住院病人的营养不良风险筛查

目的:采用主观全面评定法(SGA),营养风险评估2002(NRS 2002),营养不良通用筛查工具(MUST)和微型营养评定简表(MNA-SF),对住院病人进行评估,以确定营养风险筛查工具的临床适用性. 方法:对856例住院病人在入院后48 h内采用4种营养筛查工具进行营养筛查,以MNA简表为标准,绘制其他3种营养筛查工具的ROC曲线及曲线下面积(AUC),评估其特异性、灵敏度和Youden指数. 结果:使用MUST、SGA、NRS 20002以及MNA-SF进行评估,营养不良或存在营养不良风险的检出率分别为13.3％,13.6％,49.5％和56.0％.以MNA-SF为标准,绘制SGA、NRS 2002和MUST的ROC曲线,AUC分别为0.616、0.809和0.715,灵敏度分别为23.8％、74.5％和46.8％;特异性分别为99.5％、87.3％和96.3％;Youden指数分别为0.233、0.618和0.431.结论:4种营养筛查工具中,NRS 2002的灵敏度和正确性最高,建议病人入院时采用NRS 2002进行营养筛查.     

营养干预对维持性血液透析患者营养不良的影响

目的　分析营养干预对维持性血液透析(MHD)患者营养不良发生率的影响。方法　选取本院MHD患者196例,应用随机数字表随机分为研究组和对照组,每组98例,研究组进行营养干预6个月,对照组自主饮食,观察并对比两组6个月后的营养不良发生率。结果　干预组和对照组基线情况一致,无论是年龄、生化指标还是营养不良发生率差异均无统计学意义(均P＞0.05)。6个月后,尽管研究组营养不良率［35.7%（35/98）］较基线水平［33.7%(33/98)］略有增加,但是差异无统计学意义（P=0.764）;而对照组自主饮食6个月后营养不良率［59.2%(58/98)］显著增加,与基线相比差异有统计学意义（P=0.000）; 营养干预6个月后研究组营养不良发生率较对照组下降,差异有统计学意义（P=0.000）。结论　对MHD患者进行营养干预6个月,可以明显降低营养不良的发生率,改善预后,但长期疗效有待于进一步研究。     

风险分析在食品强化管理中的应用

目的为完善我国食品强化政策法规,修订食品营养强化剂标准提供参考和依据。方法研究风险分析在国际及国外一些国家食品强化管理中的应用状况,按照风险分析的3个组成部分分别阐述食品强化管理中风险评估、风险管理和风险交流的特征及关键因素。结果营养素风险评估需同时考虑改善营养不足及防止营养过量,应根据营养素安全范围间距划分风险等级,进行分类管理。制定食品强化法规标准时,不应局限于针对单一营养素的评价,还要评估食品强化对膳食及疾病模式的影响。结论鉴于我国居民营养状况、膳食结构十分复杂,建议根据国情按照风险分析方法调整和完善食品强化政策和标准,指导食品工业界的研发,提高消费者的营养认知水平。     

The physical functional capacity of frail elderly persons undergoing ambulatory rehabilitation is related to their nutritional status

Objectives: To estimate the prevalence of malnutrition in frail elders undergoing rehabilitation and the association between their nutritional status and physical function.Design: Observational study of new participants undergoing ambulatory rehabilitation.Setting: Two Geriatric Day Hospitals (GDH) in Montreal, Quebec.Participants: 121 women and 61 men.Intervention: Evaluation of nutritional status, body composition and physical function.Measurements: The nutritional status was assessed with a composite index based on anthropometric measurements and serum albumin, as well as using the Mini Nutritional Assessment (MNA) questionnaire. Patients were classified as well-nourished, having mild/at risk of malnutrition or malnourished. Body composition was estimated by bioimpedance and handgrip strength and gait speed by standard methods.Results: 13% of patients were found to be mildly malnourished, whereas 6% were malnourished. Malnourished patients were older and had worse cognition, lower BMI, and % body fat (all p<0.05). Malnourished patients and those with mild malnutrition had lower weight, triceps skinfold thickness, muscle and fat mass (all, p<0.003). Handgrip strength was different according to the nutritional status (p=0.034) and correlated with muscle mass (r=0.65, p<0.001). MNA classified 53% of patients as being at risk whereas 3% were malnourished and it correlated with gait speed (r=0.26, p=0.001).Conclusion: There is a high prevalence of patients in GDH at risk or with mild malnutrition. Being malnourished was associated with worse physical performance, which suggests that a nutritional intervention may be of benefit in improving their physical function. This study was supported by the Helen Hutchinson Foundation of the Division of Geriatric Medicine, Research Institute of the Montreal General Hospital     

