小儿单纯性营养不良胃肠激素测定

【目的】　探讨单纯性营养不良 (protein energymalnutrition ,PEM )患儿胃肠内分泌功能 ,为PEM的治疗提供依据。　【方法】　采用放射免疫分析法测定空腹和摄入液体实验餐后 60min时外周血胃泌素 (gastrin ,Gas)、胃动素 (motilin ,MTL)、生长抑素 (somatostatin ,SS)水平。　【结果】　与对照组比较 ,观察组空腹和餐后 60min血中Gas和MTL水平明显降低 ,而SS水平则明显升高 (P均 <0 .0 1)。与对照组相似 ,观察组患儿餐后与餐前比较 ,Gas及MTL水平差异无显著性 (P >0 .0 5 ) ,SS水平则明显升高 (P <0 .0 1)。　【结论】　PEM患儿存在明显的胃肠内分泌功能紊乱。     

Effect of erythropoietin and testosterone on bone marrow RNA synthesis in rats with protein-energy or protein malnutrition

RNA synthesis was studied in bone marrow of rats with protein-energy malnutrition (PEM) and protein malnutrition (PM) after the administration of erythro-poietin (Epo) and/or testosterone (Te). RNA synthesis appeared slighty increased in PEM animals, 25% by Epo; 66% by Te while not alteration was induced by Epo and Te together. In PM rats a considerable decrease of RNA synthesis was observed. These results would indicate that the use of ¹⁴C-formate as a labelled precursor to estimate DE NOVO RNA synthesis is a reliable experimental variable for testing bone marrow function. The data presented suggest that while in PEM the biochemical machinery required to synthesize RNA remains basically unchanged. PM induces important metabolic disturbance.     

Inducer and suppressor T cell subsets in protein-energy malnutrition: Analysis by monoclonal antibodies

Malnutrition results in impaired cell-mediated immune responses. We have examined various subsets of T lymphocytes reactive with monoclonal antibodies against cell-surface antigens using flourescein-triggered cell sorting technique. There was a reduction in the absolute number of T lymphocytes reactive with anti-T3. Both inducer cells identified by anti-T4 and suppressor cells identified by anti-T8 were decreased in number, particularly the former. The inducer/suppressor ratio was low. These alterations in lymphocyte subset numbers were reversed to normal following nutritional therapy for 4–8 weeks. Changes in T lymphocyte subpopulations may partly explain depressed cell-medicated immunity in malnutrition.     

慢性肾脏病患者蛋白质-能量营养不良研究进展

尽管临床治疗水平和透析技术不断提高,但慢性肾脏病(CKD)患者营养不良的发生率仍然逐年上升。近年来,透析前和透析阶段的CKD患者营养目标领域取得一些进展。在透析前阶段,充足的证据显示限制蛋白摄入的长期营养治疗方案可有效纠正蛋白尿、酸中毒等多种代谢异常。维持性透析阶段,现有的蛋白质能量摄入的目标逐渐受到质疑。新颁布的CKD患者蛋白质-能量消耗的诊断标准将有助于医生更轻易地识别早期的蛋白质能量消耗。     

Recognition by medical and nursing professionals of malnutrition and risk of malnutrition in elderly hospitalised patients

Objective:  To determine the prevalence of malnutrition in a population of elderly hospitalised patients and to explore health professionals' perceptions and awareness of signs and risks of malnutrition and treatment options available.
Subjects and design:  One hundred elderly patients and 57 health professionals from medical wards of a tertiary teaching hospital. Quantitative and qualitative study design using a validated malnutrition assessment tool (Mini Nutritional Assessment) and researcher-designed questionnaire to assess health professionals' knowledge of nutrition risk factors.
Main outcome measures:  Mini Nutritional Assessment score, nutrition risk category and themes in health professionals' knowledge and awareness of malnutrition and its risk factors.
Results:  Thirty per cent of patients were identified as malnourished while 61% were at risk of malnutrition. Documentation by health professionals of two major risk factors for malnutrition—recent loss of weight and appetite—were poor with only 19% and 53% of patients with actual loss of weight or appetite, respectively, identified by staff and only 7% and 9% of these patients, respectively, referred for dietetic assessment. While health professionals' knowledge of important medical risk factors for malnutrition was good, their knowledge of malnutrition risk factors such as recent loss of weight and loss of appetite was poor. Medical staff focused on biochemical factors when assessing nutrition status, while nursing staff focused on skin integrity and turgor.
Conclusion:  Malnutrition in elderly hospitalised patients remains a significant problem with low rates of recognition and referral by medical and nursing staff. Considerable scope exists to develop training and education tools and to implement an appropriate nutrition screening policy to improve referral rates to dietitians.     

