within community-based comprehensive care systems and developing skilled professionals for NCM are important issues. Japan’s initiatives in these areas offer valuable insights for designing and implementing nutrition policies in other aging societies globally.

Translated Abstract

栄養は個人の健康と福祉の基盤であると同時に，持続可能な開発および経済成長を支える重要な要素である．東京栄養サミット2021において，「あらゆる形態の栄養不良の撲滅」を目指し，世界保健総会の「世界栄養目標2025」，国連「栄養のための行動の10年（2016－2025）」，および持続可能な開発目標（SDGs）の達成に向けた政策を推進することが東京栄養宣言として発表された．これに基づき，日本政府は，日本国内の政策として，”誰一人取り残さない栄養政策”を推進することを表明した． 高齢化が進む社会的背景を踏まえ，高齢者の低栄養状態の改善と，口から食べる楽しみを支援するための取り組みが加速している．その一環として，医療，介護及び障害者福祉サービスにおける多職種連携による栄養ケア・マネジメント（NCM）が導入され，推進されている． 本稿では，NCMの理念および，医療保険，介護保険，障害福祉サービス制度における制度設計の変遷を整理した．NCMの制度の導入を支えた背景として，高齢者や患者の栄養状態の把握，栄養ケアの医療経済的効果に関する調査研究の成果についても言及する．また，2000年の栄養士法改正により，管理栄養士の業務が拡大し，傷病者を対象とした栄養管理業務が重視されるようになったことも，NCM導入の大きな要因となっている．2005年10月以降，介護，医療，障害福祉サービス制度の改正に伴い，栄養管理の重要性から，その報酬評価が充実してきた． さらに，高齢化が進む社会において，地域包括ケアシステムの構築にあたって医療・介護連携の強化，およびNCMを担う専門人材の育成は重要な課題である． これらの日本の取り組みは，今後高齢化が進む諸外国における栄養政策の策定や実施にも貢献できるものと考える．

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