外科胰腺肿瘤患者营养不足和营养风险发生率的前瞻性调查研究

目的　调查外科胰腺肿瘤患者营养不足和营养风险发生率。方法　对2014年1月至2015年12月,因各种胰腺肿瘤入住北京医院普外科,接受手术治疗的121例住院患者,根据肿瘤性质分为胰腺癌组和其他胰腺肿瘤组,主要应用营养风险筛查2002方法,前瞻性比较不同胰腺肿瘤患者的营养不足和营养风险发生率以及物理测量、体成分和外周血蛋白质水平等,记录临床结局。结果　121例符合入选标准的胰腺肿瘤患者进入本研究,胰腺癌组90例和其他胰腺肿瘤组31例,平均年龄（61.9±13.6）岁;平均体质量指数（23.20±2.95）kg/m2;上臂围（28.8±3.5）cm;肌肉组织量（44.6±7.4）kg;脂肪组织量（16.8±7.6）kg;两组在人体测量和体成分等方面差异无统计学意义（均P＞0.05）;胰腺癌组空腹血糖［（6.45±2.47）mmol/L］显著高于对照组［（4.95±0.79）mmol/L］（P＜0.001）,白蛋白［（39.0±4.7）g/L比(42.3±2.9)g/L,P＜0.001］,总蛋白［（62.8±6.2）g/L比(66.3±2.9)g/L,P＜0.001］和前白蛋白［（136.1±85.4）mg/L比(197.8±112.6),P=0.011］均显著低于对照组;营养不足发生率为4.1%,营养风险发生率78.5%;其中胰腺癌组营养风险发生率显著高于其他胰腺肿瘤组（91.1%比38.7%,χ2=36.525,P＜0.001）。结论　外科胰腺癌患者营养风险发生率较高,蛋白水平低和糖代谢异常,可导致住院时间延长。     

肝癌合并肝硬化患者术后不同剂型肠内营养的临床效果

目的 比较氨基酸型和整蛋白型肠内营养制剂用于肝癌合并肝硬化患者术后营养治疗的临床效果。方法　肝癌合并肝硬化术后患者207例,等热量等氮肠内联合肠外营养连续至少5 d,按肠内营养剂型分为氨基酸型制剂组（氨基酸为氮源,104例）和整蛋白型制剂组（整蛋白为氮源,103例）。观察肠道通气时间、术后住院时间、腹泻发生率、术后并发症发生率等临床结果,以及电解质、肝功能相关生化指标。结果　2组患者术前及术中资料差异无统计学意义（P>0.05）;氨基酸型制剂组较整蛋白型制剂组腹泻发生率高（23.08%比8.74%,P=0.005）,肠道通气时间早［（55.87±10.12）h 比（68.27±9.07）h,P=0.000）］;两组患者腹胀发生率（10.58%比13.59,P=0.506）、术后住院时间［（10.30±3.50）d 比（10.12±4.26） d,P=0.738］、并发症发生率（43.27%比33.98%,P=0.170）及术后7 d钾［（4.02±0.50） mmol/L比（3.98±0.55） mmol/L,P=0.644］、钠［（136.29±3.55）mmol/L比（136.23±2.74）mmol/L,P=0.913］、丙氨酸氨基转移酶［（90.22±64.29）U/L比（96.01±59.74）U/L,P=0.556］、天门冬氨酸氨基转移酶［（36.01±19.68）U/L比（39.00±18.88）U/L,P=0.329］、总胆红素［（15.39±8.64）μmol/L 比（15.43±8.33）μmol/L,P=0.978］差异均无统计学意义（P>0.05）;氨基酸型制剂组较整蛋白型制剂组白蛋白水平高［（32.87±3.54） g/L 比（31.37±3.50） g/L, P=0.008］、前白蛋白水平高［（11.41±4.32)mg/dl比（9.84±3.64）mg/dl,P=0.014］,但凝血酶原时间活动度水平低［（66.94±7.24） s比（70.63±8.49）s,P=0.017）］。结论　两种制剂均有利于肝癌合并肝硬化患者术后肝功能恢复,氨基酸型制剂更有助于肠功能恢复和蛋白质合成,整蛋白型制剂肠道耐受性较好并促进凝血功能恢复。     

胃癌根治术后早期肠内营养与肠外营养的疗效比较

目的 探讨胃癌根治术后经鼻肠营养管早期肠内营养（early enteral nutrition EEN）的疗效.方法 将61例胃癌术后患者随机分成早期肠内营养组31例和全胃肠外营养（total pareteral nutrition TPN）组30例.比较两种营养支持的疗效.结果 EEN组与TPN组相比,术后肛门排气时间显著提前（P＜0.05）,术后住院时间显著缩短（P0.05）,体重消耗值显著减少（P＜0.05）,营养结束后第2天的血清总蛋白、清蛋白水平有显著性差异（P＜0.05）.结论 经鼻肠营养管EEN比TPN优越,简便易行,宜予推广.     

