住院病人营养不良患病率调查与分析

目的:了解住院病人营养不良的患病率及其分布.方法:采用回顾性的调查方法,对北京和上海7所三甲综合医院的4 549例住院病人病例进行调查.结果:低体重患病率,入院时、住院中和出院时分别为11.12%、12.22%和14.62%;低清蛋白血症患病率,入院时、住院中和出院时分别为20.27%、31.57%和19.75%;营养不良性贫血患病率,入院时、住院中和出院时分别为40.36%、53.12%和50.66%.结论:住院病人营养不良发生率高,病人入院时已有较高的营养不良患病率,在疾病治疗过程中营养状况未获得改善,故出院时的营养指标均低于入院时.     

肺癌手术病人营养风险及对临床结局的影响

目的:评估肺癌手术病人的营养风险,评定营养风险对临床结局的影响。方法:前瞻性评估130例拟诊肺癌手术病人,利用欧洲营养风险筛查2002(NRS2002)作营养风险筛查工具,测定病人体质指数、血清清蛋白水平等营养指标判断营养状况,并观察病人术后并发症和住院时间等指标。结果:肺癌手术病人营养不良和营养风险发生率分别为13.8%和15.4%,并发症的发生率为4.6%,平均住院4.52 d。营养不良和有营养风险的病人平均术后住院时间明显延长。结论:可行手术的肺癌病人营养不良和营养风险发生率较低。术前存在营养不良和有营养风险对术后并发症无影响,但会延长术后住院时间。     

肠外营养支持的外科手术病人低磷血症发生率及危险因素分析

目的:了解接受肠外营养(PN)支持的外科手术病人低磷血症发生率及危险因素,并探讨其对PN支持的时间和机械通气的影响。方法:回顾性分析404例接受PN支持的所有外科住院手术病人。采集病人一般情况、接受PN前血生化指标(肝肾功能、血糖、血脂、血钙、血磷、血镁)和PN持续时间。营养不良依据BMI和血清清蛋白水平进行判定。血磷水平0.96 mmol/L为低磷血症。结果:在404例病人中,总低磷血症发生率为58.7%。神经外科、妇科肿瘤和外科ICU病人低磷血症发生率均70%。Logistic回归显示,恶性肿瘤、胆红素和血钙水平降低是低磷血症发生的危险因素,而肌酐水平升高则是低磷血症的保护因素。与正常血磷组病人比,低磷血症病人PN支持时间未明显延长(P=0.611),但机械通气使用率却显著增加(13.1%vs 3.6%,P=0.001)。结论:接受PN支持的外科手术病人低磷血症的发生率显著增高。低磷血症可显著增加病人使用机械通气的危险性。     

低清蛋白血症病人患病率及其对住院周期的影响

目的:了解住院病人低ALB血症与住院周期的关系. 方法:采用回顾性调查的方法,对上海市四所医院1435例住院病人病历资料进行回顾性分析. 结果:住院病人入院时低ALB血症患病率为28.4%,病人平均住院时间为2～98(24.48±14.55)d,低ALB组病人住院时间明显长于ALB正常组(P<0.01).相关分析表明,病人住院周期与低ALB血症呈显著负相关(P<0.01),与年龄呈正相关(P<0.01).Logistic线性回归分析显示,年龄和低ALB血症是延长住院周期的危险因素.回归方程式LOH(d)=28.243+0.096×AGE-2.567×ALB,病人年龄每增加1岁,住院周期延长0.096 d,血清ALB每减少10 g/L,住院周期延长2.567 d. 结论:低ALB血症可反映疾病的严重程度,年龄和低ALB血症是延长住院周期的危险因素,尤其是老年病人,更要及时纠正低ALB血症.     

