贵州省中小医院住院患者营养风险筛查及营养支持应用现状

Objective To investigate the prevalence of the nutritional risks, undernutrition, overweight,and obesity, and the application of nutritional support in hospitalized patients in middle and small hospitals of Guizhou province. Methods Adult patients in the departments of general surgery, chest surgery, neurology, gastroenterology, respiratory medicine, and nephrology in four hospitals in Guizhou Province were consecutively enrolled from Feberary 2008 to March 2009. Nutrional Risk Screening 2002 (NRS2002) was performed on the next morning after admission and nutritional support was evaluated on the 14 day of admission or on the discharge day.The relationship between nutritional risk and nutritional support was analyzed. Nutritional risk was defined as NRS 2002 score≥3 and under-nutrition was defined as body mass index ＜ 18.5 kg/m2. Results A total of 1668 patients were enrolled and underwent, NRS 2002 scoring. The nutritional risk was 30. 2% and the prevalence of malnutrition was 12.2%. Although 54 patients ( 11.7 % ) with NRS 2002 ≥ 3 received nutrition support, only parenteral nutrition was applied. Conclusions NRS 2002 is a feasible nutritional risk screening tool for patients in middle and small hospitals. The application of nutrition support is still at a low level, with only parenteral nutrition is applied. Evidence-based nutrition support guidelines are required to standardize the application of nutrition support.     

新疆地区三级甲等医院住院患者营养风险、营养不良(不足)、超重和肥胖发生率及营养支持应用状况

Objective To investigate the incidences of nutrition risks, malnutrition ( undernutrition),overweight, and obesity, and nutrition support in tertiary hospitals in Xinjiang Uigur Autonomous Region. Methods Using fixed-point consecutive sampling, we collected the clinical data of inpatients in 6 departments of five tertiary hospitals in Xinjiang. According to the Nutrition Risk Screening 2002 (NRS 2002 ) published by European Society for Parenteral and Enteral Nutrition, patients were graded as at nutritional risk when their NRS 2002 scores ≥3 and as malnutrition when the body mass index (BMI) was ＜ 18.5 kg/m2 (or albumin ＜ 30 g/L). NRS 2002 screening was performed on the next morning after a patient was admitted. The nutrition supports within 2 weeks after admission were also investigated. The relationship between nutrition risks and nutrition support was analyzed.Results A total of 4036 inpatients were investigated, among them 3913 patients received NRS 2002 screening.The malnutrition (undernutrition) rate and the proportion of patients at nutritional risk were 8.4% and 34. 2%, respectively. The percentage of nutrition support was 10. 2%, which included parenteral nutrition (8. 5% ) and ena simple, fast and convenient tool for the investigation of nutrition risks and can provide a basis for reasonable nutrition support Therefore, it should be widely applied in clinical practice.     

营养风险筛查2002的临床应用和分析

Objective To evaluate the clinical application of Nutritional Risk Screening 2002 (NRS 2002) in inpatients.Methods Totally 400 inpatients who were admitted to Tianjin Tianhe Hospital from Novem- ber 2008 to March 2009 were enrolled in this study.Physical examinations,including body height and body meas-urement,were performed the next morning after admission.The nutritional status was evaluated with NRS 2002.Results In all 400 inpatients.NRS 2002 was strongly practicable in 306 patients (76.5%) and weakly practica-ble in 94 patients (23.5%);Ninety-six patients (24.0%) had nutritional risks,which were most common in the department of internal medicine and the Department of neurology.The average age of patients with nutritional risks was (79.0±11.4) years,which was significantly higher than that of patients without nutritional risks [(58.1±15.8) years] (P<0.01).Conclusion NRS 2002 is effective and practicable in evaluating the nutritional status of inpatient.     