个性化营养支持对高龄顽固性心力衰竭患者近期结局的影响

目的观察和比较单纯肠内营养（EN）、单纯肠外营养（PN）、肠内肠外联合营养（EN+PN） 3种营养支持方式对高龄顽固性心力衰竭患者近期结局的影响及其安全性。方法 选取2004年1月至2012年9月在北京军区总医院263临床部住院的247例高龄顽固性心力衰竭患者,采用随机数字表法分为EN+PN组（n=87）、EN组（n=76）、PN组（n=84）。随机分组后根据患者耐受情况,EN组2例转入EN+PN组,PN组3例转入EN+PN组。于营养支持前和营养支持7 d后检测血清学指标和心脏超声血液动力学指标,根据全身症状计算营养支持后好转率,记录不良事件发生情况进行安全性评价。结果 研究过程中共8例患者退出,其中EN组4例,PN组1例,EN+PN组3例。与营养支持前比较,各组营养支持7 d后血清前白蛋白［EN组,（0.17±0.01）g/L比（0.11±0.02）g/L;PN组,（0.19±0.01）g/L比（0.09±0.02）g/L;EN+PN组,（0.24±0.04）g/L比（0.10±0.02）g/L］、白蛋白［EN组,（34.14±1.00）g/L比（31.25±1.02）g/L;PN组,（33.89±1.20）g/L比（30.99±1.07）g/L;EN+PN组,（36.66±1.36）g/L比（31.00±1.01）g/L］、转铁蛋白［EN组,（1.99±0.39）g/L比（1.86±0.36）g/L;PN组,（2.01±0.41）g/L比（1.89±0.34）g/L;EN+PN组,（2.58±0.47）g/L比（1.92±0.33）g/L］均显著升高(P均=0.008);EN+PN组的前白蛋白（P=0.007、0.008）、白蛋白（P=0.041、0.040）、转铁蛋白（P=0.007、0.008）均显著高于EN组和PN组。PN组营养支持后血糖显著升高［（8.06±2.35）mmol/L比（5.81±2.21）mmol/L,P=0.009］,其余两组营养支持前后差异无统计学意义。与营养支持前比较,3组营养支持7 d后每搏输出量（SV)［EN组,（60.91±7.26）ml比（45.09±6.42）ml;PN组,（61.01±7.29）ml比（45.19±6.39）ml;EN+PN组,（65.42±7.43）ml比（46.11±6.41）ml;P均=0.008］、左心室射血分数（LVEF）［EN组,（45.78±0.09）%比（34.61±0.09）%;PN组,（45.11±0.11）%比（34.55±0.08）%;EN+PN组,（49.79±0.11）%比（34.42±0.09）%;P均=0.008］、左心室舒张末期内径（LVEdd）［EN组,（60.22±2.42）mm比（63.20±2.19）mm,P=0.008;PN组,（60.28±2.44）mm比（62.98±2.11）mm,P=0.044;EN+PN组,（57.43±2.40）mm比（63.09±2.08）mm,P=0.008］、左心室收缩末期内径（LVEsd）［EN组,（54.08±6.06）mm比（56.15±6.03）mm,P=0.044;PN组,（54.42±6.10）mm比（56.31±6.11）mm,P=0.044;EN+PN组,（51.48±5.27）mm比（56.32±6.13）mm,P=0.008］均明显改善;EN+PN组的SV（P=0.003、0.004）和LVEF（P均=0.004）均显著大于EN组和PN组,LVEdd（P=0.004、0.005）和LVEsd（P=0.004、0.005）均显著小于EN组和PN组。EN组、PN组、EN+PN组的好转率分别为75.71%（53/70）、75.00%（60/80）、83.15%（74/89),异常状况评分与营养支持前比较均显著改善（P均=0.000）;EN+PN组的好转率显著高于EN组和PN组（P均=0.005）,PN组与EN组的好转率差异无统计学意义（P=0.059）。PN组的恶化率为15.00%,明显高于EN组（12.85%,P=0.048）和EN+PN组（6.74%,P=0.045）。营养支持期间EN+PN组不良事件发生率显著低于EN组［22.47%（20/89）比37.14%（26/70）,P=0.005］,与PN组比较差异无统计学意义［35.00%（28/80）,P=0.057］。结论 对于高龄顽固性心力衰竭患者, EN+PN可提高血清前白蛋白、白蛋白、转铁蛋白水平,缓解临床症状,改善血液动力学,且不良事件发生率较低,是优于单纯EN或PN的营养支持方式。     