神经科老年住院病人营养状态及营养支持状况的相关研究

目的:筛查神经科老年住院病人营养状态和营养支持情况,以指导临床营养干预措施. 方法:对381例神经科65 ～ 90岁住院病人,采用定点连续收集方法,抽样完成营养风险筛查2002(NRS2002)和微型营养评定(MNA),同时检测病人血清清蛋白和前清蛋白浓度以及调查营养支持状况. 结果:神经科老年住院病人使用NRS2002进行营养风险筛查适用率较低(59.84％);而MNA在老年神经科住院病人均可使用.神经科常见疾病的老年住院病人存在有一定营养风险的发生率为29.92％,营养不良发生率为13.65％,营养不良风险为23.10％,仅有15.49％的病人获得营养支持,其中肠外与肠内营养的比例大致为1∶1. 结论:NRS2002对神经科老年病人的营养风险筛查具有一定的局限性.MNA可用于神经科老年病人的营养不良和营养不良风险的评估.     

营养不良炎症评分法在血液透析病人中的应用

目的:评价营养不良炎症评分法(MIS)对血液透析病人营养状态的评估作用. 方法:对80例维持性血液透析病人应用MIS法进行营养评估,同时测定血清清蛋白(ALB) 、转铁蛋白(TF) 、血红蛋白(Hb) 、血钙(Ca)、血磷(P)、C-反应蛋白(CRP)及透析前后血肌酐(Scr)和血尿素氮(BUN).计算透析充分性指标:尿素清除率(Kt/v)、尿素减少率(URR)和蛋白分解率(PCR).并用生物电阻抗法测量透析后人体组成指标:体重(WT)、体质指数(BMI) 、全身水量(TBW )、脂肪组织(FAT MASS)和非脂肪组织(FFM)等. 结果:蛋白质营养不良(ALB＜35 g/L)、贫血(Hb＜110 g/L)和高磷血症(P＞1.8 mmol/L)发生率分别为47.5%、73.8%和70.0%.所有病人的MIS评分均属于轻、中度营养不良.MIS评分与WT、BMI、FAT MASS、ALB、TRF、Hb、CRP和透析前Scr相关,差异均有统计学意义(P＜0.001,P＜0.05).Kt/v与URR、PCR呈正相关(P＜0.001,P＜0.05),与WT、BMI、FAT MASS、FFM、TBW呈负相关(P＜0.001,P＜0.005,P＜0.05). 结论:低蛋白血症、贫血、高磷血症是血液透析病人的主要营养问题.MIS法对血液透析病人有良好的营养评价作用,是一种有效的早期营养不良筛选方法.     

老年贫血162例临床分析

目的 总结老年贫血患者的临床特点.方法 对162例老年贫血患者的临床资料进行回顾性分析.结果 162例患者贫血病因前三位分别是营养不良性贫血59例(36.4%),恶性肿瘤48例(29.6%),慢性病性贫血14例(8.6%).轻度贫血36例(22.2%),中度贫血79例(48.8%),重度贫血47例(29.O%).结论 老年贫血极为常见,且多为中重度贫血.营养不良性贫血是老年贫血的主要原因,而恶性肿瘤占有较高的比例,须引起临床医生的重视,从而提高诊治水平.     

结直肠癌病人术前营养风险筛查及术后清蛋白和住院时间的比较

目的:调查结直肠癌住院病人术前营养风险,对其术后血清清蛋白和住院时间进行比较,为临床合理应用营养支持提供依据. 方法:参照NRS2002工具的标准,对270例结直肠癌住院病人进行营养风险筛查,分别对103例存在营养风险病人和167例无营养风险病人进行营养支持与未进行营养支持者作对比,分析营养风险与营养支持之间的关系. 结果:存在营养不良风险的103例结直肠癌病人中75例实施了营养支持后,平均住院时间和第7天血清清蛋白水平与未营养支持组比有显著性差异(P＜0.01).同时对无营养风险病人62例实施了临床营养支持后,平均住院时间有显著性差异(P＜0.05),但术后清蛋白与术前比差异均无统计学意义(P＞0.05). 结论:对进行手术治疗的结直肠癌病人,应及时进行营养风险的动态评估,对存在营养不良风险的结直肠癌病人,进行积极的营养支持治疗可有效地改善其术后的营养状况和缩短住院时间.     