The nutritional status of frail elderly with care needs according to the mini-nutritional assessment

BACKGROUND AND AIMS: Although malnutrition is common in the geriatric population, the relationship between frail elderly with various care needs and nutritional status remains unknown. The purpose of this study was to analyze the association between subjects with higher care needs and poorer nutritional status in the Japanese community-dwelling frail elderly. METHODS: A total of 281 community-dwelling elderly subjects from day-care centers (81.9+/-7.2yr of age mean+/-SD; 72 men and 209 women) who were eligible for Long-Term Care Insurance were enrolled in this study to evaluate their nutritional status using the mini-nutritional assessment. The levels of care needs of participants were classified into six levels according to the Long-Term Care Insurance program. RESULTS: According to the mini-nutritional assessment classification, 39.9%, 51.2%, and 8.9% of the participants were assessed as well-nourished, at-risk of malnutrition, and malnourished, respectively. There were significant differences among the six groups with regard to the nutritional status; subjects with higher care needs were associated with poorer nutritional status. In the higher care needs group, more than half of the subjects did not know their weight change during 3-month intervals. CONCLUSIONS: The population of elderly with higher care needs in the community is associated with a higher prevalence of malnutrition.     

广元市中小学学生营养状况调查分析

目的:了解中小学生营养中存在的主要问题及其影响因素,为制订相关措施提供参考依据。方法:于2013年选择广元市八所中学,七所小学,通过对不同年级,不同年龄学生进行基本情况和膳食状况调查,同时测量学生的身高、体重、血红蛋白等指标。掌握了解学生营养中存在的主要问题及其影响因素。共调查1 879名学生,年龄为9~15岁。结果:广元市中小学生营养不良率和较低体重率分别为2.3%和41.1%,超重和肥胖率分别为5.4%和8.5%。学生营养不良和营养过剩同时存在,营养不良问题尤为突出。学生贫血率较高。经常喝牛奶者为60.2%,经常吃豆制品者为35.3%,经常吃鱼类者为23.9%,每周吃1~2次动物内脏者为10.8%。结论:广元市中小学生的营养状况不容乐观,应积极对中小学生进行营养干预,改善膳食结构,加强营养知识教育,培养健康的饮食行为,促进学生健康成长。     

老年腹部外科恶性肿瘤患者营养风险和营养不良（不足）状况的对比调查

目的 调查老年腹部外科恶性肿瘤住院患者营养风险和营养不良(不足)发生率.方法 采用定点连续抽样,以2009年12月至2010年11月北京医院普外科住院的269例老年腹部恶性肿瘤患者(≥65岁)为研究对象,入院后第2天早晨进行营养风险筛查2002,营养风险筛查评分≥3分认为存在营养风险;营养不良(不足)判断标准为体重指数＜ 18.5 kg/m2;同时与同期同类疾病的其他年龄组进行比较.结果 269例研究对象完成营养风险筛查,适用率为100％;普外科老年恶性肿瘤患者(≥65岁)的营养不良(不足)发生率为30.1％ (81/269),高龄老年患者(≥80岁)为37.5％ (21/56),其他年龄组为17.6％ (43/245) (P=0.001);老年恶性肿瘤患者的营养风险发生率为38.3％(103/269),高龄患者为57.1％ (32/56),其他年龄组为29.3％ (72/245) (P＜0.001);老年腹部恶性肿瘤患者中胰腺癌营养风险比例较高,而结直肠癌的发病率相对较低.结论 老年腹部外科恶性肿瘤住院患者营养风险和营养不良(不足)发生率明显高于其他年龄组,高龄老人营养状况更为严重,应重视老年恶性肿瘤患者的营养问题.     

