三种营养筛查工具在外科术前患者中的应用

目的采用营养风险筛查2002（NRS2002）、营养不良筛查工具（MUST）和微型营养评定简表（MNA-SF）对外科术前住院患者进行营养筛查，以确定上述工具的适用性。方法分别采用NRS2002、MUST和MNA．SF对259例术前患者进行营养筛查，以白蛋白和前清蛋白为标准评定上述工具的特异度、敏感度和预测值。结果以白蛋白为标准，NRS2002、MUST和MNA—SF的灵敏度分别为57．9％、84．2％、94．7％，特异度分别为84．2％、59．2％、30．4％，阳性预测值为22．4％、14．0％、9．7％，阴性预测值为96．2％、97．9％、98．6％，符合率为81．9％、71．0％、46．7％。以前清蛋白为标准，NRS2002、MUST和MNA．SF的灵敏度分别为34．4％、73．4％、90．6％，特异度分别为86．2％、65．6％、34．9％，阳性预测值为44．9％、41．2％、31．4％，阴性预测值为80．0％、88．3％、91．9％，符合率为73．4％、67．6％、48．6％。结论3种营养筛查工具中，MNA—SF筛出率最高，NRS2002准确性最高，建议患者入院时采用NRS2002和MUST进行营养筛查。     

老年营养风险指数在高龄老年患者中的应用与研究

目的:观察营养筛查工具老年营养风险指数(GNRI)在高龄老年患者中的适用性;方法:选取高龄老年(年龄≥80岁)患者60例,随机分为对照组、观察组各30例,对照组采用营养风险筛查方案(NRS2002),观察组采用老年营养风险指数(GNRI),分别进行营养风险筛查,比较两种筛查方法的评估结果、营养支持应用率、营养相关并发症发生率.结果:观察组的患者营养风险检出率高于对照组(P<0.05),观察组的患者营养支持应用率、营养相关并发症发生率均低于对照组(P<0.05);结论:老年营养风险指数(GNRI)作为一个简单易行的客观评价指标,与高龄老年患者的营养状况密切相关.在评估高龄老年患者营养风险中,老年营养风险指数(GNRI)准确性较高,临床运用方便有效,值得推广.     

营养质量指数法在膳食营养质量评价中的应用研究

营养质量指数法在膳食营养质量评价中的应用研究济宁医学院营养与食品卫生教研室（２７２１１３）于进芝，庞道华，宋煜炜国内外应用的膳食营养质量的评价方法有多种，一是根据《食物成分表》［１］和现行的供给量标准［２］，计算食品中营养素相对含量，此法是我国常规应...     

儿科营养不良筛查工具在危重症儿童营养风险筛查中的应用

目的 采用儿科营养不良筛查工具(STAMP)对危重症患儿进行营养风险筛查,调查其营养风险与营养不良发生率,分析营养风险与临床结局相关性.方法 以2013年2至1 1月入住上海交通大学医学院附属上海儿童医学中心儿童重症监护室(PICU)共506例患儿为研究对象.按STAMP评分分为低度营养风险(0～1分)、中度营养风险(2～3分)和高度营养风险(4～9分).以WHO正常儿童生长曲线为标准,采用标准差单位法(Z-score)评定营养状况.统计比较患儿医院感染发生率、机械通气率、器官功能障碍数目、多器官功能障碍综合征(MODS)发生率、PICU住院天数、总住院天数、住院费用、出PICU后28 d病死率等临床结局.结果 根据STAMP评分,79例(15.6％)患儿存在低营养风险,167例(33.0％)存在中度营养风险,260例(51.4％)存在高度营养风险.营养不良发生率为50.0％ (253/506),包括营养不足(225/506,44.5％)和超重(28/506,5.5％),其中低体重、生长迟缓和消瘦发生率分别为31.0％ (157/506)、29.4％ (149/506)和14.4％ (73/506).高度营养风险患儿的机械通气率、器官功能障碍数目、MODS发生率、PICU住院天数、总住院天数、住院费用和出PICU后28 d病死率显著高于中度营养风险[45.8％比31.7％,P=0.004;1(1,2)比1(0,2),P=0.000; 45.8％比26.3％,P=0.000;8(3,15)d比5(2,9)d,P =0.000;17 (9,29)d比12 (6,21)d,P=0.001;3.81 (1.67,8.53)万元比2.09(1.13,4.85)万元,P=0.000; 26.9％比18.6％,P=0.047]和低营养风险患儿[45.8％比22.8％,P=0.000;1(1,2)比1(0,1),P=0.000; 45.8％比15.2％,P=0.000;8(3,15)d比6(3,9)d,P=0.008;17(9,29)d比11(6,20)d,P=0.001;3.81 (1.67,8.53)万元比1.57 (0.96,3.37)万元,P=0.000;26.9％比7.6％,P=0.000].营养不良患儿的MODS和医院感染发生率均显著高于营养正常患儿(39.9％比29.2％,x2=6.368,P=0.012; 8.3％比4.0％,x2=4.158,P=0.041).结论 大部分危重症儿童存在高度营养风险和营养不良,且高营养风险预示临床结局不良.可采用STAMP评分对危重症患儿进行营养风险筛查,尽早予以合理营养支持.     

