应用营养风险筛查2002方法对天津市三级甲等医院住院患者营养风险、营养不足筛查、营养支持情况调查

Objective To investigate the nutritional risks, undernutrition, and nutritional support among inpatients in tertiary hospitals in Tianjin using Nutritional Risk Screening 2002 (NRS2002). Methods Inpatients in six departments in two tertiary hospitals in Tianjin (Tianjin Nankai Hospital and Tianjin Chest Hospital ) were consecutively enrolled from March 2005 to March 2006. Their nutritional risks were screened using NRS 2002, and the nutritional support was investigated. Results A total of 1200 inpatients received nutritional screening, and 93.0% of them underwent NRS 2002 scoring. The prevalence of undernutrition was 9. 8% and the prevalence of nutritional risk was 42. 8%. Of these patients, 241 patients (46.4%) with NRS2002≥3 received nutrition support, and 244 patients (35.9%) with NRS2002 ＜3 received nutritional support Conclusions NRS2002 is suitable for nutritional risk screening among inpatients. Inpatients usually have nutritional risks or undernutrition. However, physicians at different levels in different regions have different awareness of such risks or conditions, and the clinical application of nutritional supports sometimes are inappropriate.     

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.     

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.     

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.     

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.     

高脂血症性急性胰腺炎的营养支持策略

目的 探讨高脂血症性急性胰腺炎(HLAP)的营养支持策略.方法 回顾性分析1998年1月至2009年12月在北京协和医院国际医疗部就诊的6例HLAP患者9次急性胰腺炎发作的临床资料.结果 经禁食、尽早开始营养支持和降脂治疗后,所有患者的病情均好转.3例重症HLAP患者留置空肠营养管,管饲低脂肠内营养和降脂;3例轻症患者低脂饮食和口服降脂药.所有患者的血三酰甘油水平均明显下降,由(25.30±20.48)mmol/L降至(5.41±4.55)mmol/L,随诊3～24个月无复发.结论 HLAP患者宜根据病情个体化选择营养途径,合理搭配肠内营养制剂和降脂药物.重症HLAP宜早期留置空肠营养管,以保证肠内营养和降脂药物的使用,保护肠黏膜屏障,减少血糖波动.

Abstract：

Objective To summarize the strategies of nutritional support for patients with hyperlipidemic acute pancreatitis (HLAP). Methods The clinical data of six HLAP patients who were treated in our department from January 1998 to December 2009 were retrospectively reviewed. Results The disease conditions of all patients were improved after fasting and early nutritional support and lipid-lowering treatment. Three cases with severe HLAP received enteral nutrition via a nasojejunal tube. Another three patients with milder HLAP obtained low-fat diet and orally administered lipid-lowering drugs. The plasma triglyceride levels decreased from (25.30 ± 20. 48 ) mmol/L to (5.41 ±4.55) mmol/L. No relapse was noted during follow-up (range: 3 -24 months). Conclusions The approaches of nutritional support for HLAP patients should be customized based on the specific disease conditions,and the enteral nutrition and lipid-lowering drugs should be reasonably and carefully designed and applied. For severe HLAP, nasojejunal tube should be maintained in the early stage to ensure the application of enteral nutrition and lipid-lowering drugs, protect the integrity of gut mucosal barrier, and decrease the fluctuation of blood glucose.     

不同营养支持方式对重症急性胰腺炎患者肠道菌群失调的影响分析

目的 探讨不同营养支持方式对重症急性胰腺炎(SAP)患者肠道菌群失调的影响.方法 将2003年1月至2010年6月收治的66例SAP患者按随机数字表法分为研究组和对照组,每组33例,分别接受肠内营养和全胃肠外营养支持治疗,观察并比较两组患者肠道菌群失调的发生情况.结果 经营养支持治疗后,研究组大肠埃希菌和肠球菌的数量明显低于对照组,差异有统计学意义(P＜0.05);双歧杆菌和乳酸杆菌的数量则显著高于对照组,差异有统计学意义(P＜0.05).研究组肠道菌群失调的发生率为24.2%(8/33),显著低于对照组的51.5%(17/33),差异有统计学意义(P＜0.05).结论 肠内营养支持较单独全胃肠外营养支持能减少SAP患者肠道菌群失调的发生.

