肝癌合并肝硬化患者术后不同剂型肠内营养的临床效果

目的 比较氨基酸型和整蛋白型肠内营养制剂用于肝癌合并肝硬化患者术后营养治疗的临床效果。方法　肝癌合并肝硬化术后患者207例,等热量等氮肠内联合肠外营养连续至少5 d,按肠内营养剂型分为氨基酸型制剂组（氨基酸为氮源,104例）和整蛋白型制剂组（整蛋白为氮源,103例）。观察肠道通气时间、术后住院时间、腹泻发生率、术后并发症发生率等临床结果,以及电解质、肝功能相关生化指标。结果　2组患者术前及术中资料差异无统计学意义（P>0.05）;氨基酸型制剂组较整蛋白型制剂组腹泻发生率高（23.08%比8.74%,P=0.005）,肠道通气时间早［（55.87±10.12）h 比（68.27±9.07）h,P=0.000）］;两组患者腹胀发生率（10.58%比13.59,P=0.506）、术后住院时间［（10.30±3.50）d 比（10.12±4.26） d,P=0.738］、并发症发生率（43.27%比33.98%,P=0.170）及术后7 d钾［（4.02±0.50） mmol/L比（3.98±0.55） mmol/L,P=0.644］、钠［（136.29±3.55）mmol/L比（136.23±2.74）mmol/L,P=0.913］、丙氨酸氨基转移酶［（90.22±64.29）U/L比（96.01±59.74）U/L,P=0.556］、天门冬氨酸氨基转移酶［（36.01±19.68）U/L比（39.00±18.88）U/L,P=0.329］、总胆红素［（15.39±8.64）μmol/L 比（15.43±8.33）μmol/L,P=0.978］差异均无统计学意义（P>0.05）;氨基酸型制剂组较整蛋白型制剂组白蛋白水平高［（32.87±3.54） g/L 比（31.37±3.50） g/L, P=0.008］、前白蛋白水平高［（11.41±4.32)mg/dl比（9.84±3.64）mg/dl,P=0.014］,但凝血酶原时间活动度水平低［（66.94±7.24） s比（70.63±8.49）s,P=0.017）］。结论　两种制剂均有利于肝癌合并肝硬化患者术后肝功能恢复,氨基酸型制剂更有助于肠功能恢复和蛋白质合成,整蛋白型制剂肠道耐受性较好并促进凝血功能恢复。     

外科胰腺肿瘤患者营养不足和营养风险发生率的前瞻性调查研究

目的　调查外科胰腺肿瘤患者营养不足和营养风险发生率。方法　对2014年1月至2015年12月,因各种胰腺肿瘤入住北京医院普外科,接受手术治疗的121例住院患者,根据肿瘤性质分为胰腺癌组和其他胰腺肿瘤组,主要应用营养风险筛查2002方法,前瞻性比较不同胰腺肿瘤患者的营养不足和营养风险发生率以及物理测量、体成分和外周血蛋白质水平等,记录临床结局。结果　121例符合入选标准的胰腺肿瘤患者进入本研究,胰腺癌组90例和其他胰腺肿瘤组31例,平均年龄（61.9±13.6）岁;平均体质量指数（23.20±2.95）kg/m2;上臂围（28.8±3.5）cm;肌肉组织量（44.6±7.4）kg;脂肪组织量（16.8±7.6）kg;两组在人体测量和体成分等方面差异无统计学意义（均P＞0.05）;胰腺癌组空腹血糖［（6.45±2.47）mmol/L］显著高于对照组［（4.95±0.79）mmol/L］（P＜0.001）,白蛋白［（39.0±4.7）g/L比(42.3±2.9)g/L,P＜0.001］,总蛋白［（62.8±6.2）g/L比(66.3±2.9)g/L,P＜0.001］和前白蛋白［（136.1±85.4）mg/L比(197.8±112.6),P=0.011］均显著低于对照组;营养不足发生率为4.1%,营养风险发生率78.5%;其中胰腺癌组营养风险发生率显著高于其他胰腺肿瘤组（91.1%比38.7%,χ2=36.525,P＜0.001）。结论　外科胰腺癌患者营养风险发生率较高,蛋白水平低和糖代谢异常,可导致住院时间延长。     