广西中小医院住院患者营养风险原因调查

Objective To investigate the causes of nutritional risks among inpatients in middle and small hospitals in Guangxi Zhuang Autonomous Region of China. Methods All the screened subjects were surveyed through classified collection of medical records and telephone follow-up. Factors including education background of patients and their family members, career, income, residence, medical payment methods, grade of hospital, and awareness of nutrition were analyzed. Results Lower education background of patients and their family members,less income, and self-funded health care payment were significantly associated with higher nutritional risks ( P ＜0. 01 ). The scores of malnutrition risks were significantly lower in patients whose careers were involved with culture, education and health and in patients whose family members had higher education levels (P ＜ 0.01 ). The nutrition risk was also significantly higher in patients from the rural areas than those from urban areas ( P＜0.01 ). It was also significantly higher in middle and small hospitals than in tertiary hospitals ( P＜0.01). Patients who had good awareness of nutritional knowledge had significantly lower incidence of nutritional risk (P ＜ 0. 01 ). Conclusion Low education level and poor economy in Guangxi are the main reasons for high nutritional risks.     

112例炎症性肠病患者的营养风险筛查

Objective To assess the nutritional risk of patients with inflammatory bowel disease (IBD).Methods The nutritional status of 112 IBD patients from PUMC Hospital were evaluated by Nutritional Risk Screening 2002 (NRS 2002).Using Chinese standard,a body mass index (BMI) that was lowered than 18.5 kg/m~2 according to clinical material was regarded as malnutrition,and the score was recorded as 3.The se-verity of ulcerative colitis (UC) was evaluated using True-Love criteria as mild,moderate,and severe.Crohn's disease (CD) was evaluated using Harvey-Bradshaw Index as in remission stage (≤4),moderately active stage (4-8),and severely actively stage (≥9).Results All these 112 patients,including 70 UC cases and 42 CD cases,were evaluated by NRS2002.Forty-five patients (40.2%) were judged as at the risk of malnutrition.The incidence of malnutrition was significantly higher in CD patients than in UC patients (52.4% vs.32.9%,P<0.05).It was also significantly correlated with the severity of disease.In patients with severe IBD,the rate of mal-nutrition evaluated by BMI according to clinical material was significantly lower than the rate of nutritional risk.Con-clusions The risk of malnutrition is high in IBD patients.NRS 2002 can be used for nutritional risk screening.     

中国北方五市儿童功能性便秘流行病学特征现况调查

Objective Functional constipation (FC) is a common complaint in childhood but the prevalence still remains unclear, the aim of this study was to explore the prevalence of FC in childhood in the northern parts of China. Methods A screening program on FC in childhood was carried out in 5 northern cities (Beijing, Tianjin, Shenyang, Changchun, Harbin) of China according to symptoms under the Rome Ⅲ criteria. Random clustered sampling of the inhabitants was carried out under stratification of cities, geographic zones, schools or nurseries.Sample size of each area was in proportion to the population of the area. The range of age was 4-14. All subjects under study were requested to fill in a questionnaire distributed by the teachers. The screening program was carried out immediately after a section survey was completed. All together, 20 000 questionnaires were distributed with 19 638 retrievals. According to the result of the screening, a small number of patients who met the criteria were further selected to undergo a detailed clinical examination in the hospital including laboratory examination, colonic transit time, defecography or/and barium enema, electromyologram and anorectal manometry to exclude organic disease of the colon. Simultaneously, a detailed questionnaire was requested to fill under the assistance of trained doctors or medical students.Prevalence of FC of the population was adjusted by the rate of correct diagnosis from the detailed study. Results The adjusted point prevalence of FC in 5 northern cities of China according to Rome Ⅲ criteria was 4.73% with higher prevalence rate of FC seen in the Beijing area (5.02%) than in other cities (4.82%, 4.76%, 4.27%, 4.40%, with P＜0.001 ). Male to female ratio was 1.26:1 with majority of the FC fell in the 4-6 year olds (5.76%). Conclusion FC appeared a common disorder in childhood in the northern parts of China which called for greater attention. Higher prevalence was noted in the age groups of 4-6.     