老年慢性肾功能不全患者的营养状况评价

目的应用微型营养评定(MNA)方法来评价住院老年慢性肾功能不全病人的营养状况.方法110例住院老年慢性肾功能不全患者,采用微型营养评定(MNA)问卷调查法进行营养评定,同时结合人体测量、生化检查.结果[1]根据MNA评分营养不良者28例(25.5%);营养不良危险者56例(50.9%);营养良好者26例(23.6%).[2]轻度、中度、重度肾功能损害三组的营养不良及营养不良危险者发生率分别为70.9%、79.0%、100.0%.[3]MNA评价的营养状况结果有效的反映人体测量、生化检查.结论[1]住院老年慢性肾功能不全病人的营养不良发生率较高.[2]微型营养评定(MNA)方法应用在住院老年慢性肾功能不全病人的营养状况评价中是可行的.     

老年住院病人的营养状况评价

目的:应用微型营养评价精法(MNA-SF)评价老年住院病人的营养状况,并比较不同营养状况三组病人间传统营养评价指标的差异. 方法:随机选取234例老年住院病人,采用MNA-SF对其进行营养状况评价,同时测定传统营养指标,并进行分析. 结果:老年住院病人营养不良、营养不良风险的发生率分别为12.39％和46.58％,而营养正常的病人仅占40.03％.对三种不同营养状况病人的传统营养指标分析后发现,三组病人的体重指数(BMI)、上臂围(AMC)、小腿围(CC)、握力、体力活动水平(ADL)、总蛋白(TP)、清蛋白(ALB)和血红蛋白(Hb)等差异均有显著性统计学意义(P＜0.05);三组病人之间两两比较后,BMI、AMC、CC、握力、ADL、ALB均有显著性差异(P＜0.05).营养正常组病人TP和Hb明显高于营养不良组(P＜0.05),但与营养不良风险组之间无显著性差异.营养不良风险组病人Hb也明显高于营养不良组(P＜0.05). 结论:老年住院病人营养不良和营养不良风险的发生率较高,其类型多为蛋白质-热量营养不良.     

Poor nutritional habits are predictors of poor outcome in very old hospitalized patients

BACKGROUND: Malnutrition is prevalent in elderly populations. Recommended methods of nutritional screening are often too complicated and time-consuming for routine application in frail, very old, hospitalized patients. OBJECTIVE: Our aims were to identify risk factors for development of malnutrition in very old hospitalized patients and to evaluate the total Mini Nutritional Assessment (MNA) score and MNA subscores as predictors of in-hospital and long-term mortality. DESIGN: A prospective cohort study of patients aged > or =75 y was conducted in a geriatric hospital. Assessment included demographic, clinical, and laboratory data and cognitive, functional, and nutritional status. Follow-up was conducted for < or =2.7 y. RESULTS: Of the 414 patients studied, only 73 (17.6%) were well-nourished. Low serum albumin and phosphorus concentrations, dementia, and cerebrovascular accident (CVA) were significant risk factors for malnutrition. Survival was significantly lower in malnourished patients and patients at risk of malnutrition than in well-nourished patients (P < 0.0001). Low MNA-3 subscores (dietary habits) were significantly correlated with laboratory indexes of malnutrition and were significantly lower in patients with infections, malignancy, pressure ulcers, dementia, recent orthopedic surgery, and CVA. Multivariate analysis showed that a low MNA-3 score was an independent predictor of mortality; scores <7.5 increased the risk of death 2.05-fold. CONCLUSIONS: The prevalence of malnutrition was high in elderly hospitalized patients. Dietary habits were significant predictors of poor hospitalization outcome. A questionnaire on dietary habits can serve as a useful tool in assessing nutritional status and prognosis in elderly patients.     