肝切除术中应用甲基强的松龙联合围手术期肠内营养对术后康复的作用

目的　评估肝切除术中单剂应用甲基强的松龙联合围手术期肠内营养对术后肝脏合成功能的影响,以及对术后恢复的作用。方法　采用前瞻性对照研究方法,选取2013年6月至2014年5月在南京鼓楼医院肝胆胰外科行肝切除术的79例患者,按照手术顺序交替入组,分为对照组39例、研究组40例。研究组在肝切除开始时单剂静脉应用甲基强的松龙500 mg,两组患者围手术期均采用相同的肠内营养支持方案。检测术前和术后第1、3、5天血液肝功能指标、前白蛋白以及C反应蛋白,记录术后外源性人血白蛋白总输注量、术后首次肛门排气时间、术后住院时间和术后并发症发生情况。结果　与对照组比较,研究组术后第3天血清前白蛋白显著升高［（101.26±61.17）mg/L比（81.84±43.58）mg/L,t=-1.607,P=0.049］;术后第1天血清胆碱酯酶显著升高［（5.60±1.54）kU/L比（4.68±1.01）kU/L,t=-3.136,P=0.004］;术后第1、3天血清C反应蛋白显著降低［（41.79±20.86）mg/L比（62.08±38.33）mg/L,t=2.933,P=0.027;（64.14±32.38）mg/L比（102.64±49.05）mg/L,t=4.127,P=0.006］。与对照组比较,研究组术后住院时间显著缩短［（12.62±5.74）d比（15.41±10.00）d,t=1.514,P=0.002］。结论　肝切除术中单剂应用甲基强的松龙可抑制术后炎症反应,与围手术期肠内营养联合应用可促进术后肝脏合成功能的恢复,有助于促进患者康复。     

食欲素水平与慢性阻塞性肺疾病发生营养不足的相关性

目的 探讨血浆食欲素水平变化对慢性阻塞性肺疾病（COPD）发生营养不足的影响。方法 检测40例稳定期COPD患者（分为COPD伴营养不足组20例、COPD不伴营养不足组20例）及20例健康体检者的血浆食欲素、瘦素、肿瘤坏死因子-α及与营养状况相关的人体重指数。食欲素、瘦素和肿瘤坏死因子-α采用酶联免疫吸附法测定。分析食欲素与瘦素、肿瘤坏死因子-α及人体重指数之间的相关性。结果 COPD伴营养不足组血浆食欲素浓度为（0.11±0.01）μg/L,显著低于COPD不伴营养不足组（0.16±0.02）μg/L（P=0.000）和健康对照组（0.15±0.02）μg/L（P=0.002）。40例稳定期COPD患者血浆食欲素水平（0.14±0.03）μg/L与瘦素水平（16.05±3.56）ng/L、肿瘤坏死因子-α水平（9.18±2.70）ng/L存在负相关（r值分别为-0.295、-0.477,P值分别为0.049、0.002）,与体重指数（20.88±4.20）kg/m2呈正相关（r=0.641,P=0.000）。结论 食欲素水平的变化与营养状况密切相关,但其具体机制尚需进一步研究。     

经鼻空肠管行肠内营养对肝功能的影响

目的　观察经鼻空肠管行肠内营养后患者肝功能的变化。方法　选取2011年9月至2014年8月郑州人民医院重症医学科需经鼻饲管行肠内营养的住院患者74例,采用随机数字表法分为鼻空肠管组（n=36）与鼻胃管组（n=38）,分别留置鼻空肠管与鼻胃管,启动早期肠内营养。观察两组患者开始肠内营养后第7、14天的肝功能各项指标。结果　鼻空肠管组31例患者（86.11%）出现至少1项肝功能异常,鼻胃管组23例（60.53%）出现至少1项肝功能异常,差异有统计学意义（χ2=6.136,P=0.013)。鼻胃管组与鼻空肠管组患者谷丙转氨酶（ALT）、谷草转氨酶（AST）、碱性磷酸酶（ALP）、γ-谷氨酰转肽酶（γ-GGT）及白蛋白（ALB）在第7天的差异无统计学意义［（39.1±8.6）U/L比（42.3±8.9）U/L,t=-1.475,P=0.145;（36.2±6.8）U/L比（38.0±7.1）U/L,t=-1.237,P=0.220;（61.8±11.5）U/L比（63.1±13.2）U/L,t=-0.696,P=0.489;（47.3±8.2）U/L比（50.5±7.5）U/L,t=-1.640,P=0.106;（35.2±6.7）g/L比（36.2±7.4）g/L,t=-0.610,P=0.543］;第14天鼻空肠管组ALP、γ-GGT及ALB水平显著高于鼻胃管组［（201.2±15.2）U/L比（116.5±13.6）U/L,t=-25.380,P=0.000;（109.4±7.2）U/L比（49.2±6.5）U/L,t=-37.665,P=0.000;（37.2±7.1）g/L比（30.1±6.5）g/L,t=-4.490,P=0.000］。鼻胃管组与鼻空肠管组第7、14天的总胆红素［（4.6±0.9）μmol/L比（4.8±1.0）μmol/L,t=-0.905,P=0.368;（4.8±1.2）μmol/L比（5.2±1.1）μmol/L,t=-1.492,P=0.140］、间接胆红素［（6.1±0.8）μmol/L比（6.3±0.9）μmol/L,t=-1.012,P=0.315;（6.9±0.9）μmol/L比（7.3±1.0）μmol/L,t=-1.811,P=0.074］、直接胆红素［（4.0±0.6）μmol/L比（3.9±0.5）μmol/L,t=0.777,P=0.440;（5.1±0.8）μmol/L比（5.4±0.9）μmol/L,t=-1.517,P=0.134］差异均无统计学意义。鼻空肠管组肺部感染发生率显著低于鼻胃管组（30.56%比55.26%,χ2=4.598,P=0.032）。结论　与经鼻胃管行肠内营养比较,经鼻空肠管行肠内营养可能更易导致肝功能异常。     