中国北方五市儿童功能性便秘流行病学特征现况调查

Objective Functional constipation (FC) is a common complaint in childhood but the prevalence still remains unclear, the aim of this study was to explore the prevalence of FC in childhood in the northern parts of China. Methods A screening program on FC in childhood was carried out in 5 northern cities (Beijing, Tianjin, Shenyang, Changchun, Harbin) of China according to symptoms under the Rome Ⅲ criteria. Random clustered sampling of the inhabitants was carried out under stratification of cities, geographic zones, schools or nurseries.Sample size of each area was in proportion to the population of the area. The range of age was 4-14. All subjects under study were requested to fill in a questionnaire distributed by the teachers. The screening program was carried out immediately after a section survey was completed. All together, 20 000 questionnaires were distributed with 19 638 retrievals. According to the result of the screening, a small number of patients who met the criteria were further selected to undergo a detailed clinical examination in the hospital including laboratory examination, colonic transit time, defecography or/and barium enema, electromyologram and anorectal manometry to exclude organic disease of the colon. Simultaneously, a detailed questionnaire was requested to fill under the assistance of trained doctors or medical students.Prevalence of FC of the population was adjusted by the rate of correct diagnosis from the detailed study. Results The adjusted point prevalence of FC in 5 northern cities of China according to Rome Ⅲ criteria was 4.73% with higher prevalence rate of FC seen in the Beijing area (5.02%) than in other cities (4.82%, 4.76%, 4.27%, 4.40%, with P＜0.001 ). Male to female ratio was 1.26:1 with majority of the FC fell in the 4-6 year olds (5.76%). Conclusion FC appeared a common disorder in childhood in the northern parts of China which called for greater attention. Higher prevalence was noted in the age groups of 4-6.     

心功能不全患者的临床营养支持

合理的营养支持能有效延缓心功能不全向心功能衰竭的发展过程,延长生存期,提高生活质量.本文总结了心功能不全患者的营养代谢特点、营养风险筛查与营养状态评估方法、营养素需求及营养支持的应用等方面的进展,并对急性心功能不全的营养代谢支持进行讨论.

Abstract：

Rational clinical nutrition support may slow down the progress from heart insufficiency to heart failure and improve the quality of life.This article summarizes advances in nutrition support in patients with heart insufficiency in terms of nutrition and metabolic characteristics, nutritional risk screening and nutrition status evaluation, nutrient recommendations, and clinical application of nutrition support.Moreover, nutrition and metabolic support in acute heart failure is also discussed.     

北京地区4960例慢性阻塞性肺病住院患者心血管疾病发生率的回顾性调查

目的 分析慢性阻塞性肺病(COPD)住院患者心血管疾病(CVD)及其相关疾病的发生率顺位、年龄及性别特征,探讨近10年COPD患者CVD发生率的演变趋势.方法 对2000年1月1日至2010年3月20日解放军总医院、北京协和医院及北京医院住院病案数据库进行回顾性调查.结果 (1)入选患者4960例,男性3570例,女性1390例,平均年龄(72.2±10.4)岁.(2)合并CVD的COPD患者共2562例,CVD总发生率为48.8%,标化率为26.4%.标化率排名前三位为肺源性心脏病和肺循环疾病(15.8%)、心力衰竭(13.6%)和缺血性心脏病(10.6%).(3)男性COPD患者心绞痛、肺源性心脏病和肺循环疾病、急性肾功能衰竭等发生率较高(P＜0.05),而女性病例急性心肌梗死、心律失常(房颤/房扑)、心力衰竭、肺栓塞、高血压病、糖尿病等发生率较高(P＜0.05).(4)近10年COPD患者的心律失常发生率有随年龄增加而升高趋势,缺血性心脏病和心力衰竭发生率则逐年下降;COPD患者中CVD的女性比例呈上升趋势.结论 COPD住院患者中有近50%存在CVD及相关合并症,且不同年龄和性别患者CVD合并症发生率的变化趋势各具特点.