上海南市区老年人群生活质量流行病学研究

上海南市区老年人群生活质量流行病学研究李立明１周杏元２曹卫华１祝国英２詹思延１林益强２李草凡１胡兵２曹家琪１张金峰２人口老龄化已成为全球面临的重要公共卫生问题〔１〕。由于中国人口基数大，老龄化的速度快，老年人口数量多，在资源有限、经济尚不十分发达的我...     

基于营养不良风险筛查工具2002的全程营养管理在胃肠道恶性肿瘤手术患者中的应用

目的 探讨基于营养不良风险筛查工具2002(NRS 2002)的全程营养管理在胃肠道恶性肿瘤手术患者中的应用价值。方法 选取2021年8—12月医院收治的130例拟行根治术的胃肠道恶性肿瘤患者作为研究对象,按照随机数字表法分为两组,每组65例。对照组采用常规营养管理,观察组采用基于NRS 2002的全程营养管理。比较两组术后住院时间、围手术期营养费用、总住院费用、术后并发症发生率,入院、出院的体质量指数（BMI）及血红蛋白（Hb）、白蛋白（ALB）、前白蛋白（PA）、转铁蛋白（TRF）水平,入院时及术后3个月的生活质量[采用欧洲癌症研究与治疗组织（EORTC）癌症患者生活质量核心量表（QLQ-C30）评估]。结果 观察组恢复经口进食时间、术后住院时间短于对照组,围手术期营养费用高于对照组,总住院费用、术后并发症发生率低于对照组,差异均有统计学意义（P <0.05）。入院时,两组BMI及Hb、ALB、PA、TRF水平比较,差异均无统计学意义（P> 0.05）;出院时,观察组BMI及Hb、ALB、PA、TRF水平均高于对照组,差异有统计学意义（P <0.05）。入院时,两...     

营养风险筛查2002在中国的应用概况

营养风险筛查2002（NRS 2002）是欧洲肠外肠内营养学会（ESPEN）以Kondrup 为首的专家组在128个随机对照临床研究的基础上开发出来的,也是国际上第一个采用循证医学方法开发的营养筛查工具,因为增加了疾病代谢一项且简便易行,已被欧洲推荐为住院患者营养风险评定的首选工具。本文就NRS 2002在国内开展应用情况做一综述,肯定了国内越来越多的应用,同时也提出了所存在的不足并给出一些改进建议,希望NRS 2002在国内能普及并规范地应用。     

集束化营养护理在改善老年胃癌化疗患者营养状况和生活质量中的应用

目的 探讨集束化营养干预改善老年胃癌化疗患者营养状况和生活质量的效果。方法 选择天津市宁河区医院2021年10月—2022年9月收治的老年胃癌化疗患者80例为研究对象,随机分为对照组和观察组各40例。对照组予以常规营养干预,观察组在此基础上予以集束化营养干预,比较两组干预前后营养状况和生活质量。结果 观察组干预后体质量、血红蛋白、血清白蛋白高于对照组,差异有统计学意义(P<0.05)。观察组干预后整体健康评分及部分生活质量维度评分高于对照组,差异有统计学意义(P<0.05)。结论 集束化营养干预与常规营养干预相比,可以进一步改善老年胃癌化疗患者营养状况和生活质量,值得临床推广应用。     