老年骨科良性疾病住院患者的营养不足和营养风险

目的　调查老年骨科良性疾病住院患者的营养状态,分析其与临床结局的相关性。方法　应用营养风险筛查2002（NRS2002)方法,前瞻性调查2012年4月1日至5月31日因患良性骨科疾病入院老年患者的营养不足和营养风险发生率,并分析其与临床结局的相关性。结果　共纳入520例老年骨科患者,平均年龄为（75 ± 7.09）岁,平均体质量指数（BMI）为(23.20±3.83) kg/m2,平均利手握力为（16.87±19.19）kg,平均上臂围为（25.62±3.81）cm,平均小腿围为（31.92±4.02）cm,其中与普通老年患者比较,高龄（≥80岁）老年患者握力下降明显［(13.58±15.92)kg比（18.48±20.42）kg,P=0.004］。520例患者进行营养风险筛查,营养不足发生率为9.31%（BMI≤18.5 kg/m2）,营养风险发生率为45.19%（NRS2002评分≥3分）;与普通（65~79岁）老年骨科患者比较,高龄（≥ 80岁）老年骨科患者营养不足和营养风险发生率均显著增加（13.97%比7.21%,P=0.024;52.38%比41.76%,P=0.024）,有营养风险者的感染并发症发生率更高（10.21%比5.26%,P=0.044）、住院时间更长［（11.66±5.76)d比(10.42±4.37)d,P=0.016］和住院费用更高［（2.028±1.811)万元比(1.639±1.362)万元,P=0.016］。结论　老年骨科良性疾病住院患者营养不足和营养风险发生率较高,并且可能导致临床结局恶化。     

糖尿病患者的营养评价及其少肌症发生的影响因素

目的　了解糖尿病患者的营养状况及其少肌症的影响因素。方法　对2013年1月至2014年12月北京医院营养科门诊297例糖尿病患者进行回顾性分析,比较非超重组［体质量指数（BMI）≤23.9 kg/m2］与超重组(BMI≥24.0 kg/m2)人体测量指标、身体成分、实验室检查指标、膳食摄入的差别,并分析糖尿病患者少肌症发生的影响因素。结果　超重组183例、非超重组114例,非超重组左手握力、右手握力、腰臀比及臂肌围均低于超重组［（24.14±7.76）kg比（27.78±9.31）kg,P=0.00;（25.55±7.86）kg比（28.62±9.55）kg, P=0.01;0.85±0.06比0.92±0.07,P=0.00;（21.45±3.73）cm比（25.18±4.36）cm,P=0.00］;非超重组的肌肉量、体脂百分比、内脏脂肪面积及骨骼肌指数均低于超重组［（37.64±6.58）kg比（45.66±8.92）kg;（27.25±8.15）%比（35.52±6.56）%;（71.56±25.28）cm2比（118.84±28.18）cm2;（6.22±1.17）kg/m2比（7.41±1.25）kg/m2］(P均=0.00）;非超重组血红蛋白水平低于超重组［（136.29±14.81）g/L比（141.01±13.47）g/L, P=0.03］;两组总蛋白及白蛋白水平差异无统计学意义（P=0.15,P=0.52）;非超重组血糖水平低于超重组［（7.08±2.28）mmol/L比（7.76±2.57）mmol/L,P=0.03］;非超重组与超重组的能量及蛋白质摄入差异无统计学意义（P=0.17,P=0.35）。糖尿病患者少肌症的检出率为10.4%（31/297）,非超重患者的少肌症检出率高于超重患者（22.8%比2.7%,P=0.00）。回归分析结果显示,女性（B=-1.371,95% CI=-1.595～-1.146)、增龄(B=-0.018,95% CI=-0.027～-0.009)、低BMI(B=-0.115,95% CI=0.092～0.138)、能量摄入的减少(B=0.014,95% CI=0.000～-0.029）是骨骼肌指数降低的主要危险因素。结论　糖尿病患者BMI在适度超重的范围内有更好的营养状态,有利于预防少肌症的发生。     