Abstract：

Objective To retrospectively explore the prevalence of cardiovascular disease (CVD) in inpatients with chronic obstructive pulmonary disease(COPD)in Beijing.Methods The COPD patients who were discharged from the General Hospital of the Liberation Army,Peking Union medical college Hospital and Beijing Hospital between January 1st,2000 to March 20th,2010,were investigated.The prevalence of CVD were calculated.The tendency of the prevalence of CVD by age or discharge year and the difference of the prevalence of CVD between male and female were estimated by using chi-square analysis.Results There were 4960 COPD patients who were in accordance with the inclusion criteria with 3570 males and 1390 females.The mean age was 72.2±10.4 years.Of the COPD patients,48.8% were diagnosed as cardiovascular diseases.The age-adjusted over-all prevalence of CVD was 26.4%.Chronic pulmonary heart disease and other disease of pulmonary artery(15.8%)was the most frequent diseases,followed by heart failure(13.6%),ischemic heart disease (10.6%).In COPD patients,male was more likely to have angina,pulmonary heart disease and other disease of pulmonary artery and acute kidney failure (P＜0.05),while less likely to get arrhythmia (atrial fibrillation/atrial flutter),heart failure,pulmonary embolism,hypertension and diabetes mellitus (P＜0.05).The prevalence of arrhythmia increased with age,however,the ischemic heart disease and heart failure decreased.The proportion of CVD decreased in male patients while increased in females.Conclusion The overall prevalence of CVD comorbidities was 48.8% in 4960 patients with COPD who were older than 40 years in Beijing.There were differences among the groups of various age and sex in the distribution of CVD comorbidities frequencies year by year.     

Analysis on the trend of smoking prevalence and main causes of death of dead residents in Tianjin from 2010 to 2019CSCD

Objective To evaluate the change trend of smoking prevalence and the composition of main causes of death in Tianjin from 2010 to 2019. Methods The study was based on the data collected in the Tianjin All Cause of Death Surveillance System from 2010 to 2019. A total of 699 372 cases were included in the study. The smoking prevalence, ex‑smoking and never smoking prevalence were calculated according to different death years and gender. The proportion of smoking status was calculated according to the year of birth and gender. The distribution of smokers dying of smoking related diseases were calculated by different age‑group. The change trend of smoking rate was analyzed by Joinpoint regression 4.9.0.0 statistical software. The diseases that smokers died of were expressed by proportion. Results From 2010 to 2019, the smoking rate of dead residents decreased from 28.7% to 21.4%, and the average annual change percentage (AAPC) was -3.0% (95%CI: -3.9%, -2.2%). The same trend was shown in dead residents of different genders. The proportion of ex‑smokers showed an upward trend, from 10.5% in 2010 to 14.7% in 2019; The proportion of light smokers increased with the postponement of birth year. The proportion of light smokers born at and before year 1950 was 14.7%, while the proportion of light smokers born at and after year 1981 was as high as 85.9%; the proportion of heavy smokers decreased with the year of birth. Lung cancer and cardiovascular and cerebrovascular diseases were the main causes of death of smokers and quitters. 13.86% of quitters died of lung cancer, which was slightly lower than that of smokers (16.39%) and significantly higher than that of non‑smokers (5.55%). With the increase of smoking degree, the proportion of smokers who died of lung cancer also increased gradually, from 9.19% to 19.11%. Conclusions From 2010 to 2019, the smoking prevalence of dead residents in Tianjin shows a downward trend, which is consistent with the change trend of the overall smoking prevalence of residents in Tianjin. Lung cancer, acute myocardial infarction and ischemic heart disease rank among the top three causes of death among smokers. © 2021 Journal of Clinical Otorhinolaryngology Head and Neck Surgery. All rights reserved.     