中国城镇居民的膳食结构与营养状况

对１９９２年全国营养调查中８４７４户中的３１１７７名城镇居民进行膳食结构和营养状况分析，结果表明：大城市、其它城市居民的膳食结构与建议的２０００年膳食目标相当接近，谷类能量比为５２．７％和５４．９％，动物性食物能量比为１６．３％和１８．９％。蛋白质摄入足够，由动物性食物、豆类共同提供的蛋白质分别占３４．４％和４０．８％，但来自脂肪的能量已超过膳食总能量的３０％。县城居民除动物性食物热能比稍低以外，其它各项均己达到标准；郊区差距还比较大，只有脂肪热能比达到要求，多数指标只与１９８２年城市居民持平。居民膳食中钙、维生素Ｂ２和维生素Ａ的摄入明显不足；儿童发育迟缓发生率为８．３％～２６．９％，体重不足儿所占比例为４．０％～１１．３％，郊区发生率最高；成人的肥胖和消瘦的发生率均在城市最高，这说明居民膳食仍有待改善，并应加强营养知识宣传以改善居民的膳食及营养状况。     

广东省居民膳食营养状况研究

目的　了解广东省居民膳食营养状况 ,为营养改善工作提供科学依据。方法　运用多阶段整群随机抽样方法 ,抽取广东省大城市、中小城市、2类农村各 3个区 (县 ) ,1类农村 4个县 ,每个县 (区 )抽取 3个街道 (乡 )、6个居委。其中膳食共调查城乡居民 2 393户、770 8人 ,用称重法获得每个家庭的调味品的消费量 ,连续 3d 2 4h回顾法获得每个调查对象各类食物的进食量 ;测量每个调查对象的身高、体重 ;血红蛋白测定共调查 2 4 0 5 1人 ,用氰化高铁法测量。结果　每标准人日摄入能量10 2 12 2kJ,占RNIs的 10 1 8% ,城乡分别为 10 80 5 3kJ、9778 7kJ,占RNIs的 10 7 7%、97 5 % ;蛋白质、脂肪摄入量分别为 86 1g、83 9g ,提供能量的比例分别为 14 1%和 31 0 %。视黄醇、核黄素和硫胺素摄入量分别为 6 6 1 9μgRE、0 9mg、1 1mg,分别占RNIs的 82 7%、6 8 8%和 6 9 2 %。钙、铁、钠摄入量分别为 4 92 6mg、2 3 1mg和 5 814 5mg,分别为RNIs的 6 1 6 %、132 0 %和 2 6 4 3%。动物性食物提供的蛋白质占 4 5 2 % ,城市与农村分别占 5 3 1%和 37 7%。脂肪中动物性脂肪占 5 3 2 % ,城市、农村分别占 4 7 5 %、5 8 1%。 6岁以下儿童共调查 35 6 9人 ,消瘦、肥胖、低体重和生长发育迟缓的患病率分别为 2 5 %、3     

营养教育对病人营养风险筛查和营养支持效果的影响

目的:了解医护人员“临床营养诊断与治疗适宜技术”教育前后对病人营养评价和治疗合理性的改善情况. 方法:调查医护人员营养教育前后病人营养不良发生率、营养风险发生率、营养支持率和营养支持方案的合理性. 结果:营养教育前后肿瘤病人营养不良发生率、营养风险发生率、营养支持方案的合理性差异均有统计学意义(P＜0.01).但营养支持率在营养教育前后无显著性差异(P＞0.05). 结论:营养教育可有效地提高医务人员的营养知识水平,有助于改善病人的营养风险和营养不良的发生率.     