婴幼儿先天性胆总管囊肿术后早期肠内营养与肠外营养

目的　探讨婴幼儿先天性胆总管囊肿术后早期肠内营养（EEN）的实施方法及临床效果。方法　分析2014年1月至2015年12月在南京医科大学附属南京儿童医院普外科行胆总管囊肿切除＋胆道重建术（Roux-en-Y吻合术）患儿的临床资料,采用随机对照试验设计,分为研究组（EEN组）和对照组［全胃肠外营养（TPN）组］,研究组术后48 h起予以肠内营养;对照组术后常规予以TPN。比较两组患儿入院第1天和术后第7天体质量、前白蛋白、视黄醇结合蛋白、血红蛋白、免疫球蛋白及淋巴细胞计数;比较两组术后首次排便时间、平均拔胃管时间、胃肠减压引流总量以及术后并发症等方面的差异。结果　共有68例患儿完成了临床观察。两组术前体质量、身高、疾病分布、营养指标相比差异无统计学意义;术后EEN组的首次排便时间［（69.20±9.37）h比（84.73±5.12）h］、平均拔胃管时间［（110.48±5.47）h比（134.90±6.97）h］及胃肠减压引流总量［（202.31±32.89）ml比（258.70±25.52）ml］较TPN组显著提前或减少（均P＜0.001）;术后第7天EEN组的体质量和血红蛋白与TPN组相比,差异无统计学意义;前白蛋白及视黄醇结合蛋白［（0.21±0.06）g/L比（0.14±0.05）g/L、（35.98±6.13）mg/L比（28.41±6.09）mg/L）明显高于TPN组（均P＜0.001）;术后第7天免疫指标淋巴细胞计数及免疫球蛋白两组相比差异有统计学意义［（1.33±0.05）×109/L比（0.69±0.06）×109/L、（0.67±0.09）g/L比（0.49±0.10）g/L,均P＜0.001］;两组术后并发症相比差异无统计学意义（均P＞0.05）。术后平均随访3～24个月,患儿术后恢复满意,生长发育良好。结论　婴幼儿先天性胆总管囊肿术后EEN治疗可行、安全、有效,有助于患儿胃肠道功能恢复,改善营养及免疫状况,利于患儿术后恢复。     