普外科患者术前营养不足、营养风险及营养支持状况分析

目的调查分析普通外科住院患者术前营养不足、营养风险及营养支持状况。方法采用营养风险筛查2002（NRS2002）直接查询和阅读病历记录方式,对北京市某三级甲等医院普通外科1个月内所有217例新入院患者进行调查。结果术前患者营养不足和营养风险发生率分别为7．4％和15．7％,以胃肠道疾病和恶性疾病患者多见。分别有18．8％有营养不足者和14．7％有营养风险者,以及3．0％无营养不足者和2．2％无营养风险者接受了营养支持。肠内和肠外营养应用比例为1：2。结论建议在普外科推广NRS2002,以提高临床营养支持的合理性。     

Nutrition, nutritional behavior, and obesity

THE PURPOSE: Of this investigation is to explore the effect of several alimentary factors--such as diet, nutritional habits, and personal preferences--upon the occurrence of obesity. SUBJECTS: Of the study were 264 workers (203 men and 61 women) from the ammonium production department of a fertilizer plant, divided into two age groups: under 30 years and over 30 years. METHODS: The data are collected by means of a questionnaire about daily nutrition, including the types and average quantity of food (Food Frequency Questionnaires--FFQ). All collected information is analyzed by means of a computer program with a database that includes the chemical structure of food products and takes into account the losses in their nutritional value that occurs in the course of preservation and thermal processing. The nutritional status is assessed on the basis of a Body Mass Index (BMI): group I--normal body mass--BMI 18.5-25 kg/m2; group II--overweight--BMI 25.1-30 kg/m2; group III--obesity--BMI > 30 kg/m2. RESULTS: The assessment of the individual energy intake shows that hyper-energetic nutrition is typical for 67% of the individuals examined. There is no significant age and/or gender difference. This is the result of extra-intake of fat (over 30 E%), which is observed for 87.9% of all workers, and over 40 E% for almost half of the women examined. All age and gender groups display hyper-protein nutrition with pronounced cellulose (fiber) deficit, high daily intake of sodium, and disbalance of mineral salts as well as a relative deficit of vitamin A, B1, and PP. The frequency of overweight individuals is 43.9%, while that of obese individuals is 23.1%. The majority of workers (70.1% of group I, 63.2% of group II, and 79% of group III) have three meals a day. For 43% of group III individuals dinner is the largest meal. A significantly higher percentage of group III individuals (21.3%) think that they overeat. CONCLUSIONS: Hyper-energetic, disbalanced nutrition, and incorrect nutritional-behavioral model are factors that determine the prevalence of overweight and obesity among the workers examined.     

Differential correlates of nutritional status in Kinshasa, Zaire

In an effort to search for causes of malnutrition in the urban environment to guide intervention efforts, a study of more than 2000 mother/child pairs was conducted in Kinshasa, Zaire. Under the auspices of the Zairian National Nutrition Planning Center a representative sample of a large lower class urban population was interviewed at two points in time. One phase covered morbidity and nutritional status measurements for all children under five years of age. A second phase examined a complex set of socioeconomic and behavioural variables possibly linked to nutritional outcomes for a 20% sample of the households. After merging the data sets bivariate and multivariate regression analyses were performed twice, using the youngest child and the household as the unit of analysis respectively. Results showed that different complexes of variables predicted malnutrition as measured by three separate anthropometric measures. For so-called acute malnutrition (weight-for-height) morbidity, migration, and diarrhoeal knowledge, all emerged as significant predictors. Chronic malnutrition (height-for-age), however, was only significantly predicted by zone of residence, a level of living score, and recent morbidity when all major variables were considered in the regression model. Factors that were significant predictors of each of these two indices also were predictors of the third nutritional indicator, weight-for-age. Birth interval also was associated with this index. The findings here suggest more careful scrutiny of the nature, causes, interpretation and use of these widely accepted measures of nutritional status.     