Abstract：

Objective To investigate the influence of different nutritional support ways on intestinal dysbacteriosis in patients with severe acute pancreatitis (SAP).Methods Sixty-six patients with SAP from January 2003 to June 2010 were divided into study group and control group according to random digits table,33 cases in each group,they were treated with enteral nutrition and total parenteral alimentation support treatment respectively and the incidence of intestinal dysbacteriosis was observed and compared.Results In 7 - 10 d after the onset of SAP,the number of escherichia coli and enterococci in study group were significantly lower than those in control group,the difference was statistically significant (P ＜ 0.05 );the number of bifidobacterium and lactobacillus were significantly higher than those in control group (P ＜ 0.05 ).A total of 25 patients in both groups occurred intestinal dysbacteriosis,the total incidence was 37.9%,the incidence in study group was 24.2% (8/33) and which was significantly lower than that in control group [51.5%( 17/33 )](P ＜ 0.05 ).Conclusion Enteral nutrition support treatment can reduce the incidence of intestinal dysbacteriosis in patients with SAP,its efficacy is better than parenteral nutrition.     

杭州市超市消费者预包装食品营养标签行为流行病学调查

目的 了解杭州市超市消费者对预包装食品营养标签的认知、态度、行为的现状及其影响因素.方法 采用自行拟定的调查量表,选取杭州市某大型超市,随机抽取顾客进行面对面访谈.结果 在访谈的586(男202、女384)人中,平均年龄(41.6±17.23)岁.消费者对6种营养素的模拟购物题应答正确率依次为膳食纤维(71.84%)、脂肪(70.99%)、钙(60.75%)、盐(58.36%)、能量(50.85%)和糖(39.42%);对标识营养成分表、营养声称和希望了解相关知识的3个态度指标中,认同率分别为90.44%、87.03%和77.13%;对首次购买某食品阅读营养成分表和营养标签的2个行为指标中,阅读率分别为58.36%和80.03%.经logistic建模分析,男性、青少年、低教育人群是营养标签阅读行为的危险因素.结论 消费者营养标签阅读、理解和正确应用营养标签的能力不高,亟待改进营养标签与声称的可读性和权威性,应制定全国营养知识健康教育规划.

Abstract：

Objective To study the prevalence rates of knowledge,attitudes and use of the nutrition labeling and related influential factors in Hangzhou supermarket consumers.Methods Using a self-developed survey questionnaire,randomly selected customers were conducted a face-toface interview program in a large supermarket of Hangzhou city.Results 586 people were interviewed,including 202 males and 384 females,with the mean age as 41.6±17.23 years.The Facts Labels'were as follows:dietary fiber(71.84%),fat(70.99%),calcium(60.75%),salt (58.36%),energy(50.85%)and sugar(39.42%).The support rates of the three attitudes indicators were"support marking the Nutrition Facts Label"(90.44%)."support marking the nutrition claims"(87.03%)and"want to know more relative knowledge"(77.13%).There were 58.36% and 80.03%first-time buyers who would read the Nutrition Facts Food Labels and the Nutrition Claims.Through logistic model analysis,male,youth,low-educated people were found to be the risk factors related to the nutrition label reading behavior.Conclusion The capacity of the reading,understanding and correct application of nutrition labeling among consumers was not satisfactory.Improvement on the readability and the authority of nutrition labeling and the development of the national nutrition knowledge and health education programs were in urgent needs.     

低蛋白饮食对3/4期慢性肾脏病患者肾功能及营养状况的影响

Objective To assess the influences of low-protein diet on the renal function and nutritional status in patients with stage 3/4 chronic kidney diseases (CKD).Methods Totally 34 patients with stage 3/4 CKD were randomly divided into group A (protein intake:0.6 g·kg~(-1)·d~(-1);n=14) and B (protein intake:0.8 g·kg~(-1)·d~(-1);n=20).Anthropometric measurement and blood biochemical tests were performed,nutri-tional status was assessed,and 24-hour dietary recall survey was conducted before and after the treatment.Patients were followed up for 6 months.Results In group A,the creatinine level significantly decreased (P=0.010),while albumin level (P=0.042) and the intake of energy (P=0.018) and carbohydrate (P<0.001) signifi-cantly increased after the treatment In all the 34 patients,in group A and group B,the malnutrition rates were de-creased by 14.7%,7.2%,and 21.1% after nutritional intervention.Conclusion The low-protein diet (protein intake 0.6 g·kg~(-1)·d~(-1)),in which part of the staple food was replaced by wheat starch,can increase the in-takes of carbohydrate and energy and improve renal function and nutritional status in patients with stage 3/4 CKD.     