个性化营养支持对高龄顽固性心力衰竭患者近期结局的影响

目的观察和比较单纯肠内营养（EN）、单纯肠外营养（PN）、肠内肠外联合营养（EN+PN） 3种营养支持方式对高龄顽固性心力衰竭患者近期结局的影响及其安全性。方法 选取2004年1月至2012年9月在北京军区总医院263临床部住院的247例高龄顽固性心力衰竭患者,采用随机数字表法分为EN+PN组（n=87）、EN组（n=76）、PN组（n=84）。随机分组后根据患者耐受情况,EN组2例转入EN+PN组,PN组3例转入EN+PN组。于营养支持前和营养支持7 d后检测血清学指标和心脏超声血液动力学指标,根据全身症状计算营养支持后好转率,记录不良事件发生情况进行安全性评价。结果 研究过程中共8例患者退出,其中EN组4例,PN组1例,EN+PN组3例。与营养支持前比较,各组营养支持7 d后血清前白蛋白［EN组,（0.17±0.01）g/L比（0.11±0.02）g/L;PN组,（0.19±0.01）g/L比（0.09±0.02）g/L;EN+PN组,（0.24±0.04）g/L比（0.10±0.02）g/L］、白蛋白［EN组,（34.14±1.00）g/L比（31.25±1.02）g/L;PN组,（33.89±1.20）g/L比（30.99±1.07）g/L;EN+PN组,（36.66±1.36）g/L比（31.00±1.01）g/L］、转铁蛋白［EN组,（1.99±0.39）g/L比（1.86±0.36）g/L;PN组,（2.01±0.41）g/L比（1.89±0.34）g/L;EN+PN组,（2.58±0.47）g/L比（1.92±0.33）g/L］均显著升高(P均=0.008);EN+PN组的前白蛋白（P=0.007、0.008）、白蛋白（P=0.041、0.040）、转铁蛋白（P=0.007、0.008）均显著高于EN组和PN组。PN组营养支持后血糖显著升高［（8.06±2.35）mmol/L比（5.81±2.21）mmol/L,P=0.009］,其余两组营养支持前后差异无统计学意义。与营养支持前比较,3组营养支持7 d后每搏输出量（SV)［EN组,（60.91±7.26）ml比（45.09±6.42）ml;PN组,（61.01±7.29）ml比（45.19±6.39）ml;EN+PN组,（65.42±7.43）ml比（46.11±6.41）ml;P均=0.008］、左心室射血分数（LVEF）［EN组,（45.78±0.09）%比（34.61±0.09）%;PN组,（45.11±0.11）%比（34.55±0.08）%;EN+PN组,（49.79±0.11）%比（34.42±0.09）%;P均=0.008］、左心室舒张末期内径（LVEdd）［EN组,（60.22±2.42）mm比（63.20±2.19）mm,P=0.008;PN组,（60.28±2.44）mm比（62.98±2.11）mm,P=0.044;EN+PN组,（57.43±2.40）mm比（63.09±2.08）mm,P=0.008］、左心室收缩末期内径（LVEsd）［EN组,（54.08±6.06）mm比（56.15±6.03）mm,P=0.044;PN组,（54.42±6.10）mm比（56.31±6.11）mm,P=0.044;EN+PN组,（51.48±5.27）mm比（56.32±6.13）mm,P=0.008］均明显改善;EN+PN组的SV（P=0.003、0.004）和LVEF（P均=0.004）均显著大于EN组和PN组,LVEdd（P=0.004、0.005）和LVEsd（P=0.004、0.005）均显著小于EN组和PN组。EN组、PN组、EN+PN组的好转率分别为75.71%（53/70）、75.00%（60/80）、83.15%（74/89),异常状况评分与营养支持前比较均显著改善（P均=0.000）;EN+PN组的好转率显著高于EN组和PN组（P均=0.005）,PN组与EN组的好转率差异无统计学意义（P=0.059）。PN组的恶化率为15.00%,明显高于EN组（12.85%,P=0.048）和EN+PN组（6.74%,P=0.045）。营养支持期间EN+PN组不良事件发生率显著低于EN组［22.47%（20/89）比37.14%（26/70）,P=0.005］,与PN组比较差异无统计学意义［35.00%（28/80）,P=0.057］。结论 对于高龄顽固性心力衰竭患者, EN+PN可提高血清前白蛋白、白蛋白、转铁蛋白水平,缓解临床症状,改善血液动力学,且不良事件发生率较低,是优于单纯EN或PN的营养支持方式。     