恶性肿瘤住院病人营养风险和营养支持与临床转归的研究

目的:调查恶性肿瘤住院病人营养风险的发生率,分析临床营养支持对病人营养状况和临床转归的影响. 方法:收集符合纳入标准的恶性肿瘤首次住院病人526例,应用NRS 2002对其进行营养风险筛查,分析营养风险发生率,并跟踪营养支持的应用情况,比较营养支持对病人的营养状况、住院时间和临床转归的影响.结果:526例恶性肿瘤病人营养风险发生率为46.58％,且年龄越大,营养风险发生率越高(P =0.002).NRS 2002≥3分的245例病人中,营养支持率仅59.6％,肠外营养与肠内营养应用比例为8.7:1.给予营养支持的病人感染并发症的发生率低于无营养支持组(P =0.033),平均住院时间亦短于无营养支持组(P =0.041). 结论:恶性肿瘤住院病人的营养风险发生率较高,逐步提高肿瘤治疗中营养支持特别是肠内营养的应用率,以改善病人的临床转归,提高生存质量.     

北京教学医院普通外科住院患者营养风险、营养不足、超重、肥胖及营养支持状况

目的调查北京教学医院普通外科住院患者人院和入院2周（或出院）时营养风险、营养不足、超重、肥胖和营养支持的状况。方法采用定点连续抽样,选择2007年3月至6月在北京3家教学医院普通外科住院患者进行营养风险筛查,使用营养风险筛查2002（NRS2002）于患者入院和入院2周（或出院）时实施,并调查患者2周内（或至出院时）的营养支持状况,分析营养风险和营养支持之间的关系。NRS200293分为有营养风险,体重指数（BMI）〈18．5kg／m2并结合患者临床情况判定为营养不足。结果300例入选者中,有297例完成筛查,NRS2002适用率为99．0％。入院时总营养风险发生率为30．0％,营养不足、超重和肥胖的发生率分别为8．1％、38．3％和9．4％。存在营养风险和无营养风险患者的营养支持率分别为62．2％和19．O％。在接受腹部大手术的患者中,有营养风险和无营养风险患者的营养支持率分别为71．6％和43．2％。入院和入院2周（或出院）时的总营养风险发生率分别为30．0％和35．8％,两者相比差异无统计学意义（x2=2．271,P=0．132）。结论NRS2002适用于普通外科住院患者的营养筛查。临床营养支持在普通外科得到了充分重视,但临床上存在肠外、肠内营养的不合理应用。住院期间未观察到患者营养风险发生率的变化．     

Diet, nutritional status, and cancer risk in American blacks

About 35% (10-70%) of all cancers may be associated with nutritional causes (1). However, while natural or added substances in foods may be carcinogenic, nutritional deficiencies or excesses may promote carcinogenesis. We compared data from blacks and whites using dietary and nutritional status surveys in the United States to determine whether the poorer dietary patterns and nutritional status of American blacks may be associated with their higher incidence and mortality from certain cancers (compared with whites). Our review indicates that blacks eat more nitrate and animal foods and not enough fiber in relation to protein, fat, and carbohydrate. Blacks also have poorer nutritional status with respect to getting enough thiamine, riboflavin, vitamins A and C, and iron, to being obese (females), and to being underweight (males). This is in agreement with hypotheses regarding the interactions between diet and cancer (associations found in whites) and dose-response relationships reported for some cancers for which blacks have a higher incidence and mortality than whites. More large-scale prospective case-control and cohort studies are needed in both blacks and whites to elucidate the contribution of specific dietary and nutritional factors to the risk of specific cancers in these population groups. However, such studies must be preceded by methodological research to obtain more valid measures of dietary and nutritional status.     

Aging, nutritional status, and infection in the developing world

The fast rate of increase in the number of older people in less-developed countries threatens to further strain the limited health resources of these countries. However, very little is known about their health status and the risk factors that contribute to it. In this article, we review the burden of infectious diseases in elderly people in less-developed countries, discuss the contribution of nutrition and immune response to morbidity and mortality, identify gaps in current knowledge, and suggest strategies to address this fast-growing public health problem.