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目的探讨生物电阻抗相位角(phase angle, PA)在结直肠癌(colorectal cancer, CRC)手术患者营养评估及预后预测的应用。方法选取同济大学附属第十人民医院胃肠外科241例CRC手术患者,入院时采用营养风险筛查2002(Nutrition Risk Screening 2002, NRS 2002)、患者主观整体评估量表(Patient Generated-Subjective Global Assessment, PG-SGA)、全球领导人发起的营养不良倡议(Global Leadership Initiative on Malnutrition, GLIM)行营养筛查与评估,完善人体成分测定,同时收集相关营养指标及预后指标,评价PA在营养评估及预后预测的应用。结果与正常PA组相比,低PA组体质量指数(body mass index, BMI)、骨骼肌质量指数(skeletal muscle mass index, SMI)、前白蛋白(serum prealbumin, PALB)、总蛋白(total protein, TP)、白蛋白(albumin, ALB)、血红蛋白(hemoglobin, HGB)、预后营养指数(prognostic nutritional index, PNI)呈下降趋势(P<0.05),而年龄、纤维蛋白原(fibrinogen, FBG)、中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio, NLR)、血小板/淋巴细胞比值(platelet-to-lymphoccyte ratio, PLR)呈上升趋势(P<0.05)。营养风险及营养不良的患者PA明显下降(P<0.05)。PA与NRS 2002、GLIM存在一致性(P<0.05)。PA与年龄、FBG、NLR、PLR、NRS 2002、PG-SGA、改良格拉斯哥预后评分(modified Glasgow Prognostic Score, mGPS)、GLIM呈负相关,与BMI、SMI、PALB、TP、ALB、HGB、PNI呈正相关(P<0.05)。多元线性回归分析显示年龄、SMI、PALB、HGB、PNI、mGPS及GLIM对CRC手术患者的PA影响差异有统计学意义(P<0.05)。结论PA与CRC手术患者营养状况及预后指标密切相关,有利于辅助识别营养不良及预测预后,为及时进行营养干预及改善预后提供依据。  相似文献   
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目的 探讨家庭喂养方式和父母负性情绪与儿童营养不良发生的相关性,指导家庭科学喂养和预防儿童营养不良发生。方法 选取2020年4-10月广西壮族自治区妇幼保健院收治的营养不良儿童75例为观察组,另取同期健康体检儿童77例为对照组。对两组儿童父母进行问卷调查,比较两组儿童饮食行为,分析家庭喂养方式、父母负性情绪与儿童营养不良发生的相关性。结果 饮食行为方面,营养不良儿童过饱响应(t=2.104)、食物响应(t=4.206)、食物喜好(t=9.099)、渴望饮料(t=4.435)均较对照组儿童评分低(P<0.05)。喂养方式中,营养不良组和对照组儿童在父母对儿童体重的感知(t=3.167)、逼迫进食(t=3.354)、监督饮食(t=3.726)上差异有统计学意义(P<0.05)。父母情绪方面,营养不良组儿童父母焦虑发生率较对照组儿童父母高(χ2=8.660, P=0.003)。父母对儿童体重的感知(rs=0.246)、担心(rs=0.213)、逼迫进食(rs=0.254)、监督进食(rs=0.284)、父母焦虑(rs=0.218)、抑郁(rs=0.334)与营养不良发生呈正相关(P<0.05)。校正混杂因素后,父母对儿童体重的感知、逼迫进食、监督进食、父母抑郁是营养不良发生的独立影响因素(P<0.05)。ROC曲线分析显示,父母对儿童体重的感知、逼迫进食、监督进食、父母抑郁预测儿童营养不良发生的AUC分别为0.639、0.645、0.669和0.692(P<0.05)。结论 家庭喂养方式和父母焦虑、抑郁情绪与儿童营养不良发生有关,临床可通过调整家庭喂养方式缓解父母负性情绪,帮助儿童纠正不良饮食行为,减少营养不良发生风险。  相似文献   
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《Value in health》2022,25(5):677-684
ObjectivesHealthcare policy makers should ensure optimal patient access to medical nutrition (MN) as part of the management of nutrition-related disorders and conditions. Questions remain whether current healthcare policies reflect the clinical and economic benefits of MN. The objective of this article is to characterize coverage and reimbursement of MN, defined as food for special medical purposes/medical food for a diverse set of countries, including Australia, Belgium, Brazil, Canada, China, France, Germany, Hong Kong, Italy, Japan, The Netherlands, Singapore, Spain, United Kingdom, and United States.MethodsData sources included published literature and online sources. ISPOR’s Nutrition Economics Special Interest Group developed a data collection form to guide data extraction that included reimbursement coverage, years that reimbursement policies were established, and presence of a formal health technology assessment (HTA) for MN technologies.ResultsReimbursement coverage of MN technologies varied across the countries that were reviewed. All but 3 countries limited coverage to specific formulations of products, regardless of demonstrated clinical benefit. The year that reimbursement policies were established varied across countries (ranging from 1984 to 2017), and only 4 countries regularly update policies. France and Brazil are the only countries with a formal HTA process for MN technologies.ConclusionsMost countries have limited MN reimbursement, have not updated reimbursement policies, and lack HTA for MN technologies. These limitations may lead to suboptimal access to MN technologies where they are indicated to manage nutrition-related disorders and conditions, with the potential of negatively affecting patient and healthcare system outcomes.  相似文献   
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In 2014, the Emergency Nutrition Network published a report on the relationship between wasting and stunting. We aim to review evidence generated since that review to better understand the implications for improving child nutrition, health and survival. We conducted a systematic review following PRISMA guidelines, registered with PROSPERO. We identified search terms that describe wasting and stunting and the relationship between the two. We included studies related to children under five from low- and middle-income countries that assessed both ponderal growth/wasting and linear growth/stunting and the association between the two. We included 45 studies. The review found the peak incidence of both wasting and stunting is between birth and 3 months. There is a strong association between the two conditions whereby episodes of wasting contribute to stunting and, to a lesser extent, stunting leads to wasting. Children with multiple anthropometric deficits, including concurrent stunting and wasting, have the highest risk of near-term mortality when compared with children with any one deficit alone. Furthermore, evidence suggests that the use of mid-upper-arm circumference combined with weight-for-age Z score might effectively identify children at most risk of near-term mortality. Wasting and stunting, driven by common factors, frequently occur in the same child, either simultaneously or at different moments through their life course. Evidence of a process of accumulation of nutritional deficits and increased risk of mortality over a child's life demonstrates the pressing need for integrated policy, financing and programmatic approaches to the prevention and treatment of child malnutrition.  相似文献   