深度水解蛋白配方粉喂养早产儿相关营养状况分析

目的　探讨以深度水解蛋白配方粉作为开奶喂养的早产儿相关营养状况。方法　收集2013年1月至2014年12月上海儿童医学中心新生儿重症监护室首次以深度水解蛋白配方粉开奶喂养的早产儿共157例,记录相关诊断、出生情况、营养摄入、生长发育等。根据有无喂养不耐受（不耐受组和耐受组）和出生体质量（＜1 500 g、1 500~2 500 g和≥2 500 g组）进行分组,分析生长发育情况及其相关因素。结果　共60例（38.2%）早产儿发生喂养不耐受。出生体质量和胎龄越小,发生喂养不耐受越多,其中＜1 500 g组喂养不耐受为71.1%。与耐受组比较,喂养不耐受组出生体质量［（1 620±440）g比（1 980±421）g,P=0.000］、胎龄［（31.3±2.6）周比（33.0±2.1）周,P=0.000］、出生头围［（28.9±2.2）cm比（30.4±1.9）cm,P=0.000］和出生身长［（41.1±3.9）cm比（43.2±3.4）cm,P=0.000］明显减小,转奶时间［（26.4±17.6)d比（7.9±5.3)d,P=0.000］和达到足量喂养时间［（21.5±10.0)d比（13.8±6.2)d,P=0.000］明显延长。同时,开奶时间［＜1 500 g组（6.1±5.1)d,1 500~2 500 g组（3.8±2.5)d,≥2 500 g组（3.3±1.2)d,P=0.002］、转奶时间［＜1 500 g组（28.7±18.3)d,1 500~2 500 g组（9.7±8.1)d,≥2 500 g组（7.0±3.8)d,P=0.000］和达到足量喂养时间［＜1 500 g组（24.0±10.4)d,1 500~2 500 g组（14.3±6.0)d,≥2 500 g组（11.4±3.5)d,P=0.000］出生体质量越小组越晚。不耐受组和＜1 500 g组有更多患儿接受肠外营养支持（93.3%;97.8%）,且肠外营养提供热量［＜1 500 g组（325.9±59.4）kJ/（kg·d）,1 500~2 500 g组（281.2±64.8）kJ/（kg·d）,≥2 500 g组（269.9±43.9）kJ/（kg·d）,P=0.001］和持续时间［＜1 500 g组（27.1±14.5)d,1 500~2 500 g组（13.0±7.0)d,≥2 500 g组（8.7±3.4)d,P=0.000］更多。生长发育方面不耐受组头围增长较快［不耐受组（0.7±0.6） cm/周,耐受组（0.6±0.5） cm/周,P=0.045］。＜1 500 g 组体质量增长［（21.8±9.5） g/d］和头围增长［（0.8±0.4） cm/周］均明显高于其他出生体质量组［体质量增长：1 500~2 500 g组（14.2±7.6）g/d,≥2 500 g组（4.9±11.9）g/d,P=0.000;头围增长：1 500~2 500 g组（0.5±0.4）cm/周,≥2 500 g组（0.6±0.8）cm/周,P=0.005］。对是否有喂养不耐受作变量控制后,偏相关分析显示住院期间体质量增长与胎龄（r=-0.666,P=0.035）、出生体质量（r=-0.700,P=0.024）、头围（r=-0.846,P=0.002）以及恢复至出生体质量天数（r=-0.697,P=0.025）呈负相关,与头围增长（r=0.672,P=0.033）呈正相关,而与出生身长、开奶、转奶时间和达到足量喂养时间、肠外营养热量和持续天数,以及住院天数和一些并发症有无无相关性。结论　深度水解蛋白配方粉喂养的早产儿发生喂养不耐受的能获得类似于喂养耐受组早产儿的生长发育,与肠外营养的应用有关。胎龄越小、出生体质量头围越低的早产儿更适于采用深度水解蛋白配方奶作为开奶喂养。     

A review of the evidence for the impact of improving nutritional care on nutritional and clinical outcomes and cost

Background:  The association between malnutrition and poor clinical outcome is well-established, yet most research has focussed on the role of artificial nutritional support in its management. More recently, emphasis has been placed on the provision of adequate nutritional care, including nutritional screening and the routine provision of food and drink. The aim of this literature review is to establish the evidence for the efficacy of interventions that might result in improvements in nutritional and clinical outcomes and costs.
Methods:  A structured literature review was conducted investigating the role of nutritional care interventions in adults, and their effects on nutritional and clinical outcomes and costs, in all healthcare settings. Ten databases were searched electronically using keywords relating to nutritional care, patient outcomes and healthcare costs. High quality trials were included where available.
Results:  Two hundred and ninety-seven papers were identified and reviewed. Of these, only two randomised, controlled trials and six other trials were identified that addressed the major issues. A further 99 addressed some aspects of the provision of nutritional care, although very few formally evaluated nutritional or clinical outcomes and costs.
Conclusions:  This review reveals a serious lack of evidence to support interventions designed to improve nutritional care, in particular with reference to their effects on nutritional and clinical outcomes and costs. The review suggests that screening alone may be insufficient to achieve beneficial effects and thus more research is required to determine the most cost-effective interventions in each part of the nutritional care pathway, in a variety of healthcare settings and across all age ranges, to impact upon nutritional and clinical outcomes.     

Development of a nutritional knowledge questionnaire

This paper describes the development and validation of a nutritional knowledge questionnaire. The questionnaire included a forced choice nutrient density section and multiple choice exercise. Two groups of respondents (group 1, nutrition professionals, n = 27; group 2, engineering undergraduates, n =55) completed the questionnaire. Significant differences were found between group scores for each of the four nutrients (protein, carbohydrate, fat and fibre) and for the multiple choice (P < 0.001). Cronbach's alpha for the complete questionnaire was 0.82. These results suggest a robust and valid test instrument for the measurement of nutritional knowledge, which will be used to examine relationships between nutritional knowledge and behaviour.     