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

目的调查新疆地区三级甲等医院6个专科住院患者营养风险、营养不良（不足）、超重和肥胖发生率及营养支持应用状况。方法采用定点连续抽样的方法,收集新疆地区5所三级甲等医院中6个专科的住院患者,符合营养风险筛查2002（NRS2002）评分≥3分为有营养风险,体重指数（BMI）〈18．5kg／m2（或白蛋白〈30g／L）为营养不足。在患者人院次日早晨进行NRS2002筛查,并调查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。结果共调查4036例,其中3913例完成NRS2002筛查,营养不良（不足）与营养风险的发生率分别为8．4％和34．2％,实际营养支持率为10．2％,其中肠外营养为8．5％,肠内营养为1．7％,肠外营养：肠内营养为5．1：1。结论通过对新疆地区三级甲等医院的调查发现,NRS方法简单、快捷、方便,能够发现住院患者的营养风险,为进行合理营养支持提供依据,应向临床推广。     

维生素E与营养

维生素E是一种人体必需的营养素,能够保护机体组织结构的完整性,并在生命发育过程中起重要的作用.维生素E主要在肝代谢,其生理需要量为10 mg/d,是体内重要的抗氧化剂,能抑制血小板聚集、防治DNA损伤、增强机体免疫并维持正常的生殖功能.目前,维生素E已广泛应用于动脉硬化、某些肿瘤的预防和创伤感染的辅助治疗.     

Household nutrition and health in Poland

Data from 600 households in the province of Lublin, Poland, are used to assess the relationships among self-rated household health, change in health status, sociodemographic characteristics, food purchasing behavior changes, and health care seeking behaviors. High ratings of health are enjoyed by rural families headed by comparatively young individuals with high education. Average household health is also a function of household changes in food purchasing behavior over the past 5 years and per capita consumption of starch-based foods. Families consuming greater proportions of bread and potatoes and purchasing foods of reduced quality, quantity, and price experience lower average levels of subjective physical health than other families. Reduction or postponement of medical or dental care over the past 5 years did not affect health status in this model.     

终末期肝病营养代谢及营养支持

肝脏在营养调控中起到核心作用,终末期肝病患者常由于代谢异常出现营养不良,营养不良与终末期肝病患者的预后息息相关,因此正确的营养评估和支持显得尤为重要。单纯饮食摄入并不能满足终末期肝病患者的营养需求,近些年,肠内外营养制剂的使用已经大大改善了患者的营养状况,但仍缺乏一个“金标准”。如何制订适宜的营养支持方案是临床医师亟需解决的问题,本文就终末期肝病患者的营养相关问题加以阐述,旨在为终末期肝病患者个体化的营养干预提供借鉴。     

营养评定工具NRS2002、MNA和实验室检查在老年住院病人营养调查中的应用

目的:通过对老年住院病人进行营养筛查,为进一步营养支持治疗提供参考信息. 方法:选取在我院住院≥70岁的老年病人119例,采用营养风险筛查(NRS 2002)和微型营养评定(MNA)分别评定病人的营养风险和营养状况,同时记录入院时病人的年龄、体质量指数(BMI)、消化功能、有无感染等基本信息,以及前清蛋白、清蛋白、血红蛋白、淋巴细胞计数、总胆固醇、三酰甘油、肌酐、尿素氮、血清铁等实验室检验指标. 结果:①NRS 2002评估结果为“营养风险”的老年病人有21例,占17.6％;MNA评估结果为“营养不良风险或营养不良”的老年病人共有42例,占35.3％.②在上述调查中有营养风险的老年病人入院时BMI、前清蛋白、清蛋白、血红蛋白均明显低于无营养风险组.③在上述检测指标中,清蛋白与NRS 2002或MNA的相关性均优于其他指标,且其灵敏性和特异性均较高. 结论:NRS 2002和MNA均可用于评定老年病人的营养状况,BMI、前清蛋白、清蛋白、血红蛋白也可用于辅助评定老年病人的营养状况.在无条件行营养工具筛查时,清蛋白是最佳的营养评定指标.     