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In rural Bangladesh, intake of nutrient-rich foods, such as animal source foods (ASFs), is generally suboptimal. Diets low in nutrients and lacking in diversity put women of reproductive age (WRA) at risk of malnutrition as well as adverse birth outcomes. The objective of this study was to assess the relationship between maternal dietary diversity, consumption of specific food groups and markers of nutritional status, including underweight [body mass index (BMI) < 18.5 kg/m2], overweight (BMI ≥ 23 kg/m2) and anaemia (haemoglobin < 120 g/dl) among WRA in Bangladesh. This analysis used data from the third round of a longitudinal observational study, collected from February through May of 2017. Dietary data were collected with a questionnaire, and Women's Dietary Diversity Score (WDDS) was calculated. Associations between WDDS, food group consumption and markers of nutritional status were assessed with separate adjusted logistic regression models. Among WRA, the prevalence of underweight, overweight and anaemia was 13.38%, 40.94% and 39.99%, respectively. Women who consumed dark green leafy vegetables (DGLV) or eggs were less likely to be anaemic or underweight, respectively, and women who consumed ASFs, particularly fish, were less likely to be underweight compared with women who did not consume these foods. WDDS did not show any consistent relationship with WRA outcomes. Interventions that focus on promoting optimal nutritional status among WRA in Bangladesh should emphasise increasing consumption of specific nutrient-rich foods, including ASFs, DGLV and eggs, rather than solely focusing on improving diet diversity in general.  相似文献   
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Poor food and fluid intake and subsequent malnutrition and dehydration of residents are common, longstanding challenges in long-term care (LTC; eg, nursing homes, care homes, skilled nursing facilities). Institutional factors like inadequate nutrition care processes, food quality, eating assistance, and mealtime experiences, such as staff and resident interactions (ie, relationship-centered care) are partially responsible and are all modifiable. Evidence-based guidelines on nutrition and hydration for older adults, including those living with dementia, outline best practices. However, these guidelines are not sector-specific, and implementation in LTC requires consideration of feasibility in this setting, including the impact of government, LTC home characteristics, and other systems and structures that affect how care is delivered. It is increasingly acknowledged that interconnected relationships among residents, family members, and staff influence care activities and can offer opportunities for improving resident nutrition. In this special article, we reimagine LTC nutrition by reframing the evidence-based recommendations into relationship-centered care practices for nutrition care processes, food and menus, eating assistance, and mealtime experience. We then expand this evidence into actions for implementation, rating these on their feasibility and identifying the entities that are accountable. A few of the recommended activities were rated as highly feasible (6 of 27), whereas almost half were rated moderate (12/27) and the remainder low (9/27) owing to the need for additional staff and/or expert staff (including funding), or infrastructure or material (eg, food ingredients) investment. Government funding, policy, and standards are needed to improve nutrition care. LTC home leadership needs to designate roles, initiate training, and support best practices. Accountability will result from enforcement of policies through auditing of practice. Further evidence on these desirable nutrition care and mealtime actions and their benefit to residents’ nutrition and well-being is required.  相似文献   
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This prospective cohort study was conducted to compare the accuracy of QuantiFERON®-TB (QFT) Gold In-Tube test and tuberculin skin test (TST) in diagnosing tuberculosis (TB) in predominantly bacille Calmette–Guerin-vaccinated children with a high incidence of malnutrition. The sensitivity of the QFT versus the TST was 69.6% versus 52.9% for WHO-defined TB, with specificity of 86% versus 78.3%, respectively. The concordance of the TST and QFT was 79% overall (κ = 0.430), 62.5% in those with WHO-defined TB and 85.7% in those without TB. Majority of the QFT+/TST − discordance was seen in children with TB, whereas majority of the TST+/QFT − discordance was seen in those without TB. The TST was more likely to be negative in children with moderate-to-severe malnutrition (P = 0.003) compared to the QFT, which was more likely to be positive in younger children. The significantly better performance of the QFT in malnourished children and those at younger ages supports its use for TB diagnosis in these subpopulations.  相似文献   
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