The Validity of Nutrition Screening Initiative DETERMINE Checklist Responses in Older Georgians

The Nutrition Screening Initiative DETERMINE Checklist (NSI) is used throughout the United States to assess nutrition risk of those requesting the services of the Older Americans Act Nutrition Program (OAANP). This study examined the ability of the NSI to evaluate nutrition risk by comparing the responses between NSI and matched comparable survey questions using the self-administered mail survey data that were collected among 924 new OAANP applicants in Georgia (mean age 75.0 ± 9.2 years, 68.8% women, 26.1% Black). Ninety-four percent of our sample provided at least one discordant response (i.e., disagreement between responses to the NSI and matched questions). Questions regarding food intake most frequently yielded discordant responses. Black participants were more likely to provide discordant responses for the meal frequency question. Food insecure individuals were less likely to provide discordant responses for food intake questions. Those who lived alone were less likely to provide discordant responses for the dairy intake question. Some NSI items may have limited ability to reliably assess nutritional risk of older adults. Further efforts are warranted to improve nutritional assessment tools for use in vulnerable older adults.     

上海市某区老年人生命质量影响因素分析

目的了解上海市某区老年人生命质量及影响因素,为有关部门提高老年人生命质量提供决策依据。方法采用SF-36量表调查上海市某区社区、敬老院和老年病房在住老人生命质量,同时调查有关人口学资料等情况,用单因素分析、多因素分析方法进行数据处理。结果居住社区的老人生命质量相对较高,敬老院次之,老年病房较低。生命质量影响因素有：疾病（脑血管意外、冠心病、骨折、慢支、糖尿病和关节炎等）、婚姻、文化程度、老人每月收入及农民等。结论要大力发展社区卫生服务,加强健康促进工作;提高敬老院医疗服务配置标准,满足患有各种慢性病的老年人需长期服药减轻病痛的需求。     

Self‐Evaluation of Quality of Life Among Patients Receiving Home Parenteral Nutrition: A Validation Study

Background : Home parenteral nutrition (HPN) can increase survival and quality of life (QOL) in cases of chronic intestinal failure. The present study compares a gold standard—a validated QOL assessment by Baxter et al (hereafter, HPN‐QOL)—with a shorter questionnaire for QOL evaluation (hereafter, New QOL). Materials and Methods : Both questionnaires were completed by 58 patients attending the nutrition clinic of the Rabin Medical Center (Israel). A z score was used to equate means and variances. Statistical analysis was based on Pearson correlation between variances. Stepwise regression was used to evaluate the best value predictor in the New QOL for QOL during HPN. Cronbach’s α was used for internal consistency, and confirmatory factor analysis was used for structural validity. Results : Results from the sections of the New QOL that relate to the patient’s general health, level of independence, and experience with handling the parenteral nutrition therapy are highly correlated with the HPN‐QOL (r = 0.43 and r = 0.50, respectively). In addition, there was good correlation between the questionnaires with reference to the patient’s social state, mental state, and everyday functioning (r = ?0.43, New QOL; r = ?0.39, HPN‐QOL). However, the New QOL results show no correlation between the patient’s physical symptoms and QOL during HPN. This was hypothesized to result from the nature of the study population. Conclusion : The results of our new questionnaire are well correlated with the gold standard HPN‐QOL. The New QOL appears to be simple and easy to use.     

Physical Fitness,Nutrition and Quality of Life in German Medical Students

Background: Medical students are exposed to high cognitive demands as well as to a high learning effort, which as a consequence can lead to a limited quality of life (Qol) with reduced physical performance and unhealthy eating behaviors. The aim of this retrospective analysis was to evaluate the abovementioned factors and their relationship to each other. Methods: We included 380 medical students (167 men, 213 women, age 22.2 ± 3.9 yrs) who participated in the sports medicine elective subject. Qol was measured with the SF-36 questionnaire, and endurance capacity was measured by using an incremental running test. Daily dietary intake was measured using a 7-day diary protocol. Depending on sex and the maximum speed achieved, students were divided into three performance groups. Results: Men achieved higher maximal speed, heart rate, and lactate. Carbohydrates and fat intake did not meet recommendations in either group. Dietary fibre intake differed significantly between the performance groups in men and women, with the better groups having higher intakes. Conclusions: Our data do not suggest increased risk or health-damaging behaviors in medical students compared with the general population. Irrespective of this, incentives should be set to enable a healthy life even during complex studies with a high learning effort.     