肝切除术中应用甲基强的松龙联合围手术期肠内营养对术后康复的作用

目的　评估肝切除术中单剂应用甲基强的松龙联合围手术期肠内营养对术后肝脏合成功能的影响,以及对术后恢复的作用。方法　采用前瞻性对照研究方法,选取2013年6月至2014年5月在南京鼓楼医院肝胆胰外科行肝切除术的79例患者,按照手术顺序交替入组,分为对照组39例、研究组40例。研究组在肝切除开始时单剂静脉应用甲基强的松龙500 mg,两组患者围手术期均采用相同的肠内营养支持方案。检测术前和术后第1、3、5天血液肝功能指标、前白蛋白以及C反应蛋白,记录术后外源性人血白蛋白总输注量、术后首次肛门排气时间、术后住院时间和术后并发症发生情况。结果　与对照组比较,研究组术后第3天血清前白蛋白显著升高［（101.26±61.17）mg/L比（81.84±43.58）mg/L,t=-1.607,P=0.049］;术后第1天血清胆碱酯酶显著升高［（5.60±1.54）kU/L比（4.68±1.01）kU/L,t=-3.136,P=0.004］;术后第1、3天血清C反应蛋白显著降低［（41.79±20.86）mg/L比（62.08±38.33）mg/L,t=2.933,P=0.027;（64.14±32.38）mg/L比（102.64±49.05）mg/L,t=4.127,P=0.006］。与对照组比较,研究组术后住院时间显著缩短［（12.62±5.74）d比（15.41±10.00）d,t=1.514,P=0.002］。结论　肝切除术中单剂应用甲基强的松龙可抑制术后炎症反应,与围手术期肠内营养联合应用可促进术后肝脏合成功能的恢复,有助于促进患者康复。     

胃癌手术后早期肠内肠外营养支持效果

目的探讨胃癌手术后早期肠内肠外营养(EN-PN)与完全肠外营养(TPN)的治疗效果。方法对2000年1月～2004年12月在我院普外科行胃癌根治术198例患者进行回顾性分析,其中97例(EN-PN组)采用术后早期肠内肠外营养治疗,101例(TPN组)采用完全肠外营养治疗,比较两组患者的术后营养指标(体重、血浆白蛋白、前白蛋白、视黄醇结合蛋白)、肛门排气时间、胃排空恢复时间、住院时间和总住院费、并发症发生率。结果EN-PN组术后第7天的血浆前白蛋白和视黄醇结合蛋白(302.54±58.65)g/L和(39.21±6.54)mg/L均显著高于TPN组的(236.89±48.84)g/L(P<0.05)和(25.36±5.37)mg/L(P<0.01);EN-PN组的肛门排气时间、胃排空恢复时间、住院时间分别为(56.8±7.1)小时、(6.6±3.8)天、(15.5±5.8)天,均显著少于TPN组的(79.6±14.6)小时(P<0.01)、(13.2±6.2)天(P<0.05)和(22.6±5.6)天(P<0.05);EN-PN组的并发症发生率18.6%和总住院费16568.35元均显著少于TPN组的40.6%(P<0.01)和28612.85元(P<0.01)。结论胃癌术后早期肠内肠外联合营养治疗安全可靠、简便易行、符合生理、肠功能恢复快、并发症少、费用低廉。     