The role of the nutritional support dietitian in Europe

The European Community now supports the potential for professionals to practice in any of the member states subject to recognized local standards of education and practice being achieved. However, there is no agreed role for the nutritional support dietitian. This leads to an inconsistent and, sometimes, fragmented approach to the nutritional management of patients throughout Europe. There is a need to develop a common dietetic approach to nutritional support in order to raise awareness and rationalize standards. This will help to optimize care to individual patients by fostering good practice, developing effective communication and encouraging research. BACKGROUND: The role of the clinical dietitian varies widely throughout Europe - it tends to be more highly developed in some countries than in others, which is a cause for concern among dietitians in ESPEN. This appears to be caused by several factors including education, clinical awareness of the benefits of dietetic support and access to adequate financial resources. The intention of this paper is to focus on the key aspects of the role of the dietitian working in nutritional support. The educational requirements of such a dietitian are outlined and these could be used as a preliminary guide for institutions responsible for delivering undergraduate dietetic programmes. The overall intention is to identify minimum educational standards for practice in this field throughout Europe. However, these should be viewed as a baseline from which to proceed. They should also be perceived as a quality standard for facilitating professional development, sharing clinical practice and enhancing patient outcomes. This paper does not address issues of resource allocation. RECOMMENDATIONS: a) There should be agreement about the key functions of the dietitian working in nutritional support; b) There should be a common standard at first degree level for all dietitians; c) There should be an identified programme of post-graduate study (both clinical and academic) leading to specialization in nutritional support; d) There should be an innovative approach to providing clinical support for emerging specialists; e) ESPEN should investigate the potential for developing an accredited and integrated European dietetic standard in nutritional support.     

微型营养评定法在恶性肿瘤病人中的应用

为探讨微型营养评定法 (MNA)在恶性肿瘤病人的营养状况评价中的价值 ,测定 2 6 2例恶性肿瘤病人的MNA总分、身高、体重、年龄、体力状况、血液血红蛋白量 (Hb)、红细胞数 (RBC)、血清白蛋白浓度 (Alb)、血清前白蛋白浓度 (PA)。计算实际体重 健康时平时体重比 (UBW % )。根据MNA总分评价病人营养状况 :营养不良组 (MNA总分 <17) ;营养不良危险组 (MNA总分介于 17～ 2 3 5 ) ;营养良好组 (MNA总分≥ 2 4)。结果显示 :MNA总分与UBW %、Alb、PA、BMI值呈显著相关 (r=0 5 0 1～ 0 72 4,P =0 0 0 0 )。MNA与UBW %、BMI、PA、Alb方法评价病人的营养状况有良好的一致性 ,符合率分别为 82 %、76 %、71%、6 8%。根据MNA方法评价全组病人 ,营养不良者占 31 7% (83 2 6 2例 ) ,营养不良危险者占 2 5 9% (6 8 2 6 2例 ) ,营养良好者占 42 4%(111 2 6 2例 ) ;营养不良与营养不良危险的发生率无显著性差异 ;老年与非老年患者营养不良发生率无明显差异。胃癌、肝癌的营养不良发生率明显高于肺癌 (P =0 0 0 1)。体力状况越差 (ECOG分级越高 )、营养不良发生率越高。贫血患者营养不良发生率明显高于非贫血者。感染患者营养不良发生率明显高于非感染者。结果提示 ,MNA对于恶性肿瘤患者具有良好的营养评价作用。胃癌?     

Food habits and nutritional labelling of foods

This paper suggests that proposed labelling schemes that categorize foods into bands should be tested prior to use to determine what proportion of foods consumed by the public fall into each category, and that the width of each band might best be based on either having similar numbers of foods in each band or to facilitate discrimination between 'healthy' and 'unhealthy' diets. As an example, a labelling scheme based on energy density has been tested using weighed diets of nutrition students; both those that were considered 'healthy' and those that failed to satisfy the suggestions of the National Advisory Committee on Nutrition Education.     