Assessment of nutritional status on hospital admission: nutritional scores

Malnutrition is still a largely unrecognized problem in hospitals. Malnutrition in hospitalized patients is generally related to increasing morbidity and mortality, and costs and length of stay. The aim of this study was to assess the nutritional status of patients on admission to a general hospital using different nutritional scores and to test the sensitivity and specificity of these scores. Sample population included 60 patients (55% male; 45% female) selected (aged 65.6+/-15.9 y) at random by using a computer software program. The nutritional state assessment was performed within 48 h of admission, using different nutritional indices (Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Gassull classification, Instant Nutritional Assessment (INA) and a combined index). About 78.3% of patients were found to be malnourished on admission. The frequency of malnutrition degree varied from 63.3% as assessed by the SGA to 90% with the NRI. Malnutrition severity was not related to the diagnosis. However, an elderly population was associated with a higher prevalence of malnutrition. INA was the best single score to identify patients who are malnourished or at risk of malnutrition and who may benefit from nutrition support.     

Application of subjective global assessment as a screening tool for malnutrition in surgical patients in Vietnam

BACKGROUND AND AIMS: In most hospitals in Vietnam, clinical assessment of nutritional status has yet to become part of the routine clinical history taking and physical examination. It is the aim of this study to apply subjective global assessment (SGA) of nutritional status in surgical patients in the Mekong Delta, Vietnam, to determine the incidence of malnutrition according to SGA and to know whether there was an association between SGA class and infectious complications. METHODS: A prospective, cross-sectional study design was used. SGA of nutritional status was applied. Patients were rated as well nourished (A), moderately malnourished (B) or severely malnourished (C). Infectious complications (wound infection, intra-abdominal abscesses, anastomotic leakage) were recorded. RESULTS: Of the 438 patients assessed, 194 (44.3%) were classified as A, 126 patients (28.8%) were classified as B and 118 patients (26.9%) were classified as C. Of the 274 patients who underwent major abdominal surgery assessed, 61 patients (22.3%) were classified as A, 97 patients (35.4%) were classified as B and 116 patients (42.3%) were classified as C. Weight loss and percent weight loss, muscle wasting, loss of subcutaneous fat, functional capacity and significant gastrointestinal symptoms correlate significantly with the severity of SGA class (P<0.001). The rate of postoperative infectious complications was higher in patients classified as SGA class C (33.6%) than as class A (6%) and B (11%). CONCLUSIONS: A high rate of malnutrition was found, applying SGA of nutritional state in surgical patients in Vietnam. Malnutrition was associated with an increase in infectious complications. Special attention should be paid to weight loss, muscle wasting, loss of subcutaneous fat, functional capacity and gastrointestinal symptoms.     

Evaluation of the efficacy of nutritional screening tools to predict malnutrition in the elderly at a geriatric care hospital

BACKGROUND/OBJECTIVESMalnutrition in the elderly is a serious problem, prevalent in both hospitals and care homes. Due to the absence of a gold standard for malnutrition, herein we evaluate the efficacy of five nutritional screening tools developed or used for the elderly.SUBJECTS/METHODSElected medical records of 141 elderly patients (86 men and 55 women, aged 73.5 ± 5.2 years) hospitalized at a geriatric care hospital were analyzed. Nutritional screening was performed using the following tools: Mini Nutrition Assessment (MNA), Mini Nutrition Assessment-Short Form (MNA-SF), Geriatric Nutritional Risk Index (GNRI), Malnutrition Universal Screening Tool (MUST) and Nutritional Risk Screening 2002 (NRS 2002). A combined index for malnutrition was also calculated as a reference tool. Each patient evaluated as malnourished to any degree or at risk of malnutrition according to at least four out of five of the aforementioned tools was categorized as malnourished in the combined index classification.RESULTSAccording to the combined index, 44.0% of the patients were at risk of malnutrition to some degree. While the nutritional risk and/or malnutrition varied greatly depending on the tool applied, ranging from 36.2% (MUST) to 72.3% (MNA-SF). MUST showed good validity (sensitivity 80.6%, specificity 98.7%) and almost perfect agreement (k = 0.81) with the combined index. In contrast, MNA-SF showed poor validity (sensitivity 100%, specificity 49.4%) and only moderate agreement (k = 0.46) with the combined index.CONCLUSIONSMNA-SF was found to overestimate the nutritional risk in the elderly. MUST appeared to be the most valid and useful screening tool to predict malnutrition in the elderly at a geriatric care hospital.     