全胃切除术后恢复十二指肠路径P型和功能性空肠间置代胃消化道重建术对患者远期营养状况的影响

目的比较全胃切除术后P型空肠间置代胃和功能性空肠间置代胃（FJI)两种恢复食物经十二指肠路径的消化道重建方式对患者远期营养状况和生活质量的影响。方法 2003年1月至2011年6月,50例胃癌患者在东华医院行全胃切除术,其中27例行P型空肠间置代胃消化道重建术,23例行FJI消化道重建术。术后第1天至第7天予以全肠外营养支持。观察患者围术期并发症情况。术后6个月和12个月分别监测两组患者体重、血清总蛋白、血清白蛋白、血红蛋白和反流性食管炎发生情况,计算营养评定指数（NAI）。结果 50例患者均未发生严重手术并发症,无围术期及化疗相关死亡。术后6个月P型组和FJI组的体重减轻量［（3.67±0.91)kg比(3.44±0.52)kg,P=0.28］、血清总蛋白［（52.62±1.67)g/L比(53.22±1.24)g/L,,P=0.16］、血清白蛋白［（31.26±1.29)g/L比(30.70±2.41)g/L,P=0.32］、血红蛋白［（118.01±5.96)g/L比(117.83±6.72)g/L,P=0.92］、NAI(P=0.39)和反流性食管炎发生率（11.1%比13.0%,P=1.00）差异无统计学意义。术后12个月两组的体重减轻量［（2.71±0.45)kg比(2.74±0.42)kg,P=0.77］、血清总蛋白［（53.93±1.66)g/L比(53.34±1.84)g/L,P=0.24］、血清白蛋白［（32.60±1.42)g/L比(30.76±2.10)g/L,P=0.23］、血红蛋白［（124.18±6.56)g/L比(119.99±6.13)g/L,P=0.16］、NAI(P=0.43)和反流性食管炎发生率（7.4%比8.7%,P=1.00）差异无统计学意义。结论 全胃切除术后P型和FJI这两种消化道重建方式对患者术后远期营养状况和生活质量的影响无差异。     

消化道肿瘤术后早期营养对免疫和应激反应的作用

目的 比较消化道恶性肿瘤术后早期肠内营养（EEN）＋肠外营养（PN）与术后早期完全胃肠外营养（TPN）对患者应激和免疫指标的影响。方法将择期进行消化道恶性肿瘤根治手术患者随机分为EEN＋PN组（22例）和TPN组（24例），两组患者分别于术后24小时开始等热量、等氮营养治疗。比较两组患者术前与术后1周CD3、CD4、CD8、CD4／CD8、IgA、IgG、IgM、C-反应蛋白（CRP）、肿瘤坏死因子α（TNFα）、白介素2（IL2）水平的差异。结果EEN＋PN组术后7天CD3、CD4、IgM显著高于TPN组（P〈0．05）；TPN组术后1天IL2显著高于EEN＋PN组（P〈0．05）。两组患者术前、术后7天CD8、CD4／CD8、IgA、IgG、CRP、TNFα差异均无显著性（P＞0.05）。结论EEN＋PN在改善应激和免疫指标方面优于TPN，可成为消化道肿瘤患者术后首选的营养方式。     

综合干预对食管癌放射治疗患者生活质量的影响

目的　探讨综合干预对接受放射治疗食管癌患者生活质量的影响。方法　选取2012年10月至2014年12月江苏省南通市肿瘤医院收治的100例食管癌首次放射治疗患者,按随机数字表法分为对照组和观察组各50例。对照组采用常规的饮食指导、补液支持和症状干预,观察组在此基础上强化综合干预。比较两组患者放射治疗前后生活核心量表（QLQ-C30）评分和营养指标的差异。结果　放射治疗前两组患者生活核心量表（QLQ-C30）评分和营养指标差异无统计学意义（均P＞0.05）。放射治疗后观察组患者躯体功能［（75.6±13.1）分比（63.8±12.4）分］、情绪功能［（61.9±14.3）分比（52.5±13.7）分］、疲劳［（36.6±13.2）分比（45.8±15.0）分］、疼痛［（34.8±16.1）分比（44.3±17.0）分］、失眠［（49.2±15.7）分比（57.2±14.3）分］、食欲不振［（50.2±16.2）分比（59.0±15.8）分］、恶心呕吐［（21.5±10.3）分比（29.9±11.3）分］、总体健康［（68.8±13.4）分比（58.2±12.8）分］评分优于对照组（均P＜0.05）;放射治疗后观察组患者体质量［（59.3±8.5）kg比（54.4±7.3）kg］、体质量指数［（21.9±2.1）kg/m2比（18.4±2.8）kg/m2］、血红蛋白［（125.9±8.9）g/L比（107.3±9.5）g/L］、血清白蛋白［（35.1±6.9）g/L比（29.0±5.3）g/L］、前白蛋白［（213.54±37.47）mg/L比（174.56±36.26）mg/L］水平优于对照组（均P＜0.01）。结论　对接受放射治疗的食管癌患者行综合干预,可改善营养不良状况,减轻食管炎、口干、疲乏、食欲不振等症状,改善生活质量,保证放射治疗的顺利完成。     