New Zealand cookbooks as a reflection of nutritional knowledge, 1940–1969

New Zealanders have been exposed to nutritional information from health professionals, government and non-government bodies for at least 100 years. The present study analyses both community and national cookbooks published in New Zealand from 1940 to 1969 to ascertain if nutritional information and/or recipes with special nutritional significance are transmitted to the community via this medium. During the war years and rationing, it was found that food shortages limited food choice; therefore, it was important to choose food carefully to obtain the required nutrients to maintain good health. Cookbooks published during the 1940s that dealt with rationing, therefore, proved to be an important source of information about nutrition. After the war, as the food supply returned to normal, New Zealanders returned to their traditional diet which led to over consumption and a focus on slimming diets. Cookbooks examined in the present study illustrated nutrition concerns during the period and changes in our culinary culture.     

Nutritional awareness of mothers in relation to nutritional status of the preschool children

Background: In the developing world, nearly one-third (35%) of under-five children are stunted and rural children are twice likely to be underweight as those in urban areas (United Nations, Children education Fund, UNICEF Global Database. (2006–2010). United Nations Development Assistance Framework of Uganda. Retrieved from https://countryoffice.unfpa.org/uganda/drive/Uganda_UNDAF.pdf). India presents a grim scenario which lacks in various aspects inflicting sufferings on children below five years of age. The objective of the study is to find out the association between mother's nutritional awareness and nutritional status of the child (NSC). Methodology: The sample consisted of 300 children of 3–4 years of age from kindergarten and preprimary schools of Kolkata. The tools used were Nutritional Awareness of Mother (NAM) questionnaire and NSC by measuring age, height and weight of children which were used for finding weight for age, height for age and weight for height of the child and the statistical analysis used was chi-square test. Results: The result showed that nutritional awareness of mother significantly influences the NSC. Conclusions: The study would help in motivating educators for incorporating need-based educative measures for young adolescents and thus the eradication of various issues regarding infant mortality rate, maternal mortality rate, etc. may be checked to some extent.     

Mendelian randomization in nutritional epidemiology

Nutritional epidemiology aims to identify dietary and lifestyle causes for human diseases. Causality inference in nutritional epidemiology is largely based on evidence from studies of observational design, and may be distorted by unmeasured or residual confounding and reverse causation. Mendelian randomization is a recently developed methodology that combines genetic and classical epidemiological analysis to infer causality for environmental exposures, based on the principle of Mendel's law of independent assortment. Mendelian randomization uses genetic variants as proxies for environmental exposures of interest. Associations derived from Mendelian randomization analysis are less likely to be affected by confounding and reverse causation. During the past 5 years, a body of studies examined the causal effects of diet/lifestyle factors and biomarkers on a variety of diseases. The Mendelian randomization approach also holds considerable promise in the study of intrauterine influences on offspring health outcomes. However, the application of Mendelian randomization in nutritional epidemiology has some limitations.     

Anosmia and nutritional status

The present study quantified the food perception, food behavior and possible nutritional risk of anosmic patients. Anosmics were divided into three groups according to the duration of their olfactory symptoms: a) lifelong anosmics (n=9), b) mid-term anosmics (anosmics for five years or more but not lifelong) (n=22), and c) recent-onset anosmics (anosmics for less than five years) (n=22). Patients were compared to controls with no smell problem (n=33). We measured standard anthropometric, biochemical and nutritional parameters (24-hour recall and 3-day food record).Anosmics and controls did not differ in a number of anthropometric measures including body weight and body mass index. Mid-term anosmics showed significantly lower serum albumin levels but not serum total protein. Both recent onset and mid-term anosmics had significantly lower hemoglobin values than the controls but not the lifelong anosmics. A similar pattern was noted with measures of food enjoyment. Nevertheless, the anosmics did not differ in nutrient intake or eat less frequently.     

Report of a nutritional screening audit

Background: Malnutrition in hospitals has been widely documented and nutritional screening forms part of the National Professional Standards for Dietitians. As a result of this concern, a nutrition screening tool has been incorporated into the nursing care plan documentation. Aims: To audit the use of the screening tool in nursing care plans for elderly patients and examine the communication methods concerning the need for individual nutritional care. Methods: A standard chart was used to audit patient notes. In addition, a short informal interview was conducted with nursing staff. Results: Use of the screening tool was variable and fewer than half of those identified by this tool as in need of nutritional care were referred to the dietitian. Conclusion: Ward staff are prioritizing patients referred for dietetic care, even when they have been identified by the screening tool, but this is not always done systematically. Improvements could be made in the relevant documentation. Further training of ward staff and a follow-up audit should be undertaken.