Malnutrition and Clinical Outcomes: The Case for Medical Nutrition Therapy

Malnutrition is not a new or a rare problem. In studies involving more than 1,327 hospitalized adult patients, 40% to 55% were found to be either malnourished or at risk for malnutrition, and up to 12% were severely malnourished. Surgical patients with likelihood of malnutrition are two to three times more likely to have minor and major complications as well as increased mortality; and their length of stay can be extended by 90% compared with the stay of well-nourished patients. Hospital charges are reported to be from 35% to 75% higher for malnourished patients than for well-nourished patients. Obtaining data to assess the nutritional status of patients is essential to optimal patient care, especially for patients at high risk for malnutrition. Nutrition assessment can be done with readily available and relatively inexpensive methods. But it is not enough to assess and identify malnutrition. Outcomes are improved and costs are saved only when appropriate intervention follows. This article identifies many well-conducted, published studies that support the findings that health outcomes of malnourished patients can be improved and that overall use of resources can be reduced by nutrition counseling, oral diet and oral supplements, enteral formula delivered via tube, and parenteral nutrition support via central or peripheral line. Early nutrition assessment and appropriate nutrition intervention must be accepted as essential for the delivery of quality health care. Appropriately selected nutrition support can address the problem of malnutrition, improve clinical outcomes, and help reduce the costs of health care. J Am Diet Assoc. 1996; 96:361-366,369.     

Management of severe acute malnutrition in an urban nutritional rehabilitation center in Burkina Faso

BACKGROUND: Management of acute severe malnutrition greatly contributes to the reduction of childhood mortality rate. In developing countries, where malnutrition is common, number of acute severe malnutrition cases exceeds inpatient treatment capacity. Recent success of community-based therapeutic care put back on agenda the management of acute severe malnutrition. We analysed key issues of inpatient management of severe malnutrition to suggest appropriate global approach. METHODS: Data of 1322 malnourished children, admitted in an urban nutritional rehabilitation center, in Burkina Faso, from 1999 to 2003 were analyzed. The nutritional status was assessed using anthropometrics indexes. Association between mortality and variables was measured by relative risks. Kaplan-Meier survival curves and Cox model were used. RESULTS: From the 1322 hospitalized children, 8.5% dropped out. Daily weight gain was 10.18 (+/-7.05) g/kg/d. Among hospitalized malnourished children, 16% died. Patients were at high risk of early death, as 80% of deaths occurred during the first week. The risk of dying was highest among the severely malnourished: weight-for-height<-4 standard deviation (SD), RR=2.55 P<0,001; low MUAC-for-age, RR=2.05 P<0.001. Kaplan-Meier survival curves and Cox model showed that the variables most strongly associated with mortality were weight-for-height and MUAC-for-age. Among children discharged from the nutritional rehabilitation centre, 10.9% had weight-for-height<-3 SD. CONCLUSION: The nutrition rehabilitation centre is confronted with extremely ill children with high risk of death. There is need to support those units for appropriate management of acute severe malnutrition. It is also important to implement community-based therapeutic care for management of children still malnourished at discharge from nutritional rehabilitation centre. These programs will contribute to reduce mortality rate and number of severely malnourished children attending inpatient nutrition rehabilitation centers, by prevention and early management.     