Physiological and psychosocial contributors to malnutrition in children with cystic fibrosis: review

Malnutrition was once thought to be an inevitable consequence of cystic fibrosis (CF). It is now considered preventable but still contributes considerable morbidity in children. Malnutrition is linked to poorer pulmonary function, reduced survival and quality of life. As the anticipated lifespan of children with CF continues to lengthen, the prevention of malnutrition attains greater importance. This review explores the complex organic and psychosocial factors implicated in the aetiology of malnutrition associated with CF.     

Evaluation of a semi-elemental enteral feed in patients with malabsorption and/or disease-related malnutrition

A semi-elemental energy-dense enteral feed was evaluated to determine its effect on nutritional repletion and tolerance in a diverse group of patients with malabsorption and/or disease-related malnutrition. Forty-nine patients (26 male, 23 female) entered and completed this multicentre study. Mean daily energy requirements were 2107 kcals of which 1704 kcals were prescribed from the enteral feed. Mean daily energy intake from the feed was 1472 kcals and patients consumed the feed for a mean of 13.2 days either as sole source of nutrition or as a supplement. Body weight changes were related to duration of feeding: patients who were fed for more than 14 days experienced a mean increase in body weight of 0.56 kg. Biochemical parameters of nutritional status, i.e. mean total protein and serum albumin, improved during the feeding period. Tolerance of the feed and clinical response to feeding were satisfactory. In patients with malabsorption and/or malnutrition a semi-elemental enteral feed represents a viable and palatable alternative to elemental diets when everyday food and whole protein feeds are not tolerated.     

慢性阻塞性肺疾病的炎症反应与营养不良密切相关

目的 研究慢性阻塞性肺疾病(COPD)患者的炎症反应与体重指数(BMI)的关系.方法 以2007年9月-2009年4月在武汉大学人民医院就诊的稳定期COPD患者85例和健康体检者(对照组)30例为研究对象,常规行肺功能、动脉血气分析及诱导痰炎症细胞分类计数检测,酶联免疫吸附法(ELISA)测定血清C反应蛋白(CRP)、白细胞介素(IL)-8、IL-6、IL-10与肿瘤坏死因子-α(TNF-α).结果 低体重组(BMI<18.5 kg/m~2)COPD患者诱导痰细胞总数与中性粒细胞计数明显高于正常体重组(BMI=18.5～23.9 kg/m~2)和对照组(P均<0.05),第1秒用力呼气量占预计值%(FEV_1%)、第1秒用力呼气量(FEV_1)与用力肺活量(FVC)比值及动脉血氧分压(P_aO_2)明显低于正常体重组(P均<0.05),动脉血二氧化碳分压(P_aCO_2)明显高于正常体重组(P<0.05).低体重组COPD患者CRP、IL-8、IL-6和TNF-α水平明显高于正常体重组和对照组(P均<0.05).低体重组COPD患者BMI与诱导痰细胞总数(r=-0.492,P=0.0038)、中性粒细胞数(r=-0.501,P=0.0032)、CRP(r=-0.473,P=0.0083)、IL-8(r=-0.382,P=0.0421)、IL-6(r=-0.422,P=0.0147)及TNF-α(r=-0.416,P=0.0156)均呈显著负相关.结论 稳定期COPD患者的气道和全身炎症反应与BMI密切相关.     