The Expanded Food and Nutrition Education Program’s Impact on Graduates’ Quality of Life

Objective

To determine how the Expanded Food and Nutrition Education Program (EFNEP) affects the quality of life (QoL) of its low-income adult participants.

Caregiver Social Status and Health-Related Quality of Life in Neurologically Impaired Children on Home Enteral Nutrition

We aimed to investigate the association between caregiver social status and health-related quality of life (HRQoL) in children with neurological impairment (NI) on home enteral nutrition (HEN). This was an ancillary study of a multicenter, cross-sectional study which explored HRQoL in 75 NI children on HEN. All the caregivers from the original cohort were contacted, and data on education level, occupation and marital status were collected. The association between social status and HRQoL was investigated using a multiple Poisson Generalized Linear Model. In total, 93 caregivers were included, responsible for the care of 71 children. The caregivers of four children of the original cohort did not answer the questionnaire. Mothers with high-level education presented lower HRQoL in comparison to mothers with low-level (β: −5.97; 95% CI −11.51, −0.10; p = 0.027) or medium-level education (β: 4.85; 95% CI −9.87, 0.53; p = 0.044). The analysis of the subgroup of cases in which the main caregiver was represented by both parents gave similar findings, with education level of the father being negatively correlated with HRQoL. Our data showed that higher education level may negatively affect quality of life of caregivers of NI children. This could be helpful in identifying at-risk families and addressing supportive efforts.     

Quality of Life of Cancer Patients Receiving Enteral Nutrition: A Systematic Review of Randomized Controlled Trials

Most studies confirm the beneficial effects of enteral nutrition on the quality of life, but some studies indicate an inverse association and its detrimental impacts. However, there are insufficient data on the effects of enteral nutrition on the quality of life of cancer patients. This systematic review aimed to describe the influence of applied enteral nutrition on the quality of life of cancer patients, based on the results of randomized controlled trials. It was registered in the PROSPERO database (CRD42021261226) and conducted based on the PRISMA guidelines. The searching procedure was conducted using the PubMed and Web of Science databases, as well as Cochrane Library, and it included studies published until June 2021. It was conducted to select randomized controlled trials assessing the influence of enteral nutrition (compared with the other model of nutrition) on the quality of life of cancer patients. A general number of 761 records were screened and a final number of 16 studies were included in the systematic review. The studies were included and assessed by two independent researchers, while the risk of bias was analyzed using the Newcastle–Ottawa Scale (NOS). Studies compared patients treated with and without enteral nutrition, patients treated with various methods of enteral nutrition or with enteral diets of various content, as well as patients treated with enteral and parenteral nutrition. Within the included studies, the majority were conducted in patients with cancers located in various parts of the body, or diverse areas within the gastrointestinal system, while some studies were conducted in specific populations of patients with a defined cancer location—esophagus, stomach, or ovary. The duration of applied enteral nutrition within the included studies was diversified—from two weeks or less to half a year or even more. The vast majority of studies used well-known and validated tools to assess the quality of life, either developed for a specific group of head/neck, esophagus/stomach, and ovary cancer patients or developed for more general patient populations. Most studies concerning patients treated with and without enteral nutrition supported applying enteral nutrition, which was concluded in seven studies out of ten (including four studies with a low risk of bias). The other important observations to be emphasized—formulated based on the studies with a low risk of bias—presented the role of oral supportive nutrition guided by a dietitian, as well as the beneficial role of enteral and parenteral nutrition, combined. In spite of a relatively low number of randomized controlled trials assessing the influence of enteral nutrition on the quality of life of cancer patients, which should be considered as a limitation, the results were promising. Most studies supported the positive influence of enteral nutrition on the quality of life, either assessed based on the psychological measures of the quality of life or by considering the other potential determinants (e.g., malnutrition, complications, etc.). Taking this into account, enteral nutrition should be applied whenever possible, both to prevent and treat malnutrition in cancer patients. However, considering the limited number of studies conducted so far, further research conducted in homogenic populations of patients is necessary.