深度水解蛋白配方粉喂养早产儿相关营养状况分析

目的　探讨以深度水解蛋白配方粉作为开奶喂养的早产儿相关营养状况。方法　收集2013年1月至2014年12月上海儿童医学中心新生儿重症监护室首次以深度水解蛋白配方粉开奶喂养的早产儿共157例,记录相关诊断、出生情况、营养摄入、生长发育等。根据有无喂养不耐受（不耐受组和耐受组）和出生体质量（＜1 500 g、1 500~2 500 g和≥2 500 g组）进行分组,分析生长发育情况及其相关因素。结果　共60例（38.2%）早产儿发生喂养不耐受。出生体质量和胎龄越小,发生喂养不耐受越多,其中＜1 500 g组喂养不耐受为71.1%。与耐受组比较,喂养不耐受组出生体质量［（1 620±440）g比（1 980±421）g,P=0.000］、胎龄［（31.3±2.6）周比（33.0±2.1）周,P=0.000］、出生头围［（28.9±2.2）cm比（30.4±1.9）cm,P=0.000］和出生身长［（41.1±3.9）cm比（43.2±3.4）cm,P=0.000］明显减小,转奶时间［（26.4±17.6)d比（7.9±5.3)d,P=0.000］和达到足量喂养时间［（21.5±10.0)d比（13.8±6.2)d,P=0.000］明显延长。同时,开奶时间［＜1 500 g组（6.1±5.1)d,1 500~2 500 g组（3.8±2.5)d,≥2 500 g组（3.3±1.2)d,P=0.002］、转奶时间［＜1 500 g组（28.7±18.3)d,1 500~2 500 g组（9.7±8.1)d,≥2 500 g组（7.0±3.8)d,P=0.000］和达到足量喂养时间［＜1 500 g组（24.0±10.4)d,1 500~2 500 g组（14.3±6.0)d,≥2 500 g组（11.4±3.5)d,P=0.000］出生体质量越小组越晚。不耐受组和＜1 500 g组有更多患儿接受肠外营养支持（93.3%;97.8%）,且肠外营养提供热量［＜1 500 g组（325.9±59.4）kJ/（kg·d）,1 500~2 500 g组（281.2±64.8）kJ/（kg·d）,≥2 500 g组（269.9±43.9）kJ/（kg·d）,P=0.001］和持续时间［＜1 500 g组（27.1±14.5)d,1 500~2 500 g组（13.0±7.0)d,≥2 500 g组（8.7±3.4)d,P=0.000］更多。生长发育方面不耐受组头围增长较快［不耐受组（0.7±0.6） cm/周,耐受组（0.6±0.5） cm/周,P=0.045］。＜1 500 g 组体质量增长［（21.8±9.5） g/d］和头围增长［（0.8±0.4） cm/周］均明显高于其他出生体质量组［体质量增长：1 500~2 500 g组（14.2±7.6）g/d,≥2 500 g组（4.9±11.9）g/d,P=0.000;头围增长：1 500~2 500 g组（0.5±0.4）cm/周,≥2 500 g组（0.6±0.8）cm/周,P=0.005］。对是否有喂养不耐受作变量控制后,偏相关分析显示住院期间体质量增长与胎龄（r=-0.666,P=0.035）、出生体质量（r=-0.700,P=0.024）、头围（r=-0.846,P=0.002）以及恢复至出生体质量天数（r=-0.697,P=0.025）呈负相关,与头围增长（r=0.672,P=0.033）呈正相关,而与出生身长、开奶、转奶时间和达到足量喂养时间、肠外营养热量和持续天数,以及住院天数和一些并发症有无无相关性。结论　深度水解蛋白配方粉喂养的早产儿发生喂养不耐受的能获得类似于喂养耐受组早产儿的生长发育,与肠外营养的应用有关。胎龄越小、出生体质量头围越低的早产儿更适于采用深度水解蛋白配方奶作为开奶喂养。     

Impact of nutrition behaviour research on nutrition programmes and nutrition policy

Development of a society is interrelated with research. Innovation in food and nutritional sciences enable citizens to live in conditions of food security. Current dietary goals can be reached by understanding the biopsychosocial background of human nutrition behaviour. Examples of diffusion of such findings into practice are presented with emphasis on Germany and the activities of AGEV (the Working Association of Nutritional Behaviour), which was founded 25 years ago. Nutrition behaviour research should strengthen the focus on practical applications of its findings, since the prevalence of nutrition-related problems, like obesity in children and the estrangement on food and nutrition, is increasing.     