Identifying malnutrition risk in acute medical patients: Validity and utility of Malnutrition Universal Screening Tool and Modified Malnutrition Screening Tool

Aim: Nutrition screening is increasingly conducted in hospitals during the patient admission process. We aimed to explore the ease of use of two tools in the conduct of screening by nutrition technicians (NTs), and to compare validity. The tools are Malnutrition Universal Screening Tool (MUST) and Modified Malnutrition Screening Tool (Mod‐MST). Methods: A sample of 262 consecutive adult hospital patients in medical wards was screened during December 2008 to January 2009. Trained NTs used both tools to screen each patient. Dietitians who were blinded to screening results then assessed each patient using Subjective Global Assessment as a reference tool. Time taken for screening was recorded and ease of tool use was explored in interviews with technicians. Results: The specificity of MUST and Mod‐MST was 85% and 83%, respectively, with sensitivity of 80% and 77%. Both tools were easy to use and could be applied to all patients, including those unable to answer interview questions. However, the MUST took two to three times longer to complete (5–7 min) using objective data. The Mod‐MST collected subjective data that required interpretation by technicians. Conclusion: Specificity and sensitivity of the two tools were less than optimum at ≤85%, as some patients would be misclassified. Both tools were valid and feasible to use with all medical patients, including those with whom communication cannot be established. The Mod‐MST is recommended, as choice of malnutrition screening tool needs to balance efficacy with time taken to be useful for mass screening programs.     

The facilitated early enteral and dietary management effectiveness trial in hospitalized patients with malnutrition

Background: The prevalence of malnutrition in the hospitalized setting is 30% to 55%. Previous studies reported an association of malnutrition with an increased hospital length of stay (LOS), morbidity, and mortality of patients. This study evaluated the role of early nutrition intervention on LOS, diagnosis coding of malnutrition cases, calculating case mix index, and reducing delays in implementing nutrition support to patients. Methods: Demographic data, anthropometric measurements, LOS, and serum albumin levels were collected from 400 patients in 2 medical wards to determine the prevalence of malnutrition and potential delays in nutrition consultation. Based on these results, a nutrition intervention study was conducted in 1 ward; the other ward served as a control. Patients were classified as normally nourished or malnourished. Multivariate general linear regressions were used to reveal the impact of intervention on the change in LOS, controlling for other potential confounding factors on the cohort and a subset with severe malnutrition. Results: Of the 400 patients assessed, 53% had malnutrition. Multiple general linear regressions showed that nutrition intervention reduced LOS an average of 1.93 days in the cohort group and 3.2 days in the severe malnourished group. Case mix index and female gender were positively associated with LOS in the malnourished group. Nutrition intervention reduced the delays in implementing nutrition support to patients by 47%. Conclusions: Results highlight the positive impact of nutrition intervention in terms of reduced LOS in malnourished hospital patients. Reduction in LOS with diagnosis coding of malnutrition cases yielded substantial economic benefits.     

Relationship of serum leptin levels and selected nutritional parameters in patients with protein-caloric malnutrition

Leptin is a protein hormone produced by adipocytes that reflects the body fat content, i.e., its serum concentration in healthy individuals positively correlates with the body mass index and body fat content. Serum leptin levels are lower in both patients with anorexia nervosa and protein-caloric malnutrition caused by chronic non-malignant illnesses. The aim of the present study was to compare serum leptin levels and selected, routinely used nutritional parameters in women with anorexia nervosa (n = 17), severely malnourished patients with short bowel syndrome (n = 13), and control non-obese healthy women (n = 17) to clarify the relation between selected nutritional parameters and serum leptin levels. We found that serum leptin levels in the anorexia nervosa and short bowel syndrome groups were significantly lower than those in the control group (in ng/mL: 3.63 +/- 1.64 and 2.59 +/- 1.17 versus 12.06 +/- 7.59, respectively). Protein malnutrition expressed by decrease in serum concentrations of total protein, albumin, and prealbumin was more pronounced in the short bowel syndrome group. Triceps skin fold, arm muscle circumference, and body mass index were significantly lower in the patient group than in the control group and did not significantly differ between the short bowel syndrome and anorexia nervosa groups. No significant difference in serum leptin concentration between the short bowel syndrome and anorexia nervosa groups was found. Serum leptin levels correlated positively with body mass index and triceps skin fold in the control and anorexia nervosa groups but not in the short bowel syndrome group. We conclude that serum leptin levels in patients with anorexia nervosa and short bowel syndrome are significantly lower than in healthy individuals and have no statistically significant relation to serum total protein, abumin, and prealbumin.