500例住院患者的营养调查分析

目的以我院情况为抽样代表,了解我国医院住院病人的营养状况。方法采用询问法,对患者膳食史进行回顾性调查,并进行体格检查和部分生化项目测定。结果发现轻、中度和重度营养不良占48％以上,血红蛋白测定结果可看出低于正常值者占60％。结论我院住院患者中半数以上者处于营养不良状态,初步看出营养不良的表现以比较严重的肌蛋白消耗和铁的储备不足为主。     

Structural and process indicators of nutritional care: a comparison between Austrian hospitals and nursing homes

ObjectiveThe aim of this study was to describe and compare structural and process indicators of nutritional care in Austrian hospitals and nursing homes.MethodsA multicenter, cross-sectional study was performed using a standardized and tested questionnaire. Data were collected on patient and institutional levels of hospitals and nursing homes.ResultsData from 18 Austrian hospitals (n = 2326 patients) and 18 Austrian nursing homes (n = 1487 residents) were collected. The prevalence of malnutrition was 23.2% in hospitals and 26.2% in nursing homes. All hospitals and 83.3% of the nursing homes employed dietitians. Guidelines for the prevention and treatment of malnutrition were used infrequently. Nutritional screening at admission was performed in 62.6% of the hospitalized patients and 93.4% of the nursing home residents. Nutritional screening tools were used in 28.9% of the nursing home residents and 14.5% of the hospitalized patients. Oral nutritional support was preferred to enteral and parenteral nutrition in the two settings. Dietitians were consulted in 27.5% of the malnourished hospitalized patients and 74.7% of the malnourished nursing home residents.ConclusionThe study demonstrated that nursing homes fulfilled more structural indicators and performed nutritional screening at admission more often than hospitals. Nevertheless, the prevalence of malnutrition was high in the two settings and a substantial number of malnourished patients/residents received no nutritional intervention at all. These results show the necessity for improvements in the nutritional care in Austria, for instance, through the routine use of nutritional screening tools followed by tailored nutritional interventions in patients/residents in need.     

Use of Nutritional Scores to Predict Clinical Outcomes in Chronic Diseases

Many hospitalized patients are malnourished, and the relationship between malnutrition and patient outcome is well established. To determine which patients are at nutritional risks, clinical scores are probably more accurate than using a single nutritional parameter. Among the numerous scores published, both the Prognostic Nutritional Index and the Subjective Global Assessment were prospectively validated. One is based on objective measurements, whereas the second is based on medical history and physical examination. The Nutritional Risk lndex has been used in many studies including the "Veterans Study'. The Mini Nutritional Assessment is a promising score for evaluating malnutrition in the elderly. The development of nutritional scores for use by nurses may facilitate screening of a large number of hospitalized patients.     

Fast and simple screening for nutritional status in hospitalized, elderly people

BACKGROUND: Undernutrition has been frequently reported among hospitalized elderly patients. The aim of this study was to evaluate the mini nutrition assessment (MNA) and a screening sheet for malnutrition (SSM) by full nutritional assessment (FNA) in elderly people, and to construct a shorter screening method by combining important questions from MNA and SSM. Having a screening tool as fast and simple as possible could increase its use in clinical routines. METHODS: FNA, MNA and SSM were carried out on 60 hospitalized patients (>65 years). Sensitivity and specificity for MNA and SSM were calculated in comparison with FNA. In order to construct a short and simple screening tool, questions from the two screening tools, which differed significantly between mal- and well-nourished patients, were used in a multivariate, stepwise linear regression. The regression model was simplified to be suitable in clinical routines. RESULTS: Malnourishment was diagnosed by FNA in 58.3% of the elderly patients, with no gender difference. Body mass index, unintended weight loss, recent surgery and loss of appetite were predictors of malnutrition in the regression model (R(2) = 60.1%). The sensitivity and specificity of the simplified regression model were 89 and 88%, respectively, which was more precise than MNA (77 and 36%) and SSM (89 and 60%). CONCLUSION: According to FNA, malnutrition is frequent in elderly hospitalized patients. Four questions are sufficient to conduct precise nutritional screening for malnutrition in elderly hospitalized patients. This new screening tool should be verified in other samples.