Preadmission nutrition screening: expanding hospital-based nutrition services by implementing earlier nutrition intervention

The need to screen patients earlier than within the first 24 hours of hospital admission has resulted in the development of preadmission nutrition screening. At Providence Saint Joseph Medical Center (PSJMC), a 455-bed acute-care facility, this procedure has been used since 1994. The preadmission screening method was developed because of the use of critical pathways for patients in specific diagnosis-related groups. Critical pathways specified that registered dietitians must assess these patients within 24 hours of admission at PSJMC. However, at that time there was minimal data in the chart from which to assess the patient's nutritional status and the ability to interview the patient was often limited as a result of intubation or postoperative pain. Family members were not always available at the hospital to discuss a patient's preadmission nutritional status. To address this problem, we developed a system to call people at home before their admission to the hospital to obtain specific nutrition information. To analyze the effectiveness of the procedure, the Food and Nutrition Services Department developed a process to assess this method of screening and to improve the system. Patients were enrolled in a study over a 1-month period, demographics were identified for this sample population, and patient satisfaction was determined via an interview conducted by a dietetic technician after the patient was admitted. Most patients found this to be a very helpful process and an example is presented here on the role of preadmission nutrition screening in improving patient outcome. To better define the population of the case study presented, additional information was gathered on a second study group of patients screened before admission who were admitted for hip and knee surgery, one of the specific diagnosis-related groups with a critical pathway. Our findings indicate that preadmission nutrition screening has the potential to improve patient outcomes by increasing nutrient intake before their hospital admission, reducing hospitalization length, and enhancing patient satisfaction during their hospital stay.     

Neonatal nutrition: a focus on parenteral nutrition and early enteral nutrition.

No population has benefited more from the development and advancement of specialized nutrition support than pediatric patients. Today, neonates comprise the largest group of pediatric patients receiving parenteral nutrition (PN). Nutrient needs of neonates differ substantially from other populations, presenting unique challenges in optimizing nutrition care. Neonates are highly susceptible to catabolic stress because of reduced energy stores and markedly increased energy needs. Immature organ systems and metabolic pathways further complicate the delivery of adequate nutrition in the preterm neonate. Early nutrition support is essential to improve survival, reduce catabolism, promote growth, and limit developmental complications. This article discusses feeding strategies for PN and early enteral nutrition in neonates, particularly the preterm neonate.     

Total parenteral nutrition and enteral nutrition in diabetes

A quarter or more of critically ill patients are likely to have carbohydrate intolerance or frank diabetes, either pre-existing or secondary to the stress of illness. Those patients who require parenteral nutrition should be treated using regimens similar to those used in nondiabetic patients, along with sufficient insulin (given by separate infusion) to maintain near-normal glycaemia. The role of novel substrates in diabetes remains to be established. In patients who require enteral nutrition, there is accumulating evidence that high-fat (as monounsaturated fatty acid) formulations achieve better overall metabolic control than conventional high-carbohydrate preparations. In view of the fact that macrovascular disease is the major cause of morbidity and mortality in type 2 diabetes in particular, and the fact that the risk of macrovascular complications is relatively unaffected by glycaemic control, the improved lipid and haemostatic profile achieved with preparations that are high in monounsaturated fatty acids is of particular importance in patients on long-term nutritional support.     

Community nutrition

Scientific evidence has placed community nutrition among the front line strategies in health promotion. Traditional food habits have progressively changed in the last few decades. The combination of changes in food patterns and sedentary lifestyles have contributed to a significant increase in the prevalence of overweight and obesity. Efforts in community nutrition should now focus on three key aspects: nutrition education in schools and in the community, food safety and enhanced culinary skills in all age groups. School meals and other catering services provided at work or community sites should be consistent with the educational message. Catering services should ensure adequate nutritional supply, foster healthy eating practices and encourage participation in gastronomic culture and social learning. Food safety includes the procurement of a safe adequate food supply in sufficient amounts to cover the nutritional requirements of all individuals. It has become a priority for Public Health. Social changes along new scientific developments will introduce new demands into community nutrition and request a more important role for individually tailored advise. In order to face these challenges, community nutrition professionals need to be highly qualified and skilled.