Disease-related malnutrition (DRM) continues to be a highly significant healthcare problem, both in our hospitals as well as in the community. It is often underdiagnosed and poorly treated, despite a growing body of evidence showing its clinical and economic consequences. In Spain, the leading cause of malnutrition is disease. Many acute and chronic diseases and their treatments can affect nutritional status through various mechanisms involving appetite, nutrient absorption and assimilation, and different metabolic changes. The aetiology and prevalence of DRM have been extensively characterised in several clinical practice guidelines issued by the European Society for Clinical Nutrition and Metabolism (ESPEN).1, 2, 3 In addition to purely clinical factors, educational and socioeconomic factors such as poverty, loneliness, or estrangement can also contribute to the onset of DRM.

The transition between hospital clinical care and community services (primary care [PC] and care homes) is key to the prevention, detection and treatment of DRM. Several studies have highlighted the importance of continuity in nutrition therapy and care following hospital discharge, supporting the need to design joint action protocols and establish a coordination channel between clinical nutrition and diet therapy units and primary care that is flexible and adapted to the health and social circumstances.4 Some Spanish Autonomous Communities, such as Castile and Leon, have developed health and social care guidelines that can act as a benchmark.5 At the same time, the Alianza Más Nutridos [More Nourished Alliance] (www.alianzamasnutridos.es) has also established specific protocols.6

In October 2020, the Spanish Society of Endocrinology and Nutrition (SEEN) and Spain's leading societies of primary care doctors (SEMERGEN, SEMFYC and SEMG) met for the first time at the NutriSEEN virtual forum (www.seen.es/portal/actividad-plataforma-formacion/nutriseen-forum-virtual-2020) to discuss the needs of doctors from both specialisms in the approach to DRM. This meeting also saw the creation of a joint DRM working group. This document aims to establish joint working guidelines for clinical nutrition and diet therapy units and PC teams to improve the detection and treatment of DRM.