Update on diabetes in the elderly and in nursing home residents

Diabetes is common in the elderly population and in nursing home residents. More than 20% of adults aged 65 to 75 years and 40% of adults older than 80 years suffer from diabetes. Physiological changes in elderly individuals, such as decreased physical activity, abdominal obesity, and increased inflammatory state, increase insulin resistance in peripheral tissue and reduce glucose-dependent insulin release, leading to carbohydrate intolerance and diabetes. The clinical presentation in the elderly and nursing home residents is frequently guided by the high rate of comorbidities such as hypertension, depression, and cardiovascular diseases. Treatment recommendations for glycemic control in elderly ambulatory patients are similar to those in long-term care facilities. Healthy patients with diabetes should aim for near-normal fasting plasma glucose and an HbA1C of about 7%; however, treatment goals must be individualized in patients with impaired cognitive and physical ability, reduced life expectancy, and heavy burden of comorbid disease. Elderly individuals and nursing home residents are at increased risk of hypoglycemia during pharmacological treatment. In general, a conservative and stepwise approach to the treatment of the elderly patient with diabetes is suggested. Treatment may be initiated with dietary and physical activity modification and with a single oral agent, followed by a combination of oral agents and insulin therapy if needed. Evidence from clinical trials indicates that improving glycemic control, as well as cardiovascular risk factors, reduces morbidity and mortality in older individuals with diabetes.     

广西居民膳食营养状况调查

目的了解广西居民膳食营养状况,为制订营养改善策略提供科学依据.方法用多阶整群随机抽样法抽取4个城区、4个农村县,4268户、17104人.用称重法获调味品量,3d、24h回顾法获个人食物量;测定身高、体重、血红蛋白和血浆维生素A.结果每标准人日摄入能量9226.2kJ,达推荐摄入标准（RNI）91.8%,城乡分别为10301.11,8877.5kJ,达RNI 102.7%和88.5%.蛋白质、脂肪分别为64.4,75g,提供能量分别为11.9%和31.3%.视黄醇、核黄素和硫胺素分别为527.3μg RE、0.8mg和1mg,分别达30.4%,59.1%和78.1%.钙、铁分别为311.4、19.4mg,分别达适宜摄入标准（AI）35.4%和118.4%.动物蛋白质占蛋白质总摄入量的37.4%,城乡分别占46.9%和33.4%.动物脂肪占脂肪总摄入量的74.7%,城乡分别占54.7%和81.9%.营养不良率为12.9%,肥胖率9.1%（含中心性肥胖）,超重率4.4%,贫血率为17.2%,其中孕妇为48.6%,乳母为24.1%;学龄前儿童发育迟缓率15.8%,婴儿低出生体重率4.8%.结论广西居民营养状况有了较大改善.能量、蛋白质基本满足,视黄醇、核黄素和钙偏低,食盐偏高,脂肪能量偏高.亟待制定广西膳食营养促进策略,防制不良和营养相关慢性病.     

妇科恶性肿瘤患者营养风险、营养不足及营养支持状况的调查

目的 调查手术治疗的妇科恶性肿瘤住院患者营养风险和营养不足发生率以及营养支持状况.方法 采用定点连续抽样,以2013年1月1日至12月31日在北京医院妇科住院、接受手术治疗的237例恶性肿瘤患者为研究对象,入院后第2天早晨进行营养风险筛查,营养风险筛查评分≥3分认为存在营养风险,营养不足判断标准遵循营养风险筛查2002方法,描述其术后营养支持状态.结果 营养风险筛查的适用率为100％;营养不足占5.1％ （12/237）,其中≥65岁者营养不足发生率（9.2％）显著高于＜65岁者（2.7％）（P=0.034）;妇科恶性肿瘤总营养风险发生率为21.1％（50/237）,其中≥65岁者营养风险发生率（29.9％）显著高于＜65岁者（16.0％）（P=0.014）;卵巢癌和子宫内膜癌患者的营养不足和营养风险发生率相对较高,而阴道癌和外阴癌患者的发生率相对较低;237例患者中,术后接受营养支持者共47例（19.8％）,均为肠外营养,其中,应用“全合一”肠外营养者13例（5.5％）,单瓶输注（给予“葡萄糖、脂肪乳、氨基酸”中两种以上者）34例（14.3％）.无接受管饲肠内营养的病例;存在营养风险的50例患者中,接受肠外营养支持33例（66％）;无营养风险的187例患者中,接受肠外营养支持14例（7.5％）.结论 妇科恶性肿瘤住院患者存在营养风险;但老年患者营养风险发生率较高,应加强对老年患者的术后营养支持.