The nutrition of Australian aboriginal infants and young children

An anthropomentric survey of more than 600 Australian Aboriginal children aged up to 30 months has shown that there is a widespread fall-off in growth commencing in the second half of infancy. Fourteen percent of infants and 22% of older children were under-weight. Twelve percent of all subjects were stunted but, by weight for length analysis, only 2.5% of subjects were moderately malnourished. Only three individuals were severely malnourished and none had kwashiorkor. Despite widespread and prolonged breast-feeding by remote Aboriginal mothers, their children have poor growth patterns and recurrent infections. Breast-feeding is much less prevalent in and around country towns and this decline is associated with loss of traditional culture and increasing affluence and “sophistication”.     

营养门诊糖尿病医学营养治疗模式的研究

目的 观察门诊2型糖尿病患者医学营养治疗(MNT)后膳食结构及血糖的变化,以期构建更为合理有效的门诊MNT模式.方法 60例2型糖尿病患者随机分为2组,分别采用新型MNT模式和单纯个体化MNT模式,比较两组患者门诊宣教所用时间、饮食达标所用时间及饮食达标前后营养素供热比、各类食物摄入比例及血糖的变化.结果 新型MNT组患者门诊宣教人均用时[(12.3±2.3)min]少于单纯个体化MNT组[(31.9±3.9)min],差异有统计学意义(t=23.97,P＜0.01)；全部做到饮食达标所用时间[(4.3±2.4)周]少于单纯个体化MNT组[(9.0±4.4)周],差异有统计学意义(t=2.54,P＜0.05)；与营养治疗前比较,2组患者饮食达标后热量、三大营养素供热比、食物摄入比例均有较大改善.新型MNT组青中年患者餐后2h血糖(2h PG)、糖化血红蛋白(HbA1C)及老年患者空腹血糖(FPG)达标平均用时均少于单纯个体化组,差异均有统计学意义(t值分别为4.23、9.53、5.50,P＜0.01).与营养治疗前相比,2组患者上述血糖值均有下降.结论 新型MNT模式可以帮助患者尽快做到合理饮食,有效控制血糖水平,值得在营养门诊推广.     

应激与营养支持

严重创伤、烧伤、感染、急性胰腺炎、外科手术等应激状况下,蛋白质的分解反映了全身蛋白质的丢失,主要是肌肉蛋白质的降解.在应激病人中,糖皮质激素和各种前炎症因子是肌肉蛋白质水解的重要调节因素.近年来,主要有三种方法用于减少或抑制应激时的分解代谢:①营养支持;②激素;③药理学营养.该文作者将从营养的角度阐明应激情况下的代谢改变及相应的干预方法.     

泉州市大学生营养KAP对营养状况评价的影响分析

目的分析大学生营养KAP对营养状况评价的影响。方法以随机整群抽样研究方法,抽取泉州市高校在校大学生626名作为研究对象,采用问卷调查研究法进行KAP调查,采用3 d 24 h膳食记录和询问开展研究对象的膳食调查,通过食谱营养评价软件,计算医学生组(A组)和非医学生组(B组)的大学生每人每日平均摄入能量与营养素,以及通过计算BMI,进行肥胖、超重、正常、营养不良的判定,同时计算营养缺乏发生率。结果 252名(40.26%)对营养知识了解较为全面,网络、杂志是其主要了解渠道。402名(64.22%)对于营养较为重视,希望了解更多的营养知识,获取更好的膳食指导。与B组比较,A组的知识分、态度分均较高,差异有统计学意义(P0.05)。经过调查,约有90%以上的研究对象中存在不良饮食习惯;与B组比较,A组的蛋白质、能量、钙、维生素A及维生素C的每日摄入量较高,差异有统计学意义(P0.05)。A、B两组在肥胖、超重、正常以及营养不良中的比例差异均无统计学意义(P0.05)。与A组比较,B组牙龈出血、抽筋以及便秘的检出率均较高,差异有统计学意义(P0.05)。结论泉州市大学生中大多对于营养知识了解较为全面及重视,但是较多的存在不良饮食行为,对于膳食结构造成较大影响,导致营养缺乏的发生率较高,故而对其进行有针对性的营养健康教育势在必行。     

550例住院婴儿的营养调查

1988～1991年住院的急性上呼吸道感染550例2～12月龄婴儿,测量头围、体重、身高及血红蛋白值。发现头围、体重、身高与正常值相比,经统计学处理,P<0.01,有显著差异,全部婴儿Hb值均低于正常。结果表明550例都患有营养不良及贫血。这些指标对营养状态的